Are the parts as good as the whole? A meta-analysis of component treatment studies.

Bell, Erin; Marcus, David K.; Goodlad, James K.

doi:10.1037/a0033004

Cited by 176 publications

(177 citation statements)

References 96 publications

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“…Given the level of standardization found in the IC arm of this study and in similarly constructed guided IBI, the guidance itself oftentimes consists of individualizing only a minor amount of text and might thus be considered a small “add-on” to already effective treatments. Consequently, our results are in line with meta-analytic comparisons of component treatment studies suggesting that added components yield very small effects [70] or no effects at all [71]. …”

Section: Discussionsupporting

confidence: 78%

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Zagorscak

Heinrich

Sommer

et al. 2018

Psychother Psychosom

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Background: Even though there is an increasing number of studies on the efficacy of Internet-based interventions (IBI) for depression, experimental trials on the benefits of added guidance by clinicians are scarce and inconsistent. This study compared the efficacy of semistandardized feedback provided by psychologists with fully standardized feedback in IBI. Methods: Participants with mild-to-moderate depression (n = 1,089, 66% female) from the client pool of a health insurance company participated in a cognitive-behavioral IBI targeting depression over 6 weeks. Individuals were randomized to weekly semistandardized e-mail feedback from psychologists (individual counseling; IC) or to automated, standardized feedback where a psychologist could be contacted on demand (CoD). The contents and tasks were identical across conditions. The primary outcome was depression; secondary outcomes included anxiety, rumination, and well-being. Outcomes were assessed before and after the intervention and 3, 6, and 12 months later. Changes in outcomes were evaluated using latent change score modeling. Results: Both interventions yielded large pre-post effects on depression (Beck Depression Inventory-II: d_IC = 1.53, d_CoD = 1.37; Patient Health Questionnaire-9: d_IC = 1.20, d_CoD = 1.04), as well as significant improvements of all other outcome measures. The effects remained significant after 3, 6, and 12 months. The groups differed with regard to attrition (IC: 17.3%, CoD: 25.8%, p = 0.001). Between-group effects were statistically nonsignificant across outcomes and measurement occasions. Conclusion: Adding semistandardized guidance in IBI for depression did not prove to be more effective than fully standardized feedback on primary and secondary outcomes, but it had positive effects on attrition.

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Section: Discussionsupporting

confidence: 78%

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Zagorscak

Heinrich

Sommer

et al. 2018

Psychother Psychosom

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“…This result points to the added value of MOTR when integrated or combined with an established treatment form. The effect sizes of the present add-on study are slightly larger than reported in a recent meta-analysis on all additive studies in psychotherapy (d = 0.14 and d = 0.28), which are interpreted as small but significant additive improvements [50]. Larger effect sizes in our study might be due to the specific nature of MOTR, a relationship technique much closer to what Ahn and Wampold [51] called the common factors in psychotherapy.…”

Section: Discussioncontrasting

confidence: 41%

Effects of Motive-Oriented Therapeutic Relationship in a Ten-Session General Psychiatric Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Kramer

Kolly

Berthoud³

et al. 2014

Psychother Psychosom

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Background: Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. Methods: A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. Results: The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F_{1, 73} = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z₅₅ = 0.99, p < 0.04). Conclusions: These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.

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“…A next step is to determine the mechanisms of change in multicomponent PPIs. Therefore, it is necessary that future studies use a more complex design, for example by using at least a 6-armed trial wherein one component is added to each intervention arm (from one component to all six components; additive design) or wherein each component is examined in isolation and compared to the comprehensive intervention (dismantling design) (Bell, Marcus, & Goodlad, 2013).…”

Section: Disclosure Statementmentioning

confidence: 99%

Possible mechanisms in a multicomponent email guided positive psychology intervention to improve mental well-being, anxiety and depression: A multiple mediation model

Schotanus-Dijkstra

Pieterse

Drossaert

et al. 2017

The Journal of Positive Psychology

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The efficacy of several multicomponent positive psychology interventions (PPIs) have been demonstrated, but little is known about its possible mechanisms of change. We examined (1) the efficacy of an email guided self-help PPI on six core well-being processes (positive emotion, use of strengths, optimism, self-compassion, resilience and positive relations) and (2) the mediating role of these processes on mental well-being, anxiety and depressive symptoms. Adults ≥ 18 years were recruited in the general population and randomized into the intervention (n = 137) or wait-list control group (n = 138). Repeated measures analyses showed that the intervention group improved significantly more than the control group on all six processes. Improvement (t0-t1) on each process statistically mediated improvement (t0-t2) on mental well-being, anxiety and depressive symptoms. Simple-mediation analyses revealed small to moderate effect sizes. Multiple-mediation analyses revealed most pronounced results for positive relations and self-compassion, suggesting that these processes might be key mechanisms in promoting well-being.

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Are the parts as good as the whole? A meta-analysis of component treatment studies.

Abstract: These findings suggest that added specific ingredients may contribute modestly to treatment outcomes.

Cited by 176 publications

References 96 publications

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Effects of Motive-Oriented Therapeutic Relationship in a Ten-Session General Psychiatric Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Possible mechanisms in a multicomponent email guided positive psychology intervention to improve mental well-being, anxiety and depression: A multiple mediation model

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