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Online cognitive-based intervention for depression: exploring possible circularity in mechanisms of change

Published online by Cambridge University Press:  18 July 2013

R. van der Zanden ,
F. Galindo-Garre ,
K. Curie ,
J. Kramer  and
P. Cuijpers
R. van der Zanden*
Affiliation:
Centre for Youth Mental Health Studies, Trimbos Institute, Utrecht, The Netherlands
F. Galindo-Garre
Affiliation:
EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
K. Curie
Affiliation:
Department of Health Sciences, VU University, Amsterdam, The Netherlands
J. Kramer
Affiliation:
Innovation Centre of Mental Health and Technology, Trimbos Institute, Utrecht, The Netherlands
P. Cuijpers
Affiliation:
Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
*
* Address for correspondence: R. van der Zanden, Centre for Youth Mental Health, Trimbos Institute, Da Costakade 45, 3500 AS Utrecht, The Netherlands. (Email: [email protected])
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Abstract

Background

This study investigates possible circularity in mechanisms of change in participants of Master Your Mood (MYM), a cognitive-based, online intervention for young adults with depressive symptoms. A previous study showed that MYM effectively reduced depression and anxiety and strengthened mastery.

Method

We randomized 244 participants with depressive symptoms into MYM or a wait-list control condition. We explored the circularity hypothesis by several analyses. Correlations were computed to determine the association between (change in) depression and anxiety. Path analysis mediation models were used to explore whether change in anxiety and mastery mediated the intervention effect on depression, whether depression and mastery mediated the effect on anxiety and whether depression and anxiety mediated the effect on mastery. We used linear regression to explore whether early changes in anxiety predicted later changes in depression, and whether early changes in depression predicted later changes in anxiety.

Results

Co-morbidity between depression and anxiety was high (69.2%) and the association between depression and anxiety change was strong (r = 0.677, p < 0.01). Changes in anxiety and mastery mediated change in depression (mediation proportion 44%); changes in depression mediated change in anxiety (79%) and mastery (75%). We did not find an early change in anxiety predictive for a late change in depression, and vice versa.

Conclusions

This study appears to confirm the hypothesized circularity in the recovery process. We found high co-morbidity and strong correlation between depression and anxiety levels and bi-directional relationships between potential mediators and outcomes. Early anxiety change scores were not predictive of late depression change scores, and vice versa.

Keywords

Adolescentscognitive behavioral therapydepressionmechanisms of changemediation analysis
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 6 , April 2014 , pp. 1159 - 1170
Copyright
Copyright © Cambridge University Press 2013 

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References

Anholt, GE, Kempe, P, de Haan, E, van Oppen, P, Cath, DC, Smit, JH, van Balkom, AJLM (2008). Cognitive versus behavior therapy: processes of change in the treatment of obsessive–compulsive disorder. Psychotherapy and Psychosomatics 77, 38–42.CrossRefGoogle ScholarPubMed
Axelson, DA, Birmaher, B (2001). Relation between anxiety and depressive disorders in childhood and adolescence. Depression and Anxiety 14, 67–78.CrossRefGoogle ScholarPubMed
Bakker, A, Spinhoven, P, Van der Does, AJW, Van Balkom, AJLM, Van Dyck, R (2002). Locus of control orientation in panic disorder and the differential effects of treatment. Psychotherapy and Psychosomatics 71, 85–89.CrossRefGoogle ScholarPubMed
Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.CrossRefGoogle ScholarPubMed
Bate, SL, Stigler, MH, Thompson, MS, Arora, M, Perry, CL, Reddy, KS, MacKinnon, DP (2009). Psychosocial mediators of a school-based tobacco prevention program in India: results from the first year of Project MYTRI. Prevention Science 10, 116–128.CrossRefGoogle ScholarPubMed
Belsey, DA, Kuh, E, Welsch, RE (1980). Regression Diagnostics: Identifying Influential Data and Sources of Collinearity. John Wiley and Sons: New York.CrossRefGoogle Scholar
Birmaher, B, Ryan, ND, Williamson, D, Brent, D, Kaufman, J, Dahl, R, Perel, J, Nelson, B (1996). Childhood and adolescent depression: a review of the past 10 years – part I. Journal of the American Academy of Child and Adolescent Psychiatry 35, 1427–1439.CrossRefGoogle ScholarPubMed
Bouma, J, Ranchor, AV, Sanderman, R, van Sonderen, E (1995). Het meten van symptomen van depressie met de CES-D. Een handleiding (Measurement of Symptoms of Depression With the CES-D: A Manual). Rijksuniversiteit Groningen: Groningen.Google Scholar
Brady, EU, Kendall, PC (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin 111, 244–255.CrossRefGoogle ScholarPubMed
Calear, AL, Christensen, H (2010). Review of Internet-based prevention and treatment programs for anxiety and depression in children and adolescents. Medical Journal of Australia 192 (Suppl.), S12–S14.CrossRefGoogle ScholarPubMed
Chaney, JM, Mullins, LL, Uretsky, DL, Doppler, MJ, Palmer, WR, Wees, SJ (1996). Attributional style and depression in rheumatoid arthritis: the moderating role of perceived illness control. Rehabilitation Psychology 41, 205–223.CrossRefGoogle Scholar
Cole, DA, Peeke, LG, Martin, JM, Truglio, R, Seroczynski, AD (1998). A longitudinal look at the relation between depression and anxiety in children and adolescents. Journal of Consulting and Clinical Psychology 66, 451–460.CrossRefGoogle Scholar
Crawford, JR, Henry, JD, Crombie, C, Taylor, EP (2001). Brief report normative data for the HADS from a large non-clinical sample. British Journal of Clinical Psychology 40, 429–434.CrossRefGoogle Scholar
Cuijpers, P, Boluijt, P, Van Straten, A (2008). Screening of depression in adolescents through the Internet: sensitivity and specificity of two screening questionnaires. European Child and Adolescent Psychiatry 17, 32–38.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Donker, T, Andersson, G (2011). Psychological treatment of depression: results of a series of meta-analyses. Nordic Journal of Psychiatry 65, 354–364.CrossRefGoogle ScholarPubMed
Dempster, AP, Laird, NM, Rubin, DB (1977). Maximum likelihood from incomplete data via the EM algorithm. Journal of the Royal Statistical Society Series B (Statistical Methodology) 39, 1–38.Google Scholar
Dubovsky, SL (1990). Understanding and treating depression in anxious patients. Journal of Clinical Psychiatry 51 (Suppl.), 3–83–8, 14–17.Google Scholar
Garratt, G, Ingram, RE, Rand, KL, Sawalani, G (2007). Cognitive processes in cognitive therapy: evaluation of the mechanisms of change in the treatment of depression. Clinical Psychology Science and Practice 14, 224–239.CrossRefGoogle Scholar
Hale, W, Raaijmakers, Q, Muris, P, Van Hoof, A, Meeus, W (2009). One factor or two parallel processes? Comorbidity and development of adolescent anxiety and depressive disorder symptoms. Journal of Child Psychology and Psychiatry 50, 1218–1226.CrossRefGoogle ScholarPubMed
Hoek, W, Van Lier, PAC, Koot, HM (2012). Combined trajectories of depressive and anxiety symptoms from early to middle adolescence: descriptions, correlates and gender differences. In Subclinical Depression and Anxiety in Adolescence: Developmental Trajectories and Online Intervention, Dissertation (ed. Hoek, W.), pp. 25–50. Faculty of Psychology and Education, Vrije Universiteit: Amsterdam.Google Scholar
Jarrett, RB, Vittengl, JR, Doyle, K, Clark, LA (2007). Changes in cognitive content during and following cognitive therapy for recurrent depression: substantial and enduring, but not predictive of change in depressive symptoms. Journal of Consulting and Clinical Psychology 75, 432–446.CrossRefGoogle Scholar
Kazdin, AE (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology 3, 1–27.CrossRefGoogle ScholarPubMed
Lachman, ME, Weaver, SL (1998). The sense of control as a moderator of social class differences in health and well-being. Journal of Personality and Social Psychology 74, 763–773.CrossRefGoogle ScholarPubMed
Lee, LC, Rebok, GW (2002). Anxiety and depression in children: a test of the positive–negative affect model. Journal of the American Academy of Child and Adolescent Psychiatry 41, 419–426.CrossRefGoogle ScholarPubMed
Lemmens, LHJM, Arntz, A, Peeters, FPML, Hollon, SD, Roefs, A, Huibers, MJH (2011). Effectiveness, relapse prevention and mechanisms of change of cognitive therapy vs. interpersonal therapy for depression: study protocol for a randomised controlled trial. Trials 12, 150.CrossRefGoogle ScholarPubMed
Longmore, RJ, Worrell, M (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review 27, 173–187.CrossRefGoogle ScholarPubMed
MacKinnon, DP (2008). Introduction to Statistical Mediation Analysis, chapter 6. Lawrence Erlbaum Associates: New York.Google Scholar
Mausbach, BT, Mills, PJ, Patterson, TL, Aschbacher, K, Dimsdale, JE, Ancoli-Israel, S, von Känel, R, Grant, I (2007). Stress-related reduction in personal mastery is associated with reduced immune cell β2-adrenergic receptor sensitivity. International Psychogeriatrics 19, 935–946.CrossRefGoogle ScholarPubMed
Mausbach, BT, Patterson, TL, Von Känel, R, Mills, PJ, Dimsdale, JE, Ancoli-Israel, S (2006). Personal mastery attenuates the effects of caregiving stress on psychiatric morbidity. Journal of Nervous and Mental Disease 194, 132–134.CrossRefGoogle ScholarPubMed
Meulenbeek, P, Spinhoven, P, Smit, F, van Balkom, A, Cuijpers, P (2010). Cognitive mediation of panic reduction during an early intervention for panic. Acta Psychiatrica Scandinavia 122, 20–29.CrossRefGoogle ScholarPubMed
Moser, DK, Dracup, K (1995). Psychosocial recovery from a cardiac event; the influence of perceived control. Heart and Lung 24, 273–280.CrossRefGoogle ScholarPubMed
Ogles, BM, France, CR, Lunnen, KM, Bell, MT, Goldfarb, M (1998). Computerized depression screening and awareness. Community Mental Health Journal 34, 27–38.CrossRefGoogle ScholarPubMed
Pearlin, LI, Schooler, C (1978). The structure of coping. Journal of Health and Social Behavior 19, 2–21.CrossRefGoogle ScholarPubMed
Preacher, KJ, Hayes, AF (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.CrossRefGoogle ScholarPubMed
Radloff, LS (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
Rivard, V, Cappeliez, P (2007). Perceived control and coping in women faced with activity restriction due to osteoarthritis: relations to anxious and depressive symptoms. Canadian Journal of Aging 26, 241–253.CrossRefGoogle ScholarPubMed
Rosenbaum, DL, White, KS, Gervino, EV (2012). The impact of perceived stress and perceived control on anxiety and mood disorders in noncardiac chest pain. Journal of Health Psychology 17, 1183–1192.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google ScholarPubMed
Spek, V, Cuijpers, P, Nyklícek, I, Riper, H, Keyzer, J, Pop, V (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine 37, 319–328.CrossRefGoogle ScholarPubMed
Spinhoven, P, Ormel, J, Sloekers, PP, Kempen, GI, Speckens, AE, Van Hemert, AM (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine 27, 363–370.CrossRefGoogle ScholarPubMed
Stephen, SI, Craighead, WE (1995). The role of nonspecific factors in cognitive–behavior therapy for depression. Clinical Psychology: Science and Practice 1, 138–155.Google Scholar
Stephen, SI, Craighead, WE (2006). Rapid early response, cognitive modification, and nonspecific factors in cognitive behavior therapy for depression: a reply to Tang and DeRubeis. Clinical Psychology: Science and Practice 6, 295–299.Google Scholar
Thompson, SC, Schlehofer, MM (2008). The many sides of control motivation. Motives for high, low and illusory control. In Handbook of Motivation Science (ed. Shah, J. Y. and Gardner, W. L.), pp. 41–56. Guilford Press: New York.Google Scholar
Thompson, SC, Schlehofer, MM, Bovin, MJ, Dougan, BT, Montes, D, Trifskin, S (2006). Disposition, control strategies, and distress in the general public after the 2001 terrorist attack. Anxiety, Stress and Coping 19, 143–159.CrossRefGoogle Scholar
Van der Zanden, AP, Kramer, J, Gerrits, R, Cuijpers, P (2012). Effectiveness of an online group course for depression in adolescents and young adults: a randomized trial. Journal of Medical Internet Research 14, e86.CrossRefGoogle Scholar
Van Vliet, IM, Leroy, H, van Megen, H (2000). M.I.N.I. Plus. International Neuropsychological Interview. Nederlandse Versie 5.0.0. (Dutch Version 5.0.0). UMC: Utrecht.Google Scholar
Warmerdam, L, van Straten, A, Jongsma, J, Twisk, R, Cuijpers, P (2010). Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: exploring mechanisms of change. Journal of Behavior Therapy and Experimental Psychiatry 41, 64–70.CrossRefGoogle ScholarPubMed
Weisz, JR, McCarty, CA, Valeri, SM (2006). Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychological Bulletin 132, 132–149.CrossRefGoogle ScholarPubMed
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361–370.CrossRefGoogle ScholarPubMed