Introduction: Behavioural activation is an effective treatment for depression, but little is known about its working mechanisms. Theoretically, its effect is thought to rely on an interplay between activation and environmental reward. Objective: The present systematic review examines the mediators of behavioural activation for depression. Methods: A systematic literature search without time restrictions in Medline, EMBASE, PsycINFO, The Cochrane Library, and CINAHL resulted in 14 relevant controlled and uncontrolled prospective treatment studies that also performed formal mediation analyses to investigate their working mechanisms. After categorising the mediators investigated, we systematically compared the studies’ methodological quality and performed a narrative synthesis of the findings. Results: Most studies focused on activation or environmental reward, with 21 different mediators being investigated using questionnaires that focused on psychological processes or beliefs. The evidence for both activation and environmental reward as mediators was weak. Conclusions: Non-significant results, poor methodological quality of some of the studies, and differences in questionnaires employed precluded any firm conclusions as to the significance of any of the mediators. Future research should exploit knowledge from fundamental research, such as reward motivation from neurobiology. Furthermore, the use of experience sampling methods and idiographic analyses in bigger samples is recommended to investigate potential causal pathways in individual patients.
Psychother Psychosom

中文翻译：

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行为激活如何工作？对潜在调解人证据的系统审查。

简介：行为激活是一种有效的抑郁症治疗方法，但对其工作机制知之甚少。从理论上讲，它的效果被认为依赖于激活和环境奖励之间的相互作用。目的：本系统评价检查了抑郁症行为激活的中介因素。方法：在 Medline、EMBASE、PsycINFO、Cochrane 图书馆和 CINAHL 中没有时间限制的系统文献检索产生了 14 项相关的受控和非受控前瞻性治疗研究，这些研究还进行了正式的中介分析以研究其工作机制。在对调查的中介进行分类后，我们系统地比较了研究的方法学质量，并对研究结果进行了叙述性综合。结果：大多数研究侧重于激活或环境奖励，使用侧重于心理过程或信念的问卷调查了 21 种不同的中介。激活和环境奖励作为中介的证据很弱。结论：不显着的结果、一些研究的方法学质量差以及所用问卷的差异排除了任何关于任何调解员重要性的确切结论。未来的研究应该利用基础研究的知识，例如神经生物学的奖励动机。此外，建议在更大的样本中使用经验抽样方法和具体分析来调查个体患者的潜在因果途径。
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