At present, three papers have been published reporting results from the first successful study, in which internet-delivered psychodynamic therapy (IPDT) was examined in a randomized controlled trial for youth aged 15-18 with major depressive disorder. This was the first study within the project EaRly internet-based interventions for Children and Adolescents (ERiCA), funded by the Kavli Trust.

A new treatment programme developed at the Department of Psychology

The IPDT programme is developed by the PhD students and licensed psychologists Jakob Mechler and Karin Lindqvist.

The treatment is affect-focused, which means that it focuses on helping the young patients to acknowledge and approach feelings that they regularly avoid, and to recognize problematic recurrent relational patterns and to change them.

The internet-delivered treatment contains self-help material with eight modules of text and films, and also weekly reflective assignments and weekly contact with an internet therapist through text messages and chat sessions.

Björn, Jakob, Karin and Per Photo: Robert Johansson
Björn Philips, Jakob Mechler, Karin Lindqvist and Per Carlbring Photo: Robert Johansson


Principal investigator is Björn Philips, Associate Professor, and other co-researchers from Stockholm University are Per Carlbring, Professor, and Robert Johansson, Associate Professor. The project is carried out in cooperation with researchers from, among others, Linköping University, University of Oslo, and University College London.

Significantly larger effect with IPDT

In the first study of the project, IPDT was compared against internet-delivered brief supportive contact (IBSC) over eight weeks. The results showed that IPDT was significantly more effective in reducing depressive symptoms with a large effect (d=.82). In IPDT 56% of the patients improved in terms of depressive symptoms compared to 25% in the control condition. In addition, IPDT was significantly more effective in reducing anxiety, as well as improving emotion regulation and self-compassion.

The outcome paper is published in the Journal of Medical Internet Research (open access):
doi: 10.2196/18047

Improved emotion regulation

In a second paper from the study, we tested the assumption that improved emotion regulation is a change mechanism in IPDT. One result of the study was that emotion regulation prior to therapy predicted treatment outcome, showing that young patients with relatively larger problems with emotion regulation gained more from IPDT. Further, the results from week to week showed a significant effect of improved emotion regulation on subsequent depressive symptoms. Hence, improved emotion regulation seems to act as a mechanism of change in IPDT as it drives subsequent changes in depression.

This paper is published in Frontiers in Psychiatry (open access):
doi: 10.3389/fpsyt.2020.00671

"Sudden gains"

Jakob, Karin, Per and Björn Photo: Robert Johansson
Photo: Robert Johansson

The third paper from the study investigated the effect of so called 'sudden gains' in IPDT for depressed adolescents. The original definition of ‘sudden gains” postulates that the reduction of symptoms should be at least 25% compared to previous symptom level, and that the improvement should be stable during three sessions after the gain. In our study, it was rather large intersession improvements without the criteria of stability after the gain that should a significant association with better therapy outcome.  Having at least one large intersession improvement was related to better outcome after treatment (d = 0.97) and at follow-up (d = 0.76).

The paper is published in Psychotherapy Research (open access):
doi: 10.1080/10503307.2020.1804084

The second study

The second study in the ERiCA project is ongoing since Autumn 2019 – this is a large randomized controlled trial in which IPDT is compared against internet-delivered cognitive behavioural therapy (ICBT) for adolescents aged 15-19 with major depressive disorder. The ICBT programme was developed and tried by Naira Topooco and Gerhard Andersson (with colleagues) at Linköping University, and they are both co-researchers in the ongoing study.

The research protocol for the study is published in Trials (open access):
doi: 10.1186/s13063-020-04491-z

Now recruiting young people with depression

Autumn of 2020 will be the last semester of recruitment and treatment in the study, with the aim of including at least 270 participants. If you know about young people aged 15-19 struggling with depression (living in Sweden and able to communicate in Swedish) or adults who have contact with this target group, please inform about the study.

More information and online application for the study is on the web page www.erica.nu

Please contact one us for more information, for example posters or folders (in Swedish):

Björn Philips, bjorn.philips@psychology.su.se
Jakob Mechler, jakob.mechler@psychology.su.se
Karin Lindqvist, karin.lindqvist@psychology.su.se