Affect-focused psychodynamic psychotherapy for depression and anxiety through the Internet: a randomized controlled trial

Abstract

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, d f = 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.

Using the Internet to Provide Psychodynamic Psychotherapy

“…The affect-focused treatment used could be placed in a class of psychodynamic treatments called Experiential Dynamic Therapies (Osimo & Stein, 2012). The present article complements the recently published Johansson et al (2013) controlled trial with a detailed description of the treatment, practical examples, and case excerpts.…”

“…These two studies were the first to provide evidence that psychodynamic psychotherapy delivered through the Internet could be effective. Third, the most recent development, was a treatment study in which an affect-focused, psychodynamic intervention was tested on mixed groups of people with depression and anxiety disorders (Johansson et al, 2013). In that study, the treatment was shown to have a large effect on depression and a moderately large effect on anxiety, when compared to a control group who received nonspecific online support.…”

“…This article provides a detailed description of the practical work of conducting psychodynamic psychotherapy through the Internet and is a complement to a previously published, randomized controlled trial (Johansson et al, 2013). Our aim here is threefold: 1.…”

“…To illustrate the practical work of psychodynamic therapy in the form of guided selfhelp through the Internet; 2. To further describe the treatment manual used in the Johansson et al (2013) trial; and 3. To discuss similarities and differences between Internet-delivered and face-to-face psychodynamic therapy.…”

Therapeutic alliance and different treatment formats when delivering internet-based CBT for depression

“…Even though ICBT is the most studied method, there are also studies showing that other orientations such as psychodynamic (Johansson, Björklund, Hornborg, Karlsson, Hesser, Ljótsson, et al, 2013a) and interpersonal therapy (Donker et al, 2013) can be effective internet-based treatment methods for treating depression.…”