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Lindqvist K, Mechler J, Midgley N, Carlbring P, Carstorp K, Neikter HK, Strid F, Von Below C, Philips B. "I didn't have to look her in the eyes"-participants' experiences of the therapeutic relationship in internet-based psychodynamic therapy for adolescent depression. Psychother Res 2024; 34:648-662. [PMID: 36473231 DOI: 10.1080/10503307.2022.2150583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: To explore young people's perceptions of the relationship with the therapist in internet-based psychodynamic treatment for adolescent depression.Method: As a part of a randomized controlled trial, 18 adolescents aged 15-19 were interviewed after participating in treatment. Interviews followed a semi-structured interview schedule and were analyzed using thematic analysis.Results: The findings are reported around four main themes: "a meaningful and significant relationship with someone who cared", "a helping relationship with someone who guided and motivated me through therapy"; "a relationship made safer and more open by the fact that we didn't have to meet" and "a nonsignificant relationship with someone I didn't really know and who didn't know me".Conclusion: Even when contact is entirely text-based, it is possible to form a close and significant relationship with a therapist in internet-based psychodynamic treatment. Clinicians need to monitor the relationship and seek to repair ruptures when they emerge.Trial registration: ISRCTN.org identifier: ISRCTN16206254..
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Affiliation(s)
- Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud Centre / University College London, UK
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | | | - Fredrik Strid
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Seon Q, Mady N, Yang M, Karia M, Lashley M, Sescu C, Lalonde M, Puskas S, Outerbridge J, Parent-Racine E, Pagiatakis C, Gomez-Cardona L, Jiang D, Bouchard S, Linnaranta O. A Virtual Reality-Assisted Cognitive Behavioral Therapy for and With Inuit in Québec: Protocol for a Proof-of-Concept Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e40236. [PMID: 37223973 PMCID: PMC10248771 DOI: 10.2196/40236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/19/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emotion regulation is an ability related to psychological well-being; when dysregulated, individuals may have psychiatric symptoms and maladapted physiological responses. Virtual reality-assisted cognitive behavioral therapy (VR-CBT) is an effective psychotherapy to target and strengthen emotion regulation; however, it currently lacks cultural sensitivity and can be improved by adapting it to the cultural context of service users. During previous participatory research, we co-designed a culturally adapted cognitive behavioral therapy (CBT) manual and 2 virtual reality (VR) environments to function as a complement to therapy (VR-CBT) for Inuit who would like to access psychotherapy. Emotion regulation skill building will occur in virtual environments that have interactive components such as heart rate biofeedback. OBJECTIVE We describe a protocol for a proof-of-concept 2-arm randomized controlled trial (RCT) with Inuit (n=40) in Québec. The primary aims of this research are to investigate the feasibility, benefits, and challenges of the culturally adapted VR-CBT intervention versus an established VR self-management that is available commercially. We will also investigate self-rated mental well-being and objective psychophysiological measures. Finally, we will use proof-of-concept data to identify suitable primary outcome measures, conduct power calculations in a larger trial for efficacy, and collect information about preferences for on-site or at-home treatment. METHODS Trial participants will be randomly assigned to an active condition or active control condition in a 1:1 ratio. Inuit aged 14 to 60 years will receive a culturally adapted and therapist-guided VR-CBT with biofeedback or a VR relaxation program with nonpersonalized guided components over a 10-week period. We will collect pre- and posttreatment measures of emotion regulation and biweekly assessments over the treatment and at 3-month follow-up. The primary outcome will be measured by the Difficulties in Emotion Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological symptoms and well-being via rating scales (eg, anxiety or depressive symptoms). RESULTS As this is the prospective registration of an RCT protocol, we do not yet report any results from the trial. Funding was confirmed in January 2020, and recruitment is expected to start in March 2023 and is set to finish in August 2025. The expected results are to be published in spring 2026. CONCLUSIONS The proposed study responds to the community's desire for accessible and appropriate resources for psychological well-being, as it was developed in active collaboration with the Inuit community in Québec. We will test feasibility and acceptance by comparing a culturally adapted, on-site psychotherapy with a commercial self-management program while incorporating novel technology and measurement in the area of Indigenous health. We also aim to fulfill the needs for RCT evidence of culturally adapted psychotherapies that are lacking in Canada. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 21831510; https://www.isrctn.com/ISRCTN21831510. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40236.
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Affiliation(s)
- Quinta Seon
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Noor Mady
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michelle Yang
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Maharshee Karia
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Myrna Lashley
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | | | | | | | | | | | | | - Di Jiang
- National Research Council, Montreal, QC, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Outaouais, QC, Canada
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Leibovich L, Mechler J, Lindqvist K, Mortimer R, Edbrooke-Childs J, Midgley N. Unpacking the active ingredients of internet-based psychodynamic therapy for adolescents. Psychother Res 2023; 33:108-117. [PMID: 35297746 DOI: 10.1080/10503307.2022.2050829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Internet-based psychodynamic psychotherapy (iPDT) for adolescents has been found to be effective for treating depression, but not much is known about its active ingredients. OBJECTIVE To explore the techniques used in chat sessions in an iPDT program for depressed adolescents, and to investigate whether they predicted improvement in depression symptoms. METHOD The study uses data collected from a pilot study. The iPDT consisted of 8 modules delivered over 10 weeks that included text, video, exercises, and a weekly text-based chat session with a therapeutic support worker (TSW). The participants were 23 adolescents meeting criteria for depression. The TSWs were 9 psychology master's students. A depression inventory QIDS-A17-SR was filled weekly by the participants, and a self-rated techniques inventory (MULTI-30) was filled by the TSWs after each chat session. RESULTS Common factor techniques were the most widely used techniques in the chat sessions. Both common factors and psychodynamic techniques predicted improvement in depression, with psychodynamic techniques predicting improvement at the following week. CBT techniques were also used but did not predict improvement in depression. CONCLUSION iPDT seem to work in line with theory, where the mechanisms thought to be important for change in treatment were predictive of outcome.
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Affiliation(s)
- Liat Leibovich
- The Clinical Psychology Program, Ruppin Academic Center, Emek-Hefer, Israel
| | - Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Rose Mortimer
- The Anna Freud National Centre for Children and Families, London, UK
| | | | - Nick Midgley
- The Anna Freud National Centre for Children and Families, London, UK
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Maroti D, Hallberg H, Lindqvist K, Mechler J. Using psychodynamic principles in guided internet-delivered therapy (IPDT). PSYCHOANALYTIC PSYCHOTHERAPY 2022. [DOI: 10.1080/02668734.2022.2124441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Affiliation(s)
- Daniel Maroti
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Henrik Hallberg
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Hua Z, Ma D. Depression and Perceived Social Support among Unemployed Youths in China: Investigating the Roles of Emotion-Regulation Difficulties and Self-Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4676. [PMID: 35457545 PMCID: PMC9029286 DOI: 10.3390/ijerph19084676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 12/26/2022]
Abstract
In recent years, the issue of youth unemployment has begun to emerge in China. Unemployed young people are at high risk of depression and other mental health problems. The present study investigates influential factors related to depression and examines the possible mediating effects of difficulties in emotion regulation and self-efficacy between perceived social support and depressive symptoms among unemployed youths in China. Through community recruitment, 511 unemployed young people from Shanghai participated in this cross-sectional survey. The results demonstrate that the prevalence of probable depression in the sample was 49.3% (95% CI: 45.0-53.7%). Moreover, we found that both the perceived social support and self-efficacy were significant negative predictors of depression, whereas difficulties in emotion regulation were positive predictors of depression. In addition, the analysis results indicate that difficulties in emotion regulation and self-efficacy partially mediate the relationship between perceived social support and depression. Overall, this cross-sectional study reveals that depression and mental health problems among China's unemployed youths are concerning while identifying emotion-regulation difficulties as a risk factor for these and social support and self-efficacy as protective factors, all of which warrant our attention in preventing and intervening with cases of youth depression.
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Affiliation(s)
- Zhiya Hua
- School of Government, Shanghai University of Political Science and Law, Shanghai 201701, China
| | - Dandan Ma
- School of Sociology and Political Science, Shanghai University, Shanghai 200444, China;
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Mechler J, Lindqvist K, Falkenström F, Carlbring P, Andersson G, Philips B. Sudden gains and large intersession improvements in internet-based psychodynamic treatment (IPDT) for depressed adolescents. Psychother Res 2020; 31:455-467. [PMID: 32799772 DOI: 10.1080/10503307.2020.1804084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: Sudden gains (SGs) have often been found associated with better treatment outcome across different psychiatric disorders. However, no studies have evaluated SGs in internet-based treatment targeting adolescent depression. Method: The sample consisted of 66 adolescents diagnosed with major depressive disorder, attending psychodynamic internet-based treatment. Effects of SGs were evaluated at posttreatment and 6-month follow-up. We also evaluated effects of large intersession improvements (LIIs; sudden and relatively large gains, between sessions, without the stability criterion). Effects of SGs and LIIs early in treatment were also investigated. Results: A total of 17 patients (25.75%) experienced an SG. The effect of having an SG or early SG was non-significant after treatment (d = 0.48) and at follow-up (d = 0.66). However, having an LII was related to better outcome after treatment (d = 0.97) and at follow-up (d = 0.76). Early LIIs were associated with significantly better results at end of treatment (d = 0.72). Conclusions: The original criteria of SGs might be overly conservative and thus miss important improvements in depression. Relatively large intersession gains, regardless of stability, seem to be predictive of outcome.
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Affiliation(s)
- Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
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