Explaining the efficacy of an internet-based behavioral activation intervention for major depression: A mechanistic study of a randomized-controlled trial
Open accessAbstract
Background: Behavioral activation is an effective treatment for depression that is theorized to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement; to date, however, only few mechanistic studies focused on a standalone intervention. Method: Interventions using internet-based behavioral activation or psychoeducation were compared based on data from a randomized-controlled trial of 313 patients with major depressive disorder. Activation level and depression were measured fortnightly (baseline, Weeks 2, 4, 6, 8, 10), using the Patient Health Questionnaire-9 and the Behavioral Activation for Depression Scale-Short Form, respectively. Analysis was performed to determine if a change in activation level mediated treatment efficacy. Results: Latent growth modeling showed that internet-based behavioral activation treatment significantly reduced depressive symptoms from baseline to the end of treatment (standardized coefficient = −.13, p = .017) by increasing the rate of growth in the activation level (mediated effect estimate = −.17, 95% CI [−.27, −.07]. Results from mixed effects and simplex models showed that it took 4 weeks before mediation occurred (i.e., a significant change in activation that led to a reduction in depressive symptoms). Conclusion: Activation level likely mediated the therapeutic effect of behavioral activation on depression in our intervention. This finding may be of significant value to clinicians and depressed individuals who should anticipate a 4-week window before seeing a prominent change in activation level and a 6-week window before depressive symptomatology reduces. Future research must consolidate our findings on how behavioral activation works and when mediation occurs.
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Results of an internet-based CBT intervention revealed that positive effects occur already after 4 weeks of CBT.
“Recently, results of an internet-based CBT intervention revealed that positive effects occur already after 4 weeks of CBT [34].”
From A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study (2022) · cites this paper as [34]
The Discussion reports improved activation levels from Week 4, so the paper does identify a positive change at that point. But it studied internet-based behavioral activation, not an intervention described as CBT, and reports reduced depressive symptoms only from Week 6. (LLM, conf=0.88)
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- Authors
- Fu, Z., Burger, H., Arjadi, R., Nauta, M. H., & Bockting, C. L. H.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- University Medical Center Groningen (NL)
- Atma Jaya Catholic University of Indonesia (ID)
- University of Groningen (NL)
- Corresponding author
- Bockting, Claudi L. H.
- Venue
- Clinical Psychology in Europe
- Published
- 2021-09-30
- Volume
- 3
- Issue
- 3
- Pages
- e5467-e5467
- ISSN
- 2625-3410 (ISSN-L)
- PMC
- PMC9667235
- OpenAlex
- W3202894755
- Cited by
- 16
- References
- 45
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 5 · 2021: 2
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Clinical Psychology in Europe (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- PsychOpen Gold (Leibniz Institute for Psychology) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Psychology Archives (cc-by)
- Funders
- Lembaga Pengelola Dana Pendidikan
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- behavioral activation, major depressive disorder, online intervention, mediation, activation level, psychoeducation, treatment efficacy, latent growth curve models, simplex model, positive reinforcement
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