Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
Psychological Methods Group, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018WT, Amsterdam, the Netherlands.
Behav Res Ther. 2023 Mar;162:104266. doi: 10.1016/j.brat.2023.104266. Epub 2023 Jan 26.
Psychotherapies like Acceptance and Commitment Therapy (ACT) are thought to target multiple clinical outcomes by intervening on multiple mechanistic process variables. However, the standard mediation approach does not readily model the potentially complex associations among multiple processes and outcomes. The current study is one of the first to apply network intervention analysis to examine the putative change processes of a psychotherapy.
Using data from a randomized trial of ACT versus minimally-enhanced usual care for anxious cancer survivors, we computed pre-to post-intervention (n = 113) residualized change scores on anxiety-related outcomes (general anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence) and putative processes of the intervention (experiential avoidance, self-compassion, and emotional approach coping). We estimated a network model with intervention condition and residualized change scores as nodes.
Contrary to the expectation that intervention effects would pass indirectly to outcomes via processes, network analysis indicated that two anxiety-related outcomes of the trial may have acted as primary mechanisms of the intervention on other outcome and process variables.
Network intervention analysis facilitated flexible evaluation of ACT's change processes, and offers a new way to test whether change occurs as theorized in psychotherapies.
接受与承诺疗法（ACT）等心理治疗方法被认为通过干预多种机制过程变量来针对多种临床结果。然而，标准的中介分析方法不易模拟多个过程和结果之间潜在的复杂关联。本研究是首次应用网络干预分析来检验心理治疗的假定变化过程的研究之一。
使用 ACT 与焦虑癌症幸存者的最低增强常规护理的随机试验中的数据，我们计算了与焦虑相关的结果（一般焦虑症状、癌症相关创伤症状和对癌症复发的恐惧）和干预的假设过程（体验回避、自我同情和情绪应对）的干预前后（n=113）残差变化分数。我们以干预条件和残差变化分数为节点，估计了一个网络模型。
与干预效果通过过程间接传递给结果的预期相反，网络分析表明，试验的两个焦虑相关结果可能是干预对其他结果和过程变量的主要机制。
网络干预分析促进了 ACT 变化过程的灵活评估，并提供了一种新的方法来检验心理治疗中是否按照理论发生变化。
