Explaining the efficacy of an internet-based behavioral activation intervention for major depression: A mechanistic study of a randomized-controlled trial
Author(s) / Creator(s)
Fu, Zhongfang
Burger, Huibert
Arjadi, Retha
Nauta, Maaike H.
Bockting, Claudi L. H.
Abstract / Description
Background: Behavioral activation is an effective treatment for depression that is theorized to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement; to date, however, only few mechanistic studies focused on a standalone intervention. Method: Interventions using internet-based behavioral activation or psychoeducation were compared based on data from a randomized-controlled trial of 313 patients with major depressive disorder. Activation level and depression were measured fortnightly (baseline, Weeks 2, 4, 6, 8, 10), using the Patient Health Questionnaire-9 and the Behavioral Activation for Depression Scale-Short Form, respectively. Analysis was performed to determine if a change in activation level mediated treatment efficacy. Results: Latent growth modeling showed that internet-based behavioral activation treatment significantly reduced depressive symptoms from baseline to the end of treatment (standardized coefficient = −.13, p = .017) by increasing the rate of growth in the activation level (mediated effect estimate = −.17, 95% CI [−.27, −.07]. Results from mixed effects and simplex models showed that it took 4 weeks before mediation occurred (i.e., a significant change in activation that led to a reduction in depressive symptoms). Conclusion: Activation level likely mediated the therapeutic effect of behavioral activation on depression in our intervention. This finding may be of significant value to clinicians and depressed individuals who should anticipate a 4-week window before seeing a prominent change in activation level and a 6-week window before depressive symptomatology reduces. Future research must consolidate our findings on how behavioral activation works and when mediation occurs.
Keyword(s)
psychological interventions working mechanisms behavioral activation depression internet-based intervention lay counselorsPersistent Identifier
Date of first publication
2021-09-30
Journal title
Clinical Psychology in Europe
Volume
3
Issue
3
Article number
Article e5467
Publisher
PsychOpen GOLD
Publication status
publishedVersion
Review status
peerReviewed
Is version of
Citation
Fu, Z., Burger, H., Arjadi, R., Nauta, M. H., & Bockting, C. L. H. (2021). Explaining the efficacy of an internet-based behavioral activation intervention for major depression: A mechanistic study of a randomized-controlled trial. Clinical Psychology in Europe, 3(3), Article e5467. https://doi.org/10.32872/cpe.5467
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Author(s) / Creator(s)Fu, Zhongfang
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Author(s) / Creator(s)Burger, Huibert
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Author(s) / Creator(s)Arjadi, Retha
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Author(s) / Creator(s)Nauta, Maaike H.
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Author(s) / Creator(s)Bockting, Claudi L. H.
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PsychArchives acquisition timestamp2022-04-14T11:19:39Z
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Made available on2022-04-14T11:19:39Z
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Date of first publication2021-09-30
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Abstract / DescriptionBackground: Behavioral activation is an effective treatment for depression that is theorized to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement; to date, however, only few mechanistic studies focused on a standalone intervention. Method: Interventions using internet-based behavioral activation or psychoeducation were compared based on data from a randomized-controlled trial of 313 patients with major depressive disorder. Activation level and depression were measured fortnightly (baseline, Weeks 2, 4, 6, 8, 10), using the Patient Health Questionnaire-9 and the Behavioral Activation for Depression Scale-Short Form, respectively. Analysis was performed to determine if a change in activation level mediated treatment efficacy. Results: Latent growth modeling showed that internet-based behavioral activation treatment significantly reduced depressive symptoms from baseline to the end of treatment (standardized coefficient = −.13, p = .017) by increasing the rate of growth in the activation level (mediated effect estimate = −.17, 95% CI [−.27, −.07]. Results from mixed effects and simplex models showed that it took 4 weeks before mediation occurred (i.e., a significant change in activation that led to a reduction in depressive symptoms). Conclusion: Activation level likely mediated the therapeutic effect of behavioral activation on depression in our intervention. This finding may be of significant value to clinicians and depressed individuals who should anticipate a 4-week window before seeing a prominent change in activation level and a 6-week window before depressive symptomatology reduces. Future research must consolidate our findings on how behavioral activation works and when mediation occurs.en_US
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Publication statuspublishedVersion
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Review statuspeerReviewed
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CitationFu, Z., Burger, H., Arjadi, R., Nauta, M. H., & Bockting, C. L. H. (2021). Explaining the efficacy of an internet-based behavioral activation intervention for major depression: A mechanistic study of a randomized-controlled trial. Clinical Psychology in Europe, 3(3), Article e5467. https://doi.org/10.32872/cpe.5467en_US
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ISSN2625-3410
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Persistent Identifierhttps://hdl.handle.net/20.500.12034/5178
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Persistent Identifierhttps://doi.org/10.23668/psycharchives.5782
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Language of contenteng
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PublisherPsychOpen GOLD
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Is version ofhttps://doi.org/10.32872/cpe.5467
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Is related tohttps://doi.org/10.23668/psycharchives.5092
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Keyword(s)psychological interventionsen_US
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Keyword(s)working mechanismsen_US
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Keyword(s)behavioral activationen_US
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Keyword(s)depressionen_US
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Keyword(s)internet-based interventionen_US
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Keyword(s)lay counselorsen_US
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Dewey Decimal Classification number(s)150
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TitleExplaining the efficacy of an internet-based behavioral activation intervention for major depression: A mechanistic study of a randomized-controlled trialen_US
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DRO typearticle
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Article numberArticle e5467
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Issue3
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Journal titleClinical Psychology in Europe
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Volume3
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Visible tag(s)Version of Recorden_US