title: Mechanisms of change in psychotherapy for depression: An empirical update and evaluation of research aimed at identifying psychological mediators.
abstract: We present a systematic empirical update and critical evaluation of the current status of research aimed at identifying a variety of psychological mediators in various forms of psychotherapy for depression. We summarize study characteristics and results of 35 relevant studies, and discuss the extent to which these studies meet several important requirements for mechanism research. Our review indicates that in spite of increased attention for the topic, advances in theoretical consensus about necessities for mechanism research, and sophistication of study designs, research in this field is still heterogeneous and unsatisfactory in methodological respect. Probably the biggest challenge in the field is demonstrating the causal relation between change in the mediator and change in depressive symptoms. The field would benefit from a further refinement of research methods to identify processes of therapeutic change. Recommendations for future research are discussed. However, even in the most optimal research designs, explaining psychotherapeutic change remains a challenge. Psychotherapy is a multi-dimensional phenomenon that might work through interplay of multiple mechanisms at several levels. As a result, it might be too complex to be explained in relatively simple causal models of psychological change.
authors: Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: Lotte.Lemmens@Maastrichtuniversity.nl.
authors: Lotte H J M
authors: LHJM
authors: Lemmens
authors: Department of Psychology, University of Trier, Am Wissenschaftspark 25-27, 54286 Trier, Germany.
authors: Viola N L S
authors: VNLS
authors: Müller
authors: Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, University of Amsterdam, PO Box 19268, 1000 GG Amsterdam, The Netherlands.
authors: Arnoud
authors: A
authors: Arntz
authors: Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraast 1, 1081 BT Amsterdam, The Netherlands.
authors: Marcus J H
authors: MJH
authors: Huibers
mesh_terms: D003863:Depression / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy / Q000379:methods*
keywords: Depression; Mechanisms; Mediators; Psychotherapy