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Therapeutic processes in digital interventions for anxiety : A systematic review and meta-analytic structural equation modeling of randomized controlled trials. / Domhardt, Matthias; Nowak, Hannah; Engler, Sophie et al.

in: Clinical Psychology Review, Jahrgang 90, 102084, 12.2021.

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APA

Domhardt, M., Nowak, H., Engler, S., Baumel, A., Grund, S., Mayer, A., Terhorst, Y., & Baumeister, H. (2021). Therapeutic processes in digital interventions for anxiety: A systematic review and meta-analytic structural equation modeling of randomized controlled trials. Clinical Psychology Review, 90, [102084]. https://doi.org/10.1016/j.cpr.2021.102084

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Domhardt, Matthias ; Nowak, Hannah ; Engler, Sophie et al. / Therapeutic processes in digital interventions for anxiety : A systematic review and meta-analytic structural equation modeling of randomized controlled trials. in: Clinical Psychology Review. 2021 ; Jahrgang 90.

BibTeX

@article{2c0207fe74b241e68a69fc4853bbfdef,
title = "Therapeutic processes in digital interventions for anxiety: A systematic review and meta-analytic structural equation modeling of randomized controlled trials",
abstract = "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.",
keywords = "Anxiety disorder, e-and m-Health, Psychotherapy, Mechanism of change, Mediator, Two-stage structural equation modeling",
author = "Matthias Domhardt and Hannah Nowak and Sophie Engler and Amit Baumel and Simon Grund and Axel Mayer and Yannik Terhorst and Harald Baumeister",
year = "2021",
month = dec,
doi = "10.1016/j.cpr.2021.102084",
language = "English",
volume = "90",
journal = "Clinical Psychology Review",
issn = "0272-7358",
publisher = "Elsevier Inc.",

}

RIS

TY - JOUR

T1 - Therapeutic processes in digital interventions for anxiety

T2 - A systematic review and meta-analytic structural equation modeling of randomized controlled trials

AU - Domhardt, Matthias

AU - Nowak, Hannah

AU - Engler, Sophie

AU - Baumel, Amit

AU - Grund, Simon

AU - Mayer, Axel

AU - Terhorst, Yannik

AU - Baumeister, Harald

PY - 2021/12

Y1 - 2021/12

N2 - 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.

AB - 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.

KW - Anxiety disorder

KW - e-and m-Health

KW - Psychotherapy

KW - Mechanism of change

KW - Mediator

KW - Two-stage structural equation modeling

U2 - 10.1016/j.cpr.2021.102084

DO - 10.1016/j.cpr.2021.102084

M3 - Journal article

VL - 90

JO - Clinical Psychology Review

JF - Clinical Psychology Review

SN - 0272-7358

M1 - 102084

ER -

ID: 1702930