Mediators of symptom improvement in transdiagnostic internet cognitive behavioural therapy for mixed anxiety and depression,Clinical Psychologist

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Mediators of symptom improvement in transdiagnostic internet cognitive behavioural therapy for mixed anxiety and depression
Clinical Psychologist ( IF 1.2 ) Pub Date : 2022-05-12 , DOI: 10.1080/13284207.2022.2057217
Natalie Kladnistki ₁ , Melissa Black _{2,

3} , Sam Haffar ₂ , Amy Joubert ₂ , Jill M Newby _{2,

3}

Affiliation

ABSTRACT

Objectives

Transdiagnostic internet cognitive behavioural therapy (iCBT) improves depression and anxiety symptoms, but the factors mediating these improvements are unknown.

Design

In a secondary analysis of a randomised controlled trial, we compared the impact of a transdiagnostic iCBT program (n = 39) on emotion regulation, repetitive negative thinking, and experiential avoidance relative to treatment-as-usual (TAU) control (n = 35). The extent to which changes in these processes mediated treatment gains in iCBT relative to TAU was also explored. Intention-to-treat mixed models were used to assess outcomes, and unmoderated simple mediation models were used to explore mediators of change of each outcome (depression/anxiety).

Results

Results showed iCBT outperformed TAU in reducing all three processes, with largebetween-group effect sizes for repetitive negative thinking (g = 1.04), and medium effect sizes for emotion regulation (g = 0.78), and experiential avoidance (g = 0.54). Changes in symptoms of depression and anxiety were partly mediated through pre-to-post changes in all three variables, but not pre-to-mid-treatment changes.

Conclusion

These findings provide evidence that transdiagnostic iCBT for depression and anxiety improves emotion regulation, reduces repetitive thinking and experiential avoidance, and provides preliminary evidence that symptom improvements are associated with improvements in these variables.

KEY POINTS

What is already known about this topic:

(1) Transdiagnostic interventions aim to target the common symptoms and the functional emotional, cognitive, and behavioural processes shared across emotional disorders.
(2) Transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) improves depression and anxiety symptoms.
(3) However, the factors mediating these symptom improvements are largely unknown.

What this topic adds:

(1) Transdiagnostic iCBT for depression and anxiety improves emotion regulation and reduces repetitive thinking and experiential avoidance in participants with an anxiety and/or depressive disorder.
(2) Symptom improvements are associated with improvements in these transdiagnostic variables; emotion regulation, repetitive negative thinking, and experiential avoidance appear to be significant mediators of post-treatment improvements in symptoms of depression and anxiety.
(3) Targeting these shared underlying processes is likely important to improve symptoms of depression and anxiety.

中文翻译：

混合性焦虑和抑郁的跨诊断互联网认知行为治疗中症状改善的中介因素

摘要

目标

跨诊断互联网认知行为疗法 (iCBT) 可改善抑郁和焦虑症状，但介导这些改善的因素尚不清楚。

设计

在一项随机对照试验的二次分析中，我们比较了跨诊断 iCBT 计划 (n = 39) 对情绪调节、重复性消极思维和经验回避相对于常规治疗 (TAU) 控制 (n = 35) 的影响）。还探讨了这些过程中的变化在多大程度上介导了 iCBT 相对于 TAU 的治疗收益。使用意向治疗混合模型来评估结果，并使用无节制的简单中介模型来探索每个结果（抑郁/焦虑）变化的中介因素。