Investigating the mechanisms through which psychotherapy brings about desired change can inform efforts to improve therapies. We applied meta-analytic structural equation modeling (MASEM) to assess putative change mechanisms for cognitive behavioral therapy (CBT) as mediators of youth depression treatment outcome. Then, we tested whether candidate mediators (CMs) showed evidence of treatment-specificity to CBT versus interpersonal psychotherapy (IPT). Literature searches identified 34 randomized trials (27 CBT, 6 IPT, 1 CBT/IPT, 3,868 participants, published 1982-2020) that measured seven CMs: negative cognition, social engagement, family functioning, pleasant activity engagement, problem solving, reframing, or avoidance. We assessed mediational pathways and whether posttreatment CMs mediated treatment effects on posttreatment depression symptoms, covarying pretreatment CMs, and symptoms. Treatment type was tested as a moderator of mediational pathways. Results show that negative cognition (24 trials) and pleasant activities (3 trials) mediated depression symptom outcome in CBT. Social engagement and family functioning showed stronger mediation in IPT (5 and 6 trials) than in CBT (14 and 13 trials). We conclude that negative cognition is a robust mediator of CBT but may not be treatment-specific; pleasant activities may also be a mediator of CBT. However, the lack of treatment or mediation effects involving problem solving and reframing contradicts CBT theory. In contrast, social and family mechanisms appear to be IPT-specific mediators. These conclusions are provisional due to small samples examining IPT and several CMs, limitations in CM measurement (i.e., posttreatment retrospective report), and assumptions of MASEM-and will need to be confirmed when more and better evidence accumulates. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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认知行为疗法和人际心理疗法如何改善青少年抑郁症？将荟萃分析结构方程模型应用于三十年的随机试验。


研究心理治疗带来预期改变的机制可以为改进治疗的努力提供信息。我们应用荟萃分析结构方程模型（MASEM）来评估认知行为疗法（CBT）作为青少年抑郁症治疗结果的中介因素的假定变化机制。然后，我们测试了候选调解者 (CM) 是否显示出 CBT 与人际心理治疗 (IPT) 治疗特异性的证据。文献检索确定了 34 项随机试验（27 项 CBT、6 项 IPT、1 项 CBT/IPT、3,868 名参与者，1982-2020 年发表），测量了 7 种 CM：消极认知、社会参与、家庭功能、愉快的活动参与、问题解决、重构或回避。我们评估了中介途径以及治疗后 CM 是否介导对治疗后抑郁症状、共变治疗前 CM 和症状的治疗效果。治疗类型作为中介途径的调节剂进行了测试。结果表明，消极认知（24 项试验）和愉快的活动（3 项试验）介导 CBT 中的抑郁症状结果。社会参与和家庭功能在 IPT（5 和 6 项试验）中显示出比 CBT（14 和 13 项试验）更强的中介作用。我们的结论是，消极认知是 CBT 的有力中介因素，但可能不具有治疗特异性；愉快的活动也可能是 CBT 的中介因素。然而，缺乏涉及问题解决和重构的治疗或中介效应与 CBT 理论相矛盾。相比之下，社会和家庭机制似乎是 IPT 特有的调节因素。由于检查 IPT 和多个 CM 的样本量较小、CM 测量的局限性（即，治疗后回顾性报告），以及 MASEM 的假设 - 并且需要在积累更多更好的证据时得到证实。 （PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。