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Affect-focused psychodynamic psychotherapy for depression and anxiety through the Internet: a randomized controlled trial
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
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2013 (English)In: PeerJ, ISSN 2167-8359, Vol. 1, e102- p.Article in journal (Refereed) Published
Abstract [en]

Background. Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base. Research has indicated an association between therapist-facilitated affective experience and outcome in psychodynamic therapy. Affect-phobia therapy (APT), as outlined by McCullough et al., is a psychodynamic treatment that emphasizes a strong focus on expression and experience of affect. This model has neither been evaluated for depression nor anxiety disorders in a randomized controlled trial. While Internet-delivered psychodynamic treatments for depression and generalized anxiety disorder exist, they have not been based on APT. The aim of this randomized controlled trial was to investigate the efficacy of an Internet-based, psychodynamic, guided self-help treatment based on APT for depression and anxiety disorders.

Methods. One hundred participants with diagnoses of mood and anxiety disorders participated in a randomized (1:1 ratio) controlled trial of an active group versus a control condition. The treatment group received a 10-week, psychodynamic, guided self-help treatment based on APT that was delivered through the Internet. The treatment consisted of eight text-based treatment modules and included therapist contact (9.5 min per client and week, on average) in a secure online environment. Participants in the control group also received online therapist support and clinical monitoring of symptoms, but received no treatment modules. Outcome measures were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7). Process measures were also included. All measures were administered weekly during the treatment period and at a 7-month follow-up.

Results. Mixed models analyses using the full intention-to-treat sample revealed significant interaction effects of group and time on all outcome measures, when comparing treatment to the control group. A large between-group effect size of Cohen’s d = 0.77 (95% CI: 0.37–1.18) was found on the PHQ-9 and a moderately large between-group effect size d = 0.48 (95% CI: 0.08–0.87) was found on the GAD-7. The number of patients who recovered (had no diagnoses of depression and anxiety, and had less than 10 on both the PHQ-9 and the GAD-7) were at post-treatment 52% in the treatment group and 24% in the control group. This difference was significant, χ2(N = 100, df = 1) = 8.3, p < .01. From post-treatment to follow-up, treatment gains were maintained on the PHQ-9, and significant improvements were seen on the GAD-7.

Conclusion. This study provides initial support for the efficacy of Internet-delivered psychodynamic therapy based on the affect-phobia model in the treatment of depression and anxiety disorders. The results support the conclusion that psychodynamic treatment approaches may be transferred to the guided self-help format and delivered via the Internet.

Place, publisher, year, edition, pages
2013. Vol. 1, e102- p.
Keyword [en]
Depression, Anxiety, Psychotherapy, Psychodynamic therapy, Internet, Affect, Emotion, Internet-delivered treatments, e-health
National Category
Applied Psychology
URN: urn:nbn:se:liu:diva-96838DOI: 10.7717/peerj.102PubMedID: 23862104OAI: diva2:643544
Available from: 2013-08-27 Created: 2013-08-27 Last updated: 2014-11-28
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.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 596Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 179
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
urn:nbn:se:liu:diva-100385 (URN)10.3384/diss.diva-100385 (DOI)978-91-7519-467-7 (print) (ISBN)
Public defence
2013-12-06, VAL, Hus Vallfarten, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2014-11-28Bibliographically approved

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