New effective internet-based treatment for adolescent depression

A new study from Stockholm University shows that a new internet-based psychodynamic therapy (IPDT) is as effective as the already evidence-based internet-based cognitive behavioral therapy (ICBT) as a treatment method for teenage depression. The study is funded by The Kavli Trust Programme on Health Research.

In an article published in the scientific journal Lancet Digital Health, the researchers describe promising results.

“The most important finding is that internet-based PDG treatment reduces symptoms of depression to the same extent as CBT treatment,” says PhD student at Stockholm University and the main author of the article, Jakob Mechler.

“This is encouraging, as it means that we now have more treatment options to offer a group in real need of easily accessible help,” says Mechler.

“It is likely that different patients will need different treatments. Both methods seem to have an effect on other issues than depression as well, such as comorbid anxiety, self compassion and emotion regulation. It is crucial since many of those suffering from depression also suffer from comorbidities.

Equally effective interventions

The researchers have compared internet-based psychodynamic therapy (IPDT) with internet-based cognitive behavioral therapy (ICBT) as treatment methods for adolescent depression.

The study involved 272 adolescents aged 15–19 years diagnosed with depression. Half of them were treated with ICBT and the other half with IPDT.

The results showed that the two treatments had an equal and good effect on young people with depression.

This is the first major study comparing ICBT with IPDT, and it is one of three studies in the comprehensive research project ERiCA.

A need for treatment alternatives

“ICBT is a common treatment proven to be effective for many people with depression. However, a significant number of patients do not improve with ICBT, and there is a need for treatment alternatives,” explains Bjørn Philips, Associate Professor of psychology at Stockholms University.

He is head of the ERiCA project, and research lead of the international team conducting the study in cooperation with researchers at University of Linköping, University College London and University of Oslo.

The ERICA project has also conducted another randomised controlled study of the same IPDT with good effect on adolescents with depression.

Should be of interest for the healthcare system

Now the researchers hope that the treatment will be offered by the healthcare system so that it can help young people with depression and their families.

“The project has carried out two randomised controlled trials that both show a good effect of IPDT. That should be of interest for the healthcare services in youth psychiatry,” says Philips.

At the same time, there is a need for more research to improve the treatment options for young people with depression.

“We hope that further research by us as well as others will lead to more knowledge about what treatment can help different people/persons. We also aim to develop IPDT for young people with other mental disorders and evaluate the effect of these treatments,” says Philips.

“As a start, the most suitable strategy will be to conduct a few implementation studies in different countries, so that we can evaluate the results of when the treatment is used in ordinary healthcare services.

Applicable in other countries

The IPDT can be applied in other countries than Sweden as well.

“With the funding from Kavli Trust, the IPDT programme is already translated into Norwegian and English,” says Philips.

Research is carried out to investigate the effect of the treatment for young people in the different countries.

“There are also plans of translating the IPDT programme into German and to test it in a study for German young people with depression.”

Intensiv og lærerik prosess

Studien har et budsjett på til sammen 10,5 millioner kroner, hvorav Kavlifondet bidrar med 5,2 millioner kroner.

Psykolog og doktorstipendiat i klinisk psykologi ved Stockholms Universitet, Karin Lindqvist, er medforfatter av forskningsartikkelen. Hun beskriver prosessen som intensiv og svært lærerik.

– Interessen var stor og vi ble overrasket over hvor mange ungdommer som meldte seg og viste interesse for denne typen behandling, sier hun.

– Det var mye arbeid knyttet til å bedømme alle ungdommene som meldte seg, og også sikre at ungdommer som hadde alvorlige problemer ble videresendt til den riktige hjelpen, legger hun til.

– Arbeidsmengden med å rekruttere, lære opp og følge opp alle terapeutene har også vært stor, men veldig gøy. Det har vært inspirerende å arbeide med psykologstudenter fra flere av Sveriges psykologistudier. De har vært veldig dyktige og vi har lært mye i prosessen, sier Lindqvist.

I motsetning til mange andre som var avhengig av fysiske møter, behøvde ikke forskerne å utsette studien sin.

– Hele studien foregikk jo over nettet, sier Lindqvist.

Hun understreker at interessen for nettbasert behandling økte under og etter pandemien.

– Mange ble tvunget til å omstille seg og ha møter på nettet under pandemien, og mange som tidligere hadde vært skeptisk så plutselig nye muligheter for å kunne drive med behandling i flere ulike formater. På grunn av nedstengingen var behovet også stort for behandlinger hvor ungdommene kunne delta hjemmefra, sier hun.

Funding through The Kavli Trust Programme for Health Research

The study has a budget of NOK 10.5 million in total. With an allocation of NOK 5.2 million, Kavli Trust has contributed approximately half.

The funding was awarded in 2018, through The Kavli Trust Programme for Health Research.

Intensive and very educational

PhD student at Stockholm University, Karin Lindqvist, is co-author of the research article. She describes the process as intensive and very educational.

“The interest was great and we were surprised by how many young people signed up and showed an interest in this type of treatment,” she says.

“There was a lot of work involved in assessing all the young people who signed up, and also ensuring that young people who had serious problems were referred to the right help service,” she adds.

“The workload of recruiting, training and following up all the therapists has also been huge, but great fun as well. It has been inspiring to work with psychology students from several of Sweden’s psychology studies. They have been very skilled and we have learned a lot in the process,” says Lindqvist.

Great need for treatments

Unlike many others that depended on physical meetings, the researchers did not have to postpone their study.

“The entire study took place on the internet,” says Lindqvist.

She emphasizes that interest in online treatment increased during and after the pandemic.

“Many were forced to readjust and do meetings online during the pandemic, and many who had been skeptical before, suddenly discovered new opportunities to be able to run treatment in several different formats. Due to lockdowns, there was also a great need for treatments where the young people could participate from home,” she says.

“It is encouraging that more people can get treatment that works.”

A major milestone

“We congratulate Björn Philips and his team on publishing the main article from the ERiCA study. The increase mental health related problems in children and young people is a global phenomenon. It has been urgent for a long time to provide more effective help services. The results of this study are therefore very encouraging,” says General Manager of Kavli Trust, Inger Elise Iversen.

“This is a major milestone for the researchers and the study, but also for The Kavli Trust Programme on Health Research. Contributing to strengthening the mental health of children and young people is a main priority for Kavli Trust,” says Iversen.

“It is encouraging to see that funds from the health programme contribute to knowledge that can give more children and young people access to a treatment that works for them,” says Iversen.

The difference between CBT and PDT:

CBT and PDT are two different schools in psychology where the method of treatment also differs.

• CBT – Cognitive Behavioral Therapy – assumes that it is possible to influence and change thoughts, behavior and emotions. The therapy encourages you to change your thought processes and identify behaviors that contribute to depression in order to increase the actions that contribute to well-being.
• PDT – Psychodynamic Therapy – emphasizes the importance of the background of mental symptoms in unconscious emotions and thoughts. In therapy, you process past experiences, and feelings you have avoided, in order to understand yourself better or to break recurring negative relationship patterns.
• Internet-based CBT treatments are offered by most regions in Sweden.