Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial

Karin Lindqvist, Jakob Mechler, Per Carlbring, Peter Lilliengren, Fredrik Falkenström, Gerhard Andersson, Robert Johansson, Julian Edbrooke-Childs, Hanne-Sofie J Dahl, Katja Lindert Bergsten, Nick Midgley, Rolf Sandell, Agneta Thorén, Naira Topooco, Randi Ulberg, Björn Philips, Karin Lindqvist, Jakob Mechler, Per Carlbring, Peter Lilliengren, Fredrik Falkenström, Gerhard Andersson, Robert Johansson, Julian Edbrooke-Childs, Hanne-Sofie J Dahl, Katja Lindert Bergsten, Nick Midgley, Rolf Sandell, Agneta Thorén, Naira Topooco, Randi Ulberg, Björn Philips

Abstract

Background: Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments.

Objective: This trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents.

Methods: The trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment.

Results: IPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P<.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P<.001) and increasing emotion regulation (d=0.97, P<.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules.

Conclusions: IPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments.

Trial registration: International Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254.

Keywords: adolescents; depressive disorder; internet-based treatment; mobile phone; psychodynamic; treatment outcome.

Conflict of interest statement

Conflicts of Interest: None declared.

©Karin Lindqvist, Jakob Mechler, Per Carlbring, Peter Lilliengren, Fredrik Falkenström, Gerhard Andersson, Robert Johansson, Julian Edbrooke-Childs, Hanne-Sofie J Dahl, Katja Lindert Bergsten, Nick Midgley, Rolf Sandell, Agneta Thorén, Naira Topooco, Randi Ulberg, Björn Philips. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.03.2020.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) flowchart. IPDT: internet-based psychodynamic therapy; ITT: intention-to-treat.
Figure 2
Figure 2
Malan's (1979) triangle of conflict.
Figure 3
Figure 3
Weekly mean scores on the QIDS-A17-SR (Quick Inventory of Depressive Symptomatology for Adolescents). IPDT: internet-based psychodynamic therapy.

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