More Light? Opportunities and Pitfalls in Digitalized Psychotherapy Process Research

Abstract

While the evidence on the effectiveness of different psychotherapies is often strong, it is not settled whereby and how these therapies work. Knowledge on the causal factors and change mechanisms is of high clinical and public relevance, as it contributes to the empirically informed advancement of psychotherapeutic interventions. Here, digitalized research approaches might possess the potential to generate new insights into human behavior change, contributing to augmented interventions and mental healthcare practices with better treatment outcomes. In this perspective article, we describe recent findings of research into change mechanisms that were only feasible with digital tools and outline important future directions for this rather novel branch of research. Furthermore, we indicate several challenges and pitfalls that are to be solved, in order to advance digitalized psychotherapy process research, both methodologically and technologically.

Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review

“…Cognitive variables were found to be the most often investigated mediators, followed by a broad range of other mediators. Even though our eligibility criteria were not limited to a specific mental health condition in youth, only a rather low number of studies were identified by our systematic literature searches, a finding that corresponds to the limited evidence base of research on mechanisms of change in psychotherapy in general [ 37 , 74 ], and for children and adolescents in specific [ 24 , 35 , 37 ], necessitating further high-quality research efforts to improve interventions and mental health care practices for this younger age group.…”

“…Second, the therapeutic or working alliance (ie, the professional relationship between therapists and patients; eg, Grawe et al [ 90 ]) was not evaluated as a mediator in any of the included studies. However, the recent development of the working alliance inventory for digital interventions [ 91 ] may contribute to future process research, informing the evidence base of the effects of a digital therapeutic alliance in DHIs for youth [ 37 , 92 ]. Furthermore, mediators that have not been investigated so far, such as behavioral and biological variables, should be evaluated in future studies.…”

“…Furthermore, mediators that have not been investigated so far, such as behavioral and biological variables, should be evaluated in future studies. At this point, the possibilities of novel technological methods in process research seem not to be fully exploited in this research field [ 37 ]. Passive sensing methodologies and digital phenotyping approaches with smartphones [ 93 ] might generate insights on behavioral and biological mechanisms in real life, in addition to the predominant information on cognitive variables derived from self-reports identified in the current review.…”

“…Although research on DHIs is a fast growing field [ 36 ] and might also offer intriguing opportunities for psychotherapeutic process research [ 24 , 37 ], we are not aware of any systematic review of the mediators and mechanisms of change in DHI PSY and DHI HP for common mental disorders in youth published to this point. Therefore, this study aimed to: (1) systematically review the current state of research on mediators and mechanisms of change in various DHIs for mental disorders in children and adolescents, (2) identify mediators and potential mechanisms of change in these interventions, and (3) evaluate the methodological quality of eligible mediation studies according to the quality criteria for process research mentioned above.…”

Mobile-based interventions for common mental disorders in youth: a systematic evaluation of pediatric health apps

“…This concern is also nourished by the massive commercialization of the app market and limited resources in healthcare globally, raising further methodological and ethical questions [ 59 , 60 ]. Thus, the adherence to well-established standards of good clinical practices as well as scientific-based intervention evaluation should be urgently applied for MHA [ 61 ], similar as it is largely the case for internet-based interventions and conventional psychotherapies offered face-to-face. Recommendations for quality criteria and standards for MHA are available, and can complement efficacy-/effectiveness studies on MHA in RCTs [ 62 , 63 ].…”