Increased skills usage statistically mediates symptom reduction in self-guided internet-delivered cognitive–behavioural therapy for depression and anxiety: a randomised controlled trial

Cognitive Behaviour Therapy

Volumn 47, Issue 1, 2018, Pages 43-61

  Terides, Matthew D ^a   Dear, Blake F ^a   Fogliati, Vincent J ^a   Gandy, Milena ^a   Karin, Eyal ^a   Jones, Michael P ^a   Titov, Nickolai ^a  

^a MACQUARIE UNIVERSITY   (Australia)

Author keywords

Anxiety; cognitive behavioural therapy (CBT); depression; mechanisms; skills usage

Indexed keywords

ADULT; ANXIETY; ANXIETY DISORDER; COGNITIVE THERAPY; CONTROLLED STUDY; DEPRESSION; HUMAN; INTERNET; OUTCOME ASSESSMENT; PROCEDURES; PSYCHOLOGY; RANDOMIZED CONTROLLED TRIAL; SATISFACTION; SELF CARE;

ADULT; ANXIETY; ANXIETY DISORDERS; COGNITIVE THERAPY; DEPRESSION; DEPRESSIVE DISORDER; HUMANS; INTERNET; OUTCOME ASSESSMENT (HEALTH CARE); PERSONAL SATISFACTION; SELF CARE;

EID: 85025142325     PISSN: 16506073     EISSN: 16512316     Source Type: Journal    
DOI: 10.1080/16506073.2017.1347195     Document Type: Article

References (56)

1. Baron, R. M., & Kenny, D. A., (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi:10.1037//0022-3514.51.6.1173
2. Beck, A.T., Rush, A. J., Shaw, B, F., & Emery, G., (1979). Cognitive Therapy of Depression. Guilford Press.
3. Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T., (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31. doi:10.1016/j.cpr.2005.07.003
4. Chen, J., Liu, X., Rapee, R. M., & Pillay, P., (2013). Behavioural activation: A pilot trial of transdiagnostic treatment for excessive worry. Behaviour Research and Therapy, 51, 533–539. doi:10.1016/j.brat.2013.05.01010.1016/j.brat.2013.05.010
5. Cole, D. A., & Maxwell, S. E., (2003). Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. Journal of abnormal psychology, 112, 558.
6. Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F., (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta-analysis of direct comparisons. World Psychiatry, 12, 137–148. doi:10.1002/wps.20038
7. Dear, B. F., Staples, L. G., Terides, M. D., Karin, E., Zou, J., Johnston, L., … Titov, N., (2015). Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial. Journal of Anxiety Disorders, 36, 63–77. doi:10.1016/j.janxdis.2015.09.003
8. Dear, B. F., Titov, N., Sunderland, M., McMillan, D., Anderson, T., Lorian, C., & Robinson, E., (2011). Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder. Cognitive Behaviour Therapy, 40, 216–227. doi:10.1080/16506073.2011.582138
9. DeRubeis, R. J., Webb, C. A., Tang, T. Z., & Beck, A. T., (2010). Cognitive therapy. In K. S., Dobson (Ed.), Handbook of cognitive-behavioral therapies (3rd ed. pp. 277–316). New York, NY: Guilford.
10. Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S., (1985). The satisfaction with life scale. Journal ofPersonality Assessment, 49, 71–75. doi:10.1207/s15327752jpa4901
11. Dimidjian, S., Barrera, M., Martell, C., Muñoz, R. F., & Lewinsohn, P. M., (2011). The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology, 7, 1–38. doi:10.1146/annurev-clinpsy-032210-104535
12. Hanrahan, F., Field, A. P., Jones, F. W., & Davey, G. C. L., (2013). A meta-analysis of cognitive therapy for worry in generalized anxiety disorder. Clinical Psychology Review, 33, 120–132. doi:10.1016/j.cpr.2012.10.008
13. Hayes, A. F., (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.
14. Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A., (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427–440. doi:10.1007/s10608-012-9476-1
15. Hofmann, S. G., Wu, J. Q., & Boettcher, H., (2014). Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: A meta-analysis. Journal of Consulting and Clinical Psychology, 82, 375–391. doi:10.1037/a0035491
16. Hundt, N. E., Calleo, J. S., Williams, W., & Cully, J. A., (2016). Does using cognitive-behavioural therapy skills predict improvements in depression? Psychology and Psychotherapy: Theory, Research and Practice, 89(2), 235–238. doi:10.1111/papt.12065
17. Hundt, N. E., Mignogna, J., Underhill, C., & Cully, J. A., (2013). The relationship between use of cbt skills and depression treatment outcome: A theoretical and methodological review of the literature. Behavior Therapy, 44, 12–26. doi:10.1016/j.beth.2012.10.001
18. Jacob, K. L., Christopher, M. S., & Neuhaus, E. C., (2011). Development and validation of the cognitive-behavioral therapy skills questionnaire. Behavior Modification, 35, 595–618. doi:10.1177/0145445511419254
19. Jarrett, R. B., Vittengl, J. R., Clark, L. A., & Thase, M. E., (2011). Skills of cognitive therapy (SoCT): A new measure of patients’ comprehension and use. Psychological Assessment, 23, 578–586. doi:10.1037/a0022485
20. Kanter, J. W., Mulick, P. S., Busch, A. M., Berlin, K. S., & Martell, C. R., (2007). The Behavioral Activation for Depression Scale (BADS): psychometric properties and factor structure. Journal of Psychopathology and Behavioral Assessment, 29, 191.
21. Kazantzis, N., Whittington, C., & Dattilio, F., (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17, 144–156.
22. Kazdin, A. E., (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. doi:10.1146/annurev.clinpsy.3.022806.091432
23. Kroenke, K., Spitzer, R. L., & Williams, J. B., (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613. doi:10.1046/j.1525-1497.2001.016009606.x10.1046/j.1525-1497.2001.016009606.x
24. Kessler, R. C., Berglund, P. A., Dewit, D. J., Bedirhan Üstün, T., Wang, P. S., & Wïttchen, H. U., (2002). Distinguishing generalized anxiety disorder from major depression: Prevalence and impairment from current pure and comorbid disorders in the US and Ontario. International Journal of Methods in Psychiatric Research, 11, 99–111. doi: 10.1002/(ISSN)1557-065710.1002/(ISSN)1557-0657
25. Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B., (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359. doi:10.1016/j.genhosppsych.2010.03.006
26. Laurenceau, J.-P., Hayes, A. M., & Feldman, G. C., (2007). Some methodological and statistical issues in the study of change processes in psychotherapy. Clinical Psychology Review, 27, 682–695. doi:10.1016/j.cpr.2007.01.007
27. Lorenzo-Luaces, L., German, R. E., & DeRubeis, R. J., (2015). It’s complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical Psychology Review, 41, 3–15. doi:10.1016/j.cpr.2014.12.003
28. Löwe, B., Decker, O., & Müller, S., (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care, 46(3), 266–274. doi:10.1097/MLR.0b013e318160d09310.1097/MLR.0b013e318160d093
29. MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S., (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614. doi:10.1146/annurev.psych.58.110405.085542
30. Manos, R. C., Kanter, J. W., & Luo, W., (2011). The behavioral activation for depression scale-short form: development and validation. Behavior Therapy, 42, 726–739. doi:10.1016/j.beth.2011.04.004
31. Miner, A. S., Schueller, S. M., Lattie, E. G., & Mohr, D. C., (2015). Creation and validation of the cognitive and behavioral response to stress scale in a depression trial. Psychiatry Research, 230, 819–825. doi:10.1016/j.psychres.2015.10.03310.1016/j.psychres.2015.10.033
32. Morgan, A. J., Mackinnon, A. J., & Jorm, A. F., (2013). Behavior change through automated e-mails: Mediation analysis of self-help strategy use for depressive symptoms. Behaviour Research and Therapy, 51, 57–62. doi:10.1016/j.brat.2012.11.002
33. Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T., (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110. doi:10.1016/j.cpr.2015.06.00210.1016/j.cpr.2015.06.002
34. Oei, T. P., & McAlinden, N. M., (2014). Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic. Psychiatry Research, 220, 1012–1018. doi:10.1016/j.psychres.2014.08.036
35. Oei, T. P. S., McAlinden, N. M., & Cruwys, T., (2014). Exploring mechanisms of change: The relationships between cognitions, symptoms, and quality of life over the course of group cognitive-behaviour therapy. Journal of Affective Disorders, 168, 72–77. doi:10.1016/j.jad.2014.06.040
36. Pavot, W., & Diener, E., (2008). The satisfaction with life scale and the emerging construct of life satisfaction. The Journal of Positive Psychology, 3, 137–152. doi:10.1080/17439760701756946
37. Pavot, W., Diener, E., Colvin, C. R., & Sandvik, E., (1991). Further validation of the satisfaction with life scale: Evidence for the cross-method convergence of well-being measures.
38. Preacher, K. J., & Hayes, A. F., (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731. doi:10.3758/BF03206553
39. Rapee, R. M., & Heimberg, R. G., (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. doi:10.1016/S0005-7967(97)00022-310.1016/S0005-7967(97)00022-3
40. Saddichha, S., Al-Desouki, M., Lamia, A., Linden, I. A., & Krausz, M., (2014). Online interventions for depression and anxiety–A systematic review. Health Psychology and Behavioral Medicine: an Open Access Journal, 2, 841–881. doi:10.1080/21642850.2014.94593410.1080/21642850.2014.945934
41. Sasso, K. E., Strunk, D. R., Braun, J. D., DeRubeis, R. J., & Brotman, M. A., (2015). Identifying moderators of the adherence-outcome relation in cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 83, 976–984. doi:10.1037/ccp0000045
42. Schulz, K. F., Altman, D. G., & Moher, D., (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMC Medicine, 8 (1): 42. doi:10.1186/1741-7015-8-1810.1186/1741-7015-8-18
43. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C., (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl. 20), 22–33.
44. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., … Dunbar, G. C., (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12, 232–241. doi:10.1016/S0924-9338(97)83297-X10.1016/S0924-9338(97)83297-X
45. Shrout, P. E., & Bolger, N., (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422. doi:10.1037//1082-989x.7.4.422
46. Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lo, B., (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166(10), 1092–1097.
47. Strunk, D. R., Hollars, S. N., Adler, A. D., Goldstein, L. A., & Braun, J. D., (2014). Assessing patients’ cognitive therapy skills: Initial evaluation of the competencies of cognitive therapy scale. Cognitive Therapy and Research, 38, 559–569. doi:10.1007/s10608-014-9617-9
48. Teo, A. R., Choi, H., & Valenstein, M., (2013). Social relationships and depression: Ten-year follow-up from a nationally representative study. PLoS One, 8(4), e62396. doi:10.1371/journal.pone.006239610.1371/journal.pone.0062396
49. Terides, M. D., Dear, B. F., Karin, E., Jones, M. P., Gandy, M., Fogliati, V. J., … Titov, N., (2016). The frequency of actions and thoughts scale: Development and psychometric validation of a measure of adaptive behaviours and cognitions. Cognitive Behaviour Therapy, 45(3), 196–216.
50. Titov, N., Dear, B. F., Johnston, L., Lorian, C., Zou, J., Wootton, B., … Rapee, R. M., (2013). Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: Randomised controlled trial. PLoS One, 8(7), e62873. doi:10.1371/journal.pone.0062873
51. Titov, N., Dear, B. F., McMillan, D., Anderson, T., Zou, J., & Sunderland, M., (2011). Psychometric comparison of the PHQ-9 and BDI-II for measuring response during treatment of depression. Cognitive Behaviour Therapy, 40, 126–136. doi:10.1080/16506073.2010.550059
52. Titov, N., Dear, B. F., Staples, L. G., Bennett-Levy, J., Klein, B., Rapee, R. M., … Nielssen, O. B., (2015b). MindSpot clinic: An accessible, efficient, and effective online treatment service for anxiety and depression. Psychiatric Services (Washington, D.C.), 66(10), 1043–1050, appips201400477. doi:10.1176/appi.ps.201400477
53. Titov, N., Dear, B. F., Staples, L. G., Terides, M. D., Karin, E., Sheehan, J., … McEvoy, P. M., (2015). Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: A randomized controlled trial. Journal of Anxiety Disorders, 35, 88–102. doi:10.1016/j.janxdis.2015.08.002
54. Webb, C. A., DeRubeis, R. J., Dimidjian, S., Hollon, S. D., Amsterdam, J. D., & Shelton, R. C., (2012). Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: The role of therapist adherence and the therapeutic alliance. Journal of Consulting and Clinical Psychology, 80, 373–381. doi:10.1037/a0027663
55. Webb, C. A., Kertz, S. J., Bigda-Peyton, J. S., & Björgvinsson, T., (2013). The role of pretreatment outcome expectancies and cognitive-behavioral skills in symptom improvement in an acute psychiatric setting. Journal of Affective Disorders, 149, 375–382. doi:10.1016/j.jad.2013.02.016
56. World Health Organization. (1990). Composite international diagnostic interview, version 1.0. Geneva: Author.