Mediators and Moderators of Treatment Effects in Randomized Clinical Trials

Kraemer, Helena C.; Wilson, G. Terence; Fairburn, Christopher G.; Agras, W. Stewart

doi:10.1001/archpsyc.59.10.877

Cited by 2,289 publications

(2,419 citation statements)

References 38 publications

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“…Reduction in severity of defeatist attitudes during treatment was significantly correlated with improvement in functioning at 18-month follow up in CBSST, but not in supportive contact. This finding provides some evidence for mediation, but severity of defeatist attitudes did not change significantly in treatment (Table 3), which is required by contemporary mediation criteria (e.g., (36)). The finding of a large treatment group difference in participants with more severe defeatist attitudes (d=1.11), but only minimal treatment benefit in participants with less severe defeatist attitudes (d=0.18), also provides some support for moderation, but the three-way interaction between defeatist attitudes, treatment group and time in the mixed-model analysis was not significant.…”

Section: Discussionmentioning

confidence: 72%

Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Granholm

Holden

Link

et al. 2013

The American Journal of Geriatric Psychiatry

106

108

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Objectives To determine whether cognitive behavioral social skills training (CBSST) is an effective psychosocial intervention to improve functioning in older consumers with schizophrenia, and whether defeatist performance attitudes are associated with change in functioning in CBSST. Design An 18-month, single-blind, randomized controlled trial. Setting Outpatient clinic at a university-affiliated Veterans Affairs hospital. Participants Veteran and non-veteran consumers with schizophrenia or schizoaffective disorder (N=79) age 45–78. Interventions CBSST was a 36-session, weekly group therapy that combined cognitive behavior therapy with social skills training and problem solving training to improve functioning. The comparison intervention, goal-focused supportive contact (GFSC), was supportive group therapy focused on achieving functioning goals. Measurements Blind raters assessed functioning (primary outcome: Independent Living Skills Survey) CBSST skill mastery, positive and negative symptoms, depression, anxiety, defeatist attitudes, self-esteem, and life satisfaction. Results Functioning trajectories over time were significantly more positive in CBSST than in GFSC, especially for participants with more severe defeatist performance attitudes. Greater improvement in defeatist attitudes was also associated with better functioning in CBSST, but not GFSC. Both treatments showed comparable significant improvements in amotivation, depression, anxiety, positive self-esteem and life satisfaction. Conclusions CBSST is an effective treatment to improve functioning in older consumers with schizophrenia, and both CBSST and other supportive goal-focused interventions can reduce symptom distress, increase motivation and self esteem, and improve life satisfaction. Participants with more severe defeatist performance attitudes may benefit most from cognitive behavioral interventions that target functioning.

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Section: Discussionmentioning

confidence: 72%

Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Granholm

Holden

Link

et al. 2013

The American Journal of Geriatric Psychiatry

106

108

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“…However, if all the indicators of peer relations were considered simultaneously, only increases in peer acceptance significantly mediated the impact of the GBG on externalizing behavior. As this role of positive peer relations in the reduction of externalizing problems was studied in a RCT intervention study that aimed to facilitate positive peer interactions (Hinshaw, 2002;Kraemer, Wilson, Fairburn, & Agras, 2002), these findings have several implications. First, our findings are supportive of positive peer relations as environmental mediators of children's externalizing behavior development.…”

Section: Discussionmentioning

confidence: 99%

Testing links between childhood positive peer relations and externalizing outcomes through a randomized controlled intervention study.

Witvliet

Lier

Cuijpers

et al. 2009

Journal of Consulting and Clinical Psychology

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In this study, the authors used a randomized controlled trial to explore the link between having positive peer relations and externalizing outcomes in 758 children followed from kindergarten to the end of 2nd grade. Children were randomly assigned to the Good Behavior Game (GBG), a universal classroombased preventive intervention, or a control condition. Children's acceptance by peers, their number of mutual friends, and their proximity to others were assessed annually through peer ratings. Externalizing behavior was annually rated by teachers. Reductions in children's externalizing behavior and improvements in positive peer relations were found among GBG children, as compared with control-group children. Reductions in externalizing behavior appeared to be partly mediated by the improvements in peer acceptance. This mediating role of peer acceptance was found for boys only. The results suggest that positive peer relations are not just markers, but they are environmental mediators of boys' externalizing behavior development. Implications for research and prevention are discussed.

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“…The search strategy, inclusion and exclusion criteria, data extraction, and data handling are described in detail elsewhere (Haasova et al 2013). The MacArthur guidelines (Kraemer et al 2002) were followed in analyses of moderators and mediators. All statistical analyses were performed using Stata v. 11.…”

Section: Methodsmentioning

confidence: 99%

The acute effects of physical activity on cigarette cravings: Exploration of potential moderators, mediators and physical activity attributes using individual participant data (IPD) meta-analyses

et al. 2014

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Rationale The effects of acute bouts of physical activity (PA) on Strength of Desire (SoD) and Desire to Smoke (DtS) using individual participant data (IPD) from 19 acute randomised controlled studies were quantified. However, there is a need to identify factors influencing this relationship. Objectives To understand who most benefits from PA, whether changes in affect mediate these effects, and whether any specific attributes of PA are associated with cigarette cravings. Methods IPD (N=930) contributed to one-stage IPD meta-analyses.Participants engaging in PA were compared against controls, using post-intervention DtS and SoD (when DtS not available) with baseline adjustments. The cravings scales were linearly rescaled to 0-100% (a mean difference between groups of -10 would indicate that postintervention cravings were 10% lower in the PA compared with the control group).Demographic, smoking and other characteristics were examined as predictors and potential moderators whereas change in affect was considered as a mediator. PA was categorised according to type, duration and intensity, to determine PA attributes associated with cravings reduction. Results None of the included covariates were shown to moderate or mediate the effects of PA. Intensity of PA was significantly associated with a reduction in cravings; moderate and vigorous intensity PA offered the most benefits. A one-stage IPD meta-analysis yielded effects size of -9.22 (-15.24; -3.20) for light, -34.57 (-42.64; -26.50) for moderate and -31.29 (-38.00; -24.57) for vigorous intensity in comparison with controls. Conclusions Moderate intensity PA could be recommended to all smokers regardless of demographic, smoking and other characteristics.

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Mediators and Moderators of Treatment Effects in Randomized Clinical Trials

Cited by 2,289 publications

References 38 publications

Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Testing links between childhood positive peer relations and externalizing outcomes through a randomized controlled intervention study.

The acute effects of physical activity on cigarette cravings: Exploration of potential moderators, mediators and physical activity attributes using individual participant data (IPD) meta-analyses

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