Moderators, mediators and mechanisms of change in psychotherapy
Abstract
This chapter focuses on the ideas first presented in Wasserman Rachel H regarding the application and value of G-theory for psychotherapy research. Generalizability theory (G-theory) provides a framework within which multiple sources of measurement error can be simultaneously evaluated thus improving the accuracy of reliability estimates and providing critical information for modification and improvement of coding procedures. In an analogous fashion to classical test theory and the application of ICCs, G-theory further distinguishes between decisions based on the relative standing or ranking of individuals relative interpretations and decisions based on the absolute level of their scores. Facets are considered random when the size of the sample is much smaller than the size of the universe and the sample is considered to be interchangeable with any other sample of the same size drawn from the universe.
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Identifying factors responsible for change in treatment can point to ways to improve therapeutic strategies so they target change-potent components more directly.
“Indeed, factors responsible for change during these treatments are important to identify as they can point to pathways of improving therapeutic strategies so they more directly target change-potent components (Kazdin, 2014).”
From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Kazdin, 2014
Specificity requires that it is the specific mediator in question, rather than competing mediators, which facilitates change.
“Another recommended requirement for establishing mediation is specificity, namely that it is the specific mediator in question, rather than competing mediators, which facilitates change (Kazdin, 2014).”
From Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as Kazdin, 2014
Temporal precedence requires that both mediators and outcomes are evaluated multiple times and not restricted to pre- and post-therapy evaluations.
“Temporal precedence refers to a change in the mediator taking place before a change in outcome, which requires that both mediators and outcomes are evaluated multiple times and not restricted to pre- and post-therapy evaluations (Kazdin, 2014).”
From Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as Kazdin, 2014
Not all people respond in the same way to psychological treatments, including technology-supported treatments.
“Although EMIs represent an important advance compared to episodic face-to-face interventions and even self-applied psychotherapy because of their traditional rigidity, it is known that not all people respond in the same way to psychological treatments [64], including the ones supported by technology [65].”
From Using Artificial Intelligence to Enhance Ongoing Psychological Interventions for Emotional Problems in Real- or Close to Real-Time: A Systematic Review (2022) · cites this paper as [64]
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“This is a natural development of how new theoretical concepts of change are introduced into the field, but often with limited empirical knowledge related to the actual moderators and mediators of change (Kazdin, 2014).”
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“…EMIs represent an important advance compared to episodic face-to-face interventions and even self-applied psychotherapy because of their traditional rigidity, it is known that not all people respond in the same way to psychological treatments [64], including the ones supported by technology [65].”
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“Indeed, factors responsible for change during these treatments are important to identify as they can point to pathways of improving therapeutic strategies so they more directly target change-potent components (Kazdin, 2014).”
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“Even when these conditions are met, ambiguity can remain about the precise role of the mediator (Bullock, Green, & Ha, 2010; Kazdin, 2014).”
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“Correlational and mediator studies are greatly limited in describing or explaining the more molecular processes of change (Kazdin 2014).”
BackgroundSelf-citationKazdin, A. E. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1208374 · Cited by 43 · see citing works
“There remain many critically important unresolved questions related to understanding mechanisms of change of the treatment, identifying moderators of treatment that can be used in ways that guide decision making in clinical practice, and evaluating the long-term benefits of treatments (Kazdin, 2014).”
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“A mediator does not necessarily explain the process of how a change occurs (Kazdin, 2009; 2014; Wampold et al., 2010).”
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“Kazdin (2014) describes a mechanism as more specific than a mediating process in that a mechanism explains how an intervention translates into precise events that lead to changes in outcome.”
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“The study of predictors and moderators of treatment outcomes plays an important role in psychotherapy research because the same treatment is not likely to work for everyone in the same way (Kazdin, 2014).”
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“For instance, (1) monetary and temporal costs are high due to the need for a therapist and real-world materials for conducting an exposure (eg, plane tickets, time for traveling to and from the airport or flight destination, etc) [7,8]; (2) waitlists are longer, again due to the need for a therapist over the course of…”
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“The relevancy factor has to do with research not having yet established how change occurs in psychotherapy; e.g. Kazdin (2014), ‘. . .there is little empirical research to provide an evidence-based explanation of precisely why treatments work and how the changes come about’ (p. 87) (see also…”
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“, treatment mechanisms accounting for the detected effect) [19].”
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“Thus, gaining a deeper understanding of the characteristics that influence symptom change during CPT can identify variables that may bolster (or interfere) with treatment response (Kazdin, 2014).”
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Self-citationSingle-Case Experimental Research Designs
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Self-citationCautions, Negative Effects, and Replication
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Self-citationSelecting Measures for Research
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Self-citationKazdin, A. E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108993647.013
Self-citationKazdin, A. E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108993647.022
Self-citationIdeas that Begin the Research Process
Kazdin, A. E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108993647.005
Self-citationKazdin, A. E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108993647.020
Self-citationKazdin, A. E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108993647.025
Self-citationPresenting and Analyzing the Data
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Self-citationEthical Issues and Guidelines for Research
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Self-citationCommunication of Research Findings
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Self-citationER DET HÅRDT AT VÆRE PSYKOTERAPEUT?
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Expanding the Conceptual and Intervention Options
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Self-citationChallenges, Contexts, and Constraints
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Self-citationRecommendations and Next Steps
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0014
Self-citationSocial Contacts and Support, Volunteering, and Hobbies and Leisure Activities
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0010
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Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0008
Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.002.0003
Self-citationSelection of Interventions from Everyday Life
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0005
Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0002
Self-citationDigital and Technological Means of Delivering Interventions
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0011
Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.002.0009
Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0007
Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.002.0008
Self-citationPhysical Activity and Exercise and Diet and Nutrition
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0006
Self-citationWhy Do So Few People Receive Treatment
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0003
Self-citationEffective Treatments Are Available, Sort Of
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0004
Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.002.0006
Self-citationKazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0001
Self-citationContact with Nature, Pets, and Other Nonhuman Animals
Kazdin, A. E. (2025) · doi:10.1093/oso/9780197773659.003.0009
Self-citationLiu, L., Tang, J. Y.-M., & Xu, J.-Q. (2026) · Mindfulness · doi:10.1007/s12671-026-02868-w
“Second, some studies in this review fail to establish temporal precedence by measuring changes in mediators prior to measuring changes in outcomes (Kazdin, 2014).”
- Authors
- Kazdin, A. E.
- Affiliations
- Yale University (US)
- Corresponding author
- Kazdin, Alan E.
- ORCID
- Kazdin, Alan E.
- Venue
- Quantitative and Qualitative Methods in Psychotherapy Research
- Publisher
- Routledge
- Published
- 2014-01-03
- Pages
- 87-101
- OpenAlex
- W2952377786
- Cited by
- 99
- References
- 0
- Citations by year
- 2026: 1 · 2025: 23 · 2024: 6 · 2023: 6 · 2022: 4 · 2021: 33 · 2020: 6 · 2019: 5 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 6 · 2014: 1
- FWCI
- 17.38
- Type
- book chapter
- Language
- en
- Open access
- closed
- Locations
- Routledge eBooks (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Keywords
- generalizability theory, measurement error, reliability estimation, coding procedures, inter-rater reliability, psychotherapy research, mediators and moderators, mechanisms of change
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