Mechanisms of change in digital cognitive behavioral therapy for depression in patients with chronic back pain: A mediation analysis of a multicenter randomized clinical trial

被引:1
作者
Lutsch, Arne G. [1 ]
Baumeister, Harald [1 ]
Paganini, Sarah [2 ]
Sander, Lasse B. [3 ]
Terhorst, Yannik [1 ]
Domhardt, Matthias [1 ]
机构
[1] Ulm Univ, Dept Clin Psychol & Psychotherapy, Lise Meitner Str 16, D-89081 Ulm, Germany
[2] Univ Freiburg, Inst Sports & Sport Sci, Dept Sport Psychol, Freiburg, Germany
[3] Univ Freiburg, Med Fac, Med Psychol & Med Sociol, Freiburg, Germany
关键词
Chronic pain; Depression; Digital mental health; Mediator; Change process; Cross-lagged analyses; COMORBID MENTAL-DISORDERS; OSWESTRY DISABILITY INDEX; QUALITY-OF-LIFE; SELF-EFFICACY; COMMITMENT THERAPY; PSYCHOLOGICAL INTERVENTIONS; PRIMARY-CARE; HEALTH; MODEL; PSYCHOTHERAPY;
D O I
10.1016/j.brat.2023.104369
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Background: While there is evolving knowledge on change processes of digital cognitive behavioral therapy (CBT) in the treatment of depression, little is known about how these interventions produce therapeutic change in the comorbid constellation of chronic back pain (CBP). Here, we examined whether the effects of a digital intervention to treat depression in patients with CBP are mediated by three pain-related variables (i.e., pain self efficacy, pain-related disability, pain intensity). Methods: This study is a secondary analysis of a randomized clinical trial conducted in routine care at 82 orthopedic clinics across Germany. In total, 209 adults with CBP and diagnosed depression (SCID interview) were randomly assigned to the intervention (n = 104) or treatment-as-usual (n = 105). Cross-lagged mediation models were estimated to investigate longitudinal mediation effects of putative mediators with depression symptom severity (PHQ-9) as primary outcome at post-treatment. Results: Longitudinal mediation effects were observed for pain self-efficacy (ss =-0.094, 95%-CI [-0.174,-0.014], p = 0.021) and pain-related disability (ss =-0.068, 95%-CI [-0.130,-0.001], p = 0.047). Furthermore, the hypothesized direction of the mediation effects was supported, reversed causation did not occur. Pain intensity did not reveal a mediation effect. Conclusions: The results suggest a relevant role of pain self-efficacy and pain-related disability as change processes in the treatment of depression for patients with CBP in routine care. However, further research is needed to disclose potential reciprocal relationships of mediators, and to extend and specify our knowledge of the mechanisms of change in digital CBT for depression.
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页数:11
相关论文
共 95 条
[21]   PSYCHOSOCIAL PREDICTORS OF OUTCOME IN ACUTE AND SUBCHRONIC LOW-BACK TROUBLE [J].
BURTON, AK ;
TILLOTSON, KM ;
MAIN, CJ ;
HOLLIS, S .
SPINE, 1995, 20 (06) :722-728
[22]   Persistent pain and depression: A biopsychosocial perspective [J].
Campbell, LC ;
Clauw, DJ ;
Keefe, FJ .
BIOLOGICAL PSYCHIATRY, 2003, 54 (03) :399-409
[23]   Interventions for Depressive Symptoms in People Living with Chronic Pain: A Systematic Review of Meta-Analyses [J].
Cheng, Darren K. ;
Lai, Ka Sing Paris ;
Pico-Espinosa, Oscar Javier ;
Rice, Danielle B. ;
Chung, Chadwick ;
Modarresi, Golale ;
Sud, Abhimanyu .
PAIN MEDICINE, 2022, 23 (05) :934-954
[24]   Predicting poor outcomes for back pain seen in primary care using patients' own criteria [J].
Cherkin, DC ;
Deyo, RA ;
Street, JH ;
Barlow, W .
SPINE, 1996, 21 (24) :2900-2907
[25]   Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling [J].
Cole, DA ;
Maxwell, SE .
JOURNAL OF ABNORMAL PSYCHOLOGY, 2003, 112 (04) :558-577
[26]   Prognosis for patients with chronic low back pain: inception cohort study [J].
Costa, Luciola da C. Menezes ;
Maher, Christopher G. ;
McAuley, James H. ;
Hancock, Mark J. ;
Herbert, Robert D. ;
Refshauge, Kathryn M. ;
Henschke, Nicholas .
BMJ-BRITISH MEDICAL JOURNAL, 2009, 339 :850
[27]   The Role of Common Factors in Psychotherapy Outcomes [J].
Cuijpers, Pim ;
Reijnders, Mirjam ;
Huibers, Marcus J. H. .
ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, VOL 15, 2019, 15 :207-231
[28]   A randomized controlled trial of an Internet-based cognitive-behavioural intervention for non-specific chronic pain: An effectiveness and cost-effectiveness study [J].
de Boer, M. J. ;
Versteegen, G. J. ;
Vermeulen, K. M. ;
Sanderman, R. ;
Struys, M. M. R. F. .
EUROPEAN JOURNAL OF PAIN, 2014, 18 (10) :1440-1451
[29]   Mediators of Digital Depression Prevention in Patients With Chronic Back Pain: Findings From a Multicenter Randomized Clinical Trial [J].
Domhardt, Matthias ;
Lutsch, Arne ;
Sander, Lasse B. ;
Paganini, Sarah ;
Spanhel, Kerstin ;
Ebert, David D. ;
Terhorst, Yannik ;
Baumeister, Harald .
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY, 2023, 91 (08) :462-473
[30]   Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis [J].
Domhardt, Matthias ;
Grund, Simon ;
Mayer, Axel ;
Buscher, Rebekka ;
Ebert, David D. ;
Sander, Lasse B. ;
Karyotaki, Eirini ;
Cuijpers, Pim ;
Baumeister, Harald .
FRONTIERS IN PSYCHIATRY, 2022, 13