Strengths and limitations
ASB
This is the first study to investigate mechanisms explaining the effect of CBT and UCT on ASB using counterfactual outcome mediation analysis [Our study, however, has some important limitations. First, we cannot be sure that our estimates of the relationship between mediators and ASB is causal. Although we controlled for observables, the fact that mediators are not randomly assigned means that confounding may still bias our estimates of mediation of the effect of treatment on ASB. An alternative approach would be to use an instrumental variable approach that exploits potentially exogenous variation in mediators and incorporate these in the models. However, identifying valid instruments for executive function, self-control, and time preferences is challenging. Future studies should examine to what extent the relationship between executive function, self-control, and time preferences, and ASB is causal.We had some losses to follow-up, which are most likely not at random, this could affect our measures of association. Nonetheless, missing data was less than 8%, and we consider that this would not have had a great impact in our overall analyses. We had to limit our study to a subset of mechanisms, i.e., executive function, self-control, and time preferences. These involve malleable skills that can be trained or even improved by therapy or mental training [