Emotion Regulation as a Time-Invariant and Time-Varying Covariate Predicts Outcome in an Internet-Based Psychodynamic Treatment Targeting Adolescent Depression.

Jakob Mechler,Gerhard Andersson,Per Carlbring,Fredrik Falkenström,Karin Lindqvist,Björn Philips

doi:10.3389/fpsyt.2020.00671

Jakob Mechler, Gerhard Andersson + Show 4 more

Open Access

https://doi.org/10.3389/fpsyt.2020.00671

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Abstract

ObjectiveAlthough psychodynamic psychotherapy is efficacious in the treatment of depression, research on mechanisms of change is still scarce. The aim of this study was to investigate if and how emotion regulation affects outcome both as a time-invariant and a lagged time-varying predictor.MethodThe sample consisted of 67 adolescents diagnosed with major depressive disorder, attending affect-focused psychodynamic internet-based treatment (IPDT). Linear mixed models were used to analyze emotion regulation as a baseline predictor and to assess the effect of within-person changes in emotion regulation on depression.ResultsAnalyses suggested that emotion regulation at baseline was a significant predictor of outcome, where participants with relatively larger emotion regulation deficits gained more from IPDT. Further, the results showed a significant effect of improved emotion regulation on subsequent depressive symptomatology. When not controlling for time, increased emotion regulation explained 41.23% of the variance in subsequent symptoms of depression. When detrending the results were still significant, but the amount of explained variance was reduced to 8.7%.ConclusionThe findings suggest that patients with relatively larger deficits in emotion regulation gain more from IPDT. Decreased emotion regulation deficits seem to act as a mechanism of change in IPDT as it drives subsequent changes in depression.Clinical Trial RegistrationInternational Standard Randomised Controlled Trial Number (ISRCTN) 16206254, https://doi.org/10.1186/ISRCTN16206254.

Highlights

Depression is the fourth leading cause of illness and disability among young people aged 15–19 years [1]
Analyses suggested that emotion regulation at baseline was a significant predictor of outcome, where participants with relatively larger emotion regulation deficits gained more from internet-based psychodynamic psychotherapy (IPDT)
Internet-based cognitive behavioral therapy (ICBT) generally seems to perform on par with traditional face-to-face treatment delivered individually or in group [6], but to our knowledge no such head-to-head comparisons exist in the treatment of adolescent psychopathology

Summary

Introduction

Depression is the fourth leading cause of illness and disability among young people aged 15–19 years [1]. Depression rates increase dramatically from childhood to adolescence [2], and many individuals will not receive any treatment for their condition [3, 4]. There is a pressing need for accessible as well as cost- and time-efficient treatments for adolescent depression. One recent response to this need is the development and evaluation of internet-based treatments, which have the potential to reach and treat a larger number of patients [5]. Internet-based cognitive behavioral therapy (ICBT) generally seems to perform on par with traditional face-to-face treatment delivered individually or in group [6], but to our knowledge no such head-to-head comparisons exist in the treatment of adolescent psychopathology. Internet-based treatment for adolescent depression has been found effective when based on both ICBT [7, 8] and IPDT [9]. Little is known about the mechanisms of change in these treatments

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