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Mestre JM, Taubner S, Mota CP, Rangel Henriques M, Saliba A, Heinonen E, Ramos S, Moreno-Peral P, Volkert J, Adler A, Barkauskiene R, Conejo-Cerón S, Di Giacomo D, Ioannou Y, Mucha Vieira F, Røssberg JI, Sales CMD, Schmidt SJ, Stepisnik Perdih T, Ulberg R, Protić S. Theories of Change and Mediators of Psychotherapy Effectiveness in Adolescents With Externalising Behaviours: A Systematic Review. Front Psychiatry 2022; 12:730921. [PMID: 35095586 PMCID: PMC8795767 DOI: 10.3389/fpsyt.2021.730921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old). METHODS A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis. RESULTS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent-adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively. CONCLUSIONS Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified. ETHICS AND DISSEMINATION Ethical approval was not required. PROSPERO registration number: CRD42021231835.
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Affiliation(s)
- José M. Mestre
- Instituto para el Desarrollo Social y Sostenible (INDESS), Universidad de Cádiz, Cadiz, Spain
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Catarina Pinheiro Mota
- Department of Education and Psychology, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Margarida Rangel Henriques
- Center for Psychology at University of Porto, Porto, Portugal
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Andrea Saliba
- Department of Psychiatry, University of Malta and Mental Health Services Malta, Valletta, Malta
| | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sara Ramos
- Instituto para el Desarrollo Social y Sostenible (INDESS), Universidad de Cádiz, Cadiz, Spain
| | | | - Jana Volkert
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Asta Adler
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | | | - Dina Di Giacomo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Yianna Ioannou
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Filipa Mucha Vieira
- Center for Psychology at University of Porto, Porto, Portugal
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Célia M. D. Sales
- Center for Psychology at University of Porto, Porto, Portugal
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Stefanie J. Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Randi Ulberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Sonja Protić
- Institute of Criminological and Sociological Research, Belgrade, Serbia
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