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BACKGROUND Cognitive behavioral therapy CBT is frequently used to treat depressive symptoms in people living with HIV We developed an internet-based cognitive behavioral intervention for people with HIV and depressive symptoms which was based on an effective self-help booklet The Web-based intervention was previously found to be effective OBJECTIVE The objective of this study was to investigate potential mediators of the Web-based intervention METHODS This study was part of a randomized controlled trial in which the intervention was compared with an attention-only waiting list control condition Participants were 188 97 in intervention group and 91 in control group people with HIV and mild to moderate depressive symptoms recruited in HIV treatment centers in the Netherlands A total of 22 participants 22 188 11 7 in the study were female and 166 166 188 88 3 were male The average age of the participants was 46 30 years SD 10 63 The intervention comprised Web-based self-help CBT for 8 weeks 1 to 2 hours a week including minimal telephone support from a coach The participants received Web-based questionnaires at pretest 3 times during the intervention or waiting period and post intervention The outcome was depressive symptoms Factors tested as potential mediators were changes in behavioral activation relaxation the cognitive coping strategies catastrophizing and positive refocusing goal re-engagement and coping self-efficacy RESULTS Using multilevel structural equation modeling changes in behavioral activation P 006 and goal re-engagement P 009 were found to be significant mediators of the intervention effect The mediation effect seemed to occur between weeks 3 and 5 for behavioral activation and weeks 1 and 3 for goal re-engagement Using bivariate autoregressive latent trajectory analysis we found a return effect from the dependent variable to the mediator for goal re-engagement but not for behavioral activation which suggested that the mediation effect of changes in behavioral activation was stronger than that in goal re-engagement CONCLUSIONS The results suggest that changes in behavioral activation and goal re-engagement may mediate the effect of the Web-based intervention for people with HIV and depressive symptoms The results may lead to possible mechanisms of change of the intervention and improvement of therapy outcomes TRIAL REGISTRATION Netherlands Trial Register NTR5407 https www trialregister nl trial 5298 status published

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Exploring mediators of a guided web-based self-help intervention for people with HIV and depressive symptoms: Randomized...

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with ACTIVATION TREATMENTS as keyword