12. October 2022

Evaluating the effect of online treatment for youth with mental health problems

Karolinska Institutet has been awarded a NOK 8 million (771 000 euro) grant from Kavli Trust to study the effect and cost-effectiveness of an intervention called “Primary care Online Emotion-regulation Treatment” (POET) for youth seeking treatment for mental health problems.

Mental health problems in youth are a global problem, causing incalculable suffering in youth and families, harming long-term prospects of youths, and are creating substantial economic costs to society.

“Existing treatments are not fully addressing these problems because they focus on a subset of mental health problems.They are limited in efficacy, and are not provided to most youth in need”, explains Principal Investigator of the project, Assistant Professor Johan Bjureberg at Karolinska Institutet.

Transdiagnostic digital treatments that address mechanisms underlying mental health problems, such as emotion regulation, have been called for to address these problems.

Johan Bjureberg.

Scalable intervention

The overall objective of the project is to build an evidence base for a novel highly scalable transdiagnostic intervention called the Primary care Online Emotion-regulation Treatment (POET) for youth seeking treatment for mental health problems.

The researchers will include 388 boys and girls aged 12-17 years and their parents in a randomized controlled trial comparing a 6-week POET to a 6-week active control condition.

Both interventions will be delivered in blended format combining online therapist-supported treatment modules with a video-link session.

“The primary study aims are to examine the effects of POET vs active control at post-treatment, 3-, and 12-month follow-up on mental health problems, emotion regulation, and to test whether changes in emotion regulation mediates reduction in mental health problems during treatment,” said Bjureberg.

“Secondarily we will evaluate if POET is cost-effective, test if POET is more effective for some individuals than others, and test whether there are detectable effects on distal outcomes 12 to 60 months post treatment”.

According to Bjureberg, the proposed project would be one of the largest transdiagnostic emotion regulation intervention study for youth to date, with a design that will allow the researchers to address some of the most important questions in the field of affective psychology, child and adolescent mental health, and psychiatry research.

Involving patients

Former patients (now young adults) and patient-relatives will be members of the steering group for the study and will provide the project with a user perspective during planning, realization, and dissemination of results.

An advisory board including former patients and clinicians will review all treatment material. Feedback from end users will be continuously integrated in the development of the program including collecting qualitative data on satisfaction and utility experience within the clinical trials.

“The broad long-term goal is also to provide politicians with estimates of cost-effectiveness, provide evidence for whom and under what circumstances the treatment is efficacious, and show how a brief treatment provided in youth may change the trajectory into young adulthood, preventing important adverse outcome,” said Bjureberg.

Thorough process

“It is with great pleasure Kavli Trust has awarded Johan Bjureberg and his team at Karolinska Institutet funding for the POET study. Interventions that can strengthen the mental health of children and young people are one Kavli Trust’s priority areas. By supporting research in the field, we hope to be able to contribute to children and young people having access to knowledge-based, effective treatment,” says General Manager of Kavli Trust, Inger Elise Iversen.

The POET project was chosen as one out of three projects awarded funding from The Kavli Trust Programme for Health Research in 2021, among a total of 43 project proposals.

“This study is very well designed, and it can provide important knowledge about the effect of online emotion-regulation treatment”, said senior advisor in The Kavli Trust Programme on Health Research, Ida Svege.

The health research programme is specially designed to ensure that the research granted financing is based on evidence gaps and that it is relevant to users.

Read more: Reducing avoidable waste in health research

Every year new evidence gaps are selected through a thorough process, starting with a strategic scientific committee carrying out updated searches for systematic reviews in selected databases to identify significant evidence gaps in child and adolescent mental health.

“The committee identified 41 evidence gaps for the 2021 call. Then a user panel that consisted of patients, their carers and relevant health professionals, ranked the evidence gaps,” said Kavli Trust’s programme manager, Jan-Ole Hesselberg.

Then the ten evidence gaps that were ranked highest by the user panel, were included in the call for proposals, meaning that all applicants were encouraged to design studies addressing one or more of these ten evidence gaps.

Read more: 2021 call for proposals and list of the evidence gaps (closed)

The POET will address the evidence gap listed as number 7, “What is the effect of psychological interventions to improve emotion regulation in adolescents?”, angled at therapeutic interventions for children with a mix of emotional and behavioural problems.

Summary of the project

“Primary Care Online Emotion-regulation Treatment (POET)”

Host institution: Karolinska Institutet
Principal investigator: Johan Bjureberg
Collaborating institutions: Linköping University, Sweden, Örebro University, Sweden, Stanford University, CA, USA
Amount: NOK 8 million
Duration: 2022-2027

The project addresses the following evidence gap: 7. What is the effect of psychological interventions to improve emotion regulation in adolescents?

The study will examine the effect of two treatment interventions for mental health problems and emotion regulation, and whether changes in emotion regulation mediates reduction of mental health problems during treatment.

The researchers will include 388 boys and girls aged 12-17 years and their parents in a randomised controlled trial.

The study will compare a six-week transdiagnostic digital treatment given to adolescents and their parents with a digital active control conditioncognitive behavioural therapy.

Both interventions will combine online therapist-supported treatment modules with a video-link session.

The study will hopefully provide answers to important questions about treatment efficacy and mechanisms of change. The long-term goal is to provide estimates of cost-effectiveness, as well as evidence for whom and under what circumstances the treatment is efficacious.

THE RESEARCH TEAM: From left above: Hugo Hesser, James Gross, Katja Sjöblom. From left below: Johan Bjureberg, Erik Hedman Lagerlöf, Maria Zetterqvist. All photos by Stockholm University.