The DOI matches its Crossref record; 113 of the 113 references it cites were found in a registry or an index.
Beyond linear mediation: Toward a dynamic network approach to study treatment processes
Open accessAbstract
Few clinical scientists would disagree that more research is needed on the underlying mechanisms and processes of change in psychological therapies. In the dominant current approach, processes of change are studied through mediation. The study of mediation has been largely structured around a distinction between moderation and mediation first popularized by Baron and Kenny's (1986) seminal article, which is based on a nomothetic and cross-sectional framework. In this article, we argue that this approach is unable to adequately address change processes in psychological therapies, because it falsely assumes that treatment change is a linear, unidirectional, pauci-variate process and that the statistical assumptions are met to study processes of change in an individual using a nomothetic approach. In contrast, we propose that treatment is a dynamic process involving numerous variables that may form bi-directional and complex relationships that differ between individuals. Such relationships can best be studied using an individual dynamic network approach connected to nomothetic generalization methods that are based on a firm idiographic foundation. We argue that our proposal is available, viable, and can readily be integrated into existing research strategies. We further argue that adopting an individual dynamic network approach combined with experimental analyses will accelerate the study of treatment change processes, which is necessary as the field of evidence-based care moves toward a process-based model. We encourage future research to gather empirical evidence to examine this approach.
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“Modeling downstream mechanisms will likely require complex approaches such as network analytic frameworks”
From Measuring the active elements of cognitive-behavioral therapies (2023) · cites this paper as Hofmann et al., 2020
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“The second important component of PBT is the personalization of treatment based on (a) information about the individual network of the problem and (b) matching interventions based on their effective components to the central node of the network [10].”
From Process-based therapy vs. routine-CBT for difficult-to-treat mood and anxiety disorders: study protocol for a randomized controlled trial (2024) · cites this paper as [10]
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In the citing paper
“both outcomes and processes of therapeutic change are likely to be different from person to person (Hofmann et al., 2020;Vlaeyen et al., 2020).”
From Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online (2022) · cites this paper as Hofmann et al., 2020
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In the citing paper
“Linear mediation models, as employed in our study, may not be suitable to capture the complexity of therapeutic processes”
From Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol (2022) · cites this paper as Hofmann et al., 2020
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In the citing paper
“the relationship between outcome and mediator are dynamic, bidirectional, and non-linear (Hofmann etal., 2020)”
From Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol (2022) · cites this paper as Hofmann et al., 2020
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In the citing paper
“If only studies of mediation within randomized controlled trials are examined, more than 1,000 significant findings can be identified, encompassing more than 100 processes of change 71 .”
From “Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry (2021) · cites this paper as [71]
Experimental — accuracy not yet measuredIn the citing paper
“Mediators often form bi-directional and complex relationships that differ between individuals (Hofmann, Curtiss, & Hayes, 2020).”
From A process-based approach to psychological diagnosis and treatment:The conceptual and treatment utility of an extended evolutionary meta model (2020) · cites this paper as Hofmann, Curtiss, & Hayes, 2020
In the citing paper
“A similar lack of progress has been noted for behavioural markers in guiding and individualizing behavioural treatments such as psychotherapy.33”
From Precision clinical trials: a framework for getting to precision medicine for neurobehavioural disorders (2021) · cites this paper as [33]
In the citing paper
“However, neurobehavioural treatment response may not obey a dose–response curve; it could evolve in complex, nonlinear ways both acutely and in the longer term, as patients’ needs, preferences, psychosocial context and neurobiology change over time.33”
From Precision clinical trials: a framework for getting to precision medicine for neurobehavioural disorders (2021) · cites this paper as [33]
In the citing paper
“New statistical methods allow researchers to model the temporal dynamics of illness at an individual level.33,48,49”
From Precision clinical trials: a framework for getting to precision medicine for neurobehavioural disorders (2021) · cites this paper as [33]
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Citations
Cites
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.51.6.1173 · Cited by 91,532
Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium
Hayes, A. F. (2009) · Communication Monographs · doi:10.1080/03637750903310360 · Cited by 9,757 · cited 2×
“Some of these modifications and clarifications have been explicit in their desire to go beyond Baron and Kenny (e.g., A. F. Hayes, 2009).”
BackgroundMethodA comparison of methods to test mediation and other intervening variable effects
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002) · Psychological Methods · doi:10.1037/1082-989x.7.1.83 · Cited by 9,406 · cited 1×
“That was addressed by non-parametric tests of the significance of the cross-product of the coefficients, which also allow mediation to be tested on smaller data sets provided the data sets were internally consistent (A. F. Hayes & Preacher, 2014; MacKinnon et al., 2002).”
MethodInsel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C., & Wang, P. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09091379 · Cited by 7,067
What good are positive emotions?
Fredrickson, B. L. (1998) · Review of General Psychology · doi:10.1037/1089-2680.2.3.300 · Cited by 6,066 · cited 1×
“This phenomenon has been described in the broaden-and-build model (e.g., Fredrickson, 2000); positive affect loosens the influence of negative affect on the person and at the same time broadens the behavioral repertoire by enhancing physical, social, and intellectual resources.”
BackgroundEarly-warning signals for critical transitions
Scheffer, M., Bascompte, J., Brock, W. A., Brovkin, V., Carpenter, S. R., Dakos, V., Held, H., van Nes, E. H., Rietkerk, M., & Sugihara, G. (2009) · Nature · doi:10.1038/nature08227 · Cited by 4,854 · cited 1×
“An example of an important sign of an impending transition or tipping point is critical slowing down (Scheffer et al., 2009).”
BackgroundNetwork analysis: An integrative approach to the structure of psychopathology
Borsboom, D., & Cramer, A. O. J. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185608 · Cited by 4,359
Statistical mediation analysis with a multicategorical independent variable
Hayes, A. F., & Preacher, K. J. (2014) · British Journal of Mathematical and Statistical Psychology · doi:10.1111/bmsp.12028 · Cited by 3,403
Defining empirically supported therapies.
Chambless, D. L., & Hollon, S. D. (1998) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.66.1.7 · Cited by 3,067
Single Case Experimental Designs: Strategies for Studying Behavior Change
Barlow, D. H., Nock, M. K., & Hersen, M. (1976) · Cited by 3,036
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Research works printed but not linked: 1
- Hayes, 2020, Creating an alternative to syndromal diagnosis: Needed features of processes of change and the models that organize them. Chapter to appear in
Cited by
Sorted by citations
Hayes, S. C., & Hofmann, S. G. (2021) · World Psychiatry · doi:10.1002/wps.20884 · Cited by 260
Self-citationHayes, S. C., Ciarrochi, J., Hofmann, S. G., Chin, F., & Sahdra, B. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104155 · Cited by 234
Self-citationHayes, S. C., Hofmann, S. G., & Ciarrochi, J. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101908 · Cited by 227
Self-citationPutting the “mental” back in “mental disorders”: a perspective from research on fear and anxiety
Taschereau‐Dumouchel, V., Michel, M., Lau, H. C., Hofmann, S. G., & LeDoux, J. E. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01395-5 · Cited by 200
Self-citationStudying Behaviour Change Mechanisms under Complexity
Heino, M. T. J., Knittle, K. P., Noone, C., Hasselman, F., & Hankonen, N. E. (2021) · Behavioral Sciences · doi:10.3390/bs11050077 · Cited by 161
“Of particular importance to human behaviour change, however, is that the accuracy of mediation analysis depends on four key assumptions [13]: (1) The number of variables involved is small, and dynamics can be meaningfully assessed with only a few time points; (2) The process of change is the same for all individuals,…”
Background
Metadata
- Authors
- Hofmann, S. G., Curtiss, J. E., & Hayes, S. C.
- Affiliations
- Boston University (US)
- University of Nevada, Reno (US)
- Corresponding author
- Hofmann, Stefan G.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 76
- Pages
- 101824
- ISSN
- 0272-7358 (ISSN-L)
- PMC
- PMC7137783
- OpenAlex
- W3000381339
- Cited by
- 232
- References
- 110
- Citations by year
- 2026: 25 · 2025: 37 · 2024: 52 · 2023: 31 · 2022: 35 · 2021: 34 · 2020: 18
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Keywords
- treatment process, psychotherapy, mediation analysis, moderation, dynamic network model, individual differences, idiographic approach, mechanistic model, evidence-based care, mechanisms of change
- MeSH terms
- Humans, Psychotherapy
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