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Therapeutic processes in digital interventions for anxiety: A systematic review and meta-analytic structural equation modeling of randomized controlled trials
Clinical Psychology Review ( IF 12.8 ) Pub Date : 2021-09-13 , DOI: 10.1016/j.cpr.2021.102084
Matthias Domhardt 1 , Hannah Nowak 1 , Sophie Engler 1 , Amit Baumel 2 , Simon Grund 3 , Axel Mayer 4 , Yannik Terhorst 5 , Harald Baumeister 1
Affiliation  

While the efficacy of Internet- and mobile-based interventions (IMIs) for treating anxiety disorders is well established, there is no comprehensive overview about the underlying therapeutic processes so far. Thus, this systematic review and meta-analysis evaluated research on mediators and mechanisms of change in IMIs for adult anxiety disorders (PROSPERO: CRD42020185545). A systematic literature search was performed in five databases (i.e., CENTRAL, Embase, MEDLINE, PsycINFO and ClinicalTrials.gov). Two reviewers independently screened studies for inclusion, assessed the risk of bias and adherence to quality criteria for process research. Overall, 26 studies (N = 6042) investigating 64 mediators were included. Samples consisted predominantly of participants with clinically relevant symptoms of generalized anxiety disorder and severe health anxiety, as well as of participants with non-clinically relevant anxiety symptoms. The largest group of examined mediators (45%) were cognitive variables, evincing also the second highest proportion of significance (19/29); followed in numbers by skills (examined: 22%; significant: 10/14) and a wide range of other (19%; 7/12), emotional/affective (11%; 2/7) and behavioral mediators (3%; 1/2). Meta-analytical synthesis of mediators, limited by a small number of eligible studies, was conducted by deploying a two-stage structural equation modeling approach, resulting in a significant indirect effect for negative thinking (k = 3 studies) and non-significant indirect effects for combined cognitive variables, both in clinical (k = 5) and non-clinical samples (k = 3). The findings of this review might further the understanding on presumed change mechanisms in IMIs for anxiety, informing intervention development and the concurrent optimization of outcomes. Furthermore, by reviewing eligible mediation studies, we discuss methodological implications and recommendations for future process research, striving for causally robust findings. Future studies should investigate a broader range of variables as potential mediators, as well as to develop and apply original (digital) process and engagement measures to gather qualitative and high-resolution data on therapeutic processes.



中文翻译:

焦虑症数字干预的治疗过程:随机对照试验的系统评价和元分析结构方程模型

虽然基于互联网和移动设备的干预 (IMI) 治疗焦虑症的功效已经确立,但目前还没有关于潜在治疗过程的全面概述。因此,这项系统评价和荟萃分析评估了成人焦虑症 IMI 变化的介质和机制的研究(PROSPERO:CRD42020185545)。在五个数据库(即 CENTRAL、Embase、MEDLINE、PsycINFO 和 ClinicalTrials.gov)中进行了系统的文献检索。两名审查员独立筛选纳入的研究,评估偏倚风险和过程研究质量标准的遵守情况。总体而言,26 项研究(N = 6042) 调查了 64 名调解员。样本主要包括具有广泛性焦虑症和严重健康焦虑的临床相关症状的参与者,以及具有非临床相关焦虑症状的参与者。最大的一组被检查的中介 (45%) 是认知变量,也显示出第二高的显着性比例 (19/29);其次是技能(检查:22%;显着:10/14)和广泛的其他(19%;7/12)、情绪/情感(11%;2/7)和行为调解员(3%; 1/2)。受少数符合条件的研究限制,通过部署两阶段结构方程建模方法进行了介体的元分析综合,对消极思维产生了显着的间接影响(k = 3 项研究)和对组合认知变量的非显着间接影响,包括临床 ( k  = 5) 和非临床样本 ( k  = 3)。本综述的结果可能会进一步了解 IMI 中假定的焦虑变化机制,告知干预措施的发展和结果的同步优化。此外,通过审查符合条件的中介研究,我们讨论了对未来过程研究的方法学意义和建议,力求获得因果关系稳健的结果。未来的研究应该调查更广泛的变量作为潜在的中介,以及开发和应用原始(数字)过程和参与措施来收集关于治疗过程的定性和高分辨率数据。

更新日期:2021-10-03
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