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Randomized clinical trials (RCTs) not only are the gold standard for evaluating the efficacy and effectiveness of psychiatric treatments but also can be valuable in revealing moderators and mediators of therapeutic change. Conceptually, moderators identify on whom and under what circumstances treatments have different effects. Mediators identify why and how treatments have effects. We describe an analytic framework to identify and distinguish between moderators and mediators in RCTs when outcomes are measured dimensionally. Rapid progress in identifying the most effective treatments and understanding on whom treatments work and do not work and why treatments work or do not work depends on efforts to identify moderators and mediators of treatment outcome. We recommend that RCTs routinely include and report such analyses.

Type

Journal article

Journal

Arch Gen Psychiatry

Publication Date

10/2002

Volume

59

Pages

877 - 883

Keywords

Clinical Protocols, Cognitive Therapy, Depressive Disorder, Effect Modifier, Epidemiologic, Humans, Models, Statistical, Outcome Assessment (Health Care), Patient Selection, Randomized Controlled Trials as Topic, Treatment Outcome