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Psychodynamic Guided Self-Help for Adult Depression through the Internet: A Randomised Controlled Trial
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. (Internet, hälsa och klinisk psykologi)
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
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2012 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 5, e38021- p.Article in journal (Refereed) Published
Abstract [en]

Background and aims

Psychodynamic psychotherapy (PDT) is an effective treatment for major depressive disorder (MDD), but not all clients with MDD can receive psychotherapy. Using the Internet to provide psychodynamic treatments is one way of improving access to psychological treatments for MDD. The aim of this randomised controlled trial was to investigate the efficacy of an Internet-based psychodynamic guided self-help treatment for MDD.

Methods

Ninety-two participants who were diagnosed with MDD according to the Mini-International Neuropsychiatric Interview were randomised to treatment or an active control. The treatment consisted of nine treatment modules based on psychodynamic principles with online therapist contact. The active control condition was a structured support intervention and contained psychoeducation and scheduled weekly contacts online. Both interventions lasted for 10 weeks. The primary outcome measure was the Beck Depression Inventory-II (BDI-II).

Results

Mixed-effects model analyses of all randomised participants showed that participants receiving Internet-based PDT made large and superior improvements compared with the active control group on the BDI-II (between-group Cohen's d = 1.11). Treatment effects were maintained at a 10-month follow-up.

Conclusions

Internet-based psychodynamic guided self-help is an efficacious treatment for MDD that has the potential to increase accessibility and availability of PDT for MDD.

Place, publisher, year, edition, pages
2012. Vol. 7, no 5, e38021- p.
National Category
Psychology Psychiatry
Identifiers
URN: urn:nbn:se:liu:diva-77847DOI: 10.1371/journal.pone.0038021ISI: 000305349600055OAI: oai:DiVA.org:liu-77847DiVA: diva2:529666
Note

http://dx.plos.org/10.1371/journal.pone.0038021

Available from: 2012-05-31 Created: 2012-05-31 Last updated: 2017-12-07
In thesis
1. Treating depression and its comorbidity: From individualized Internet-delivered cognitive behavior therapy to affect-focused psychodynamic psychotherapy
Open this publication in new window or tab >>Treating depression and its comorbidity: From individualized Internet-delivered cognitive behavior therapy to affect-focused psychodynamic psychotherapy
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att behandla depression och dess komorbiditet : Från individanpassad internetbaserad kognitiv beteendeterapi till affektfokuserad psykodynamisk psykoterapi
Abstract [en]

The overarching goal of this thesis has been to enhance Internet-delivered psychological treatments for depression and its comorbidity. To this end, three randomized controlled trials (Study II, III and IV) with a total of 313 participants were conducted. A prevalence study (Study I) was also conducted to provide an up-to-date estimate of the prevalence of depression, anxiety disorders, and their comorbidity in the Swedish general population.

Study I showed that more than every sixth individual in Sweden suffers from symptoms of depression and/or anxiety. Comorbidity between depression and anxiety was substantial and associated with higher symptom burden and lower health-related quality of life. Study II showed that a tailored Internet-based CBT protocol (ICBT) was effective in reducing symptoms of depression when compared to a control group. Among individuals with more severe depression and comorbidities, the tailored ICBT treatment worked better than standardized ICBT. Study III showed that a psychodynamic Internet-based psychotherapy was highly effective in the treatment of depression, when compared to a group who received psychoeducation and online support. In Study IV, an Internet-delivered affect-focused psychodynamic psychotherapy proved to have a large effect on depression and a moderately large effect on anxiety disorders.

In conclusion, this thesis shows that in the context of treating depression and its comorbidity, Internet-delivered psychological treatments can be potentially enhanced by psychodynamic psychotherapy and by individualization.

Abstract [sv]

Det övergripande syftet med denna avhandling har varit att vidareutveckla internetbaserad psykologisk behandling för depression och dess komorbiditet. Tre randomiserade kontrollerade studier (Studie II, III och IV) med totalt 313 deltagare genomfördes i linje med detta syfte. En prevalensstudie (Studie I) genomfördes också för att tillhandahålla ett uppdaterat estimat av prevalensen av depression, ångest och deras komorbiditet i Sverige.

Studie I visade att mer än var sjätte individ i Sverige lider av symptom på depression och/eller ångest. Det fanns påtaglig komorbiditet mellan depression och ångest, vilket var associerat med högre symptombörda och lägre livskvalitét. Studie II visade att en skräddarsydd internetbaserad KBT-behandling var effektiv för att reducera symptom på depression, i jämförelse med en kontrollgrupp. Bland individer med svårare depression och komorbiditet, fungerade den skräddarsydda interventionen bättre än en standardiserad. Studie III visade att psykodynamisk internetbehandling var effektiv vid behandling av depression, i jämförelse med en grupp som fick psykoedukation och stödsamtal online. I Studie IV visades att en affektfokuserad psykodynamisk internetbehandling hade stor effekt vad gällde att reducera symptom på depression, och medelstor effekt vad gällde att reducera symptom på ångest.

Sammanfattningsvis visar denna avhandling att internetbaserad psykologisk behandling kan potentiellt vidareutvecklas av psykodynamisk psykoterapi och individanpassning, vid behandling av depression och dess komorbiditet.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 104 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 596Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 179
Keyword
Depression, comorbidity, psychological treatment, psychotherapy, Internet, Internet-delivered treatment, cognitive behavior therapy, psychodynamic psychotherapy, Depression, komorbiditet, psykologisk behandling, psykoterapi, Internet, internetbaserad behandling, kognitiv beteendeterapi, psykodynamisk psykoterapi
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-100385 (URN)10.3384/diss.diva-100385 (DOI)978-91-7519-467-7 (ISBN)
Public defence
2013-12-06, VAL, Hus Vallfarten, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2014-11-28Bibliographically approved

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