EaRly internet-based interventions for Children and Adolescents (ERiCA)

EaRly internet-based interventions for Children and Adolescents (ERiCA) - Stockholm University (2025)

The ERiCA project started with the development of an internet-delivered psychodynamic treatment (IPDT) for adolescent depression. At this point, the treatment has been tested in two randomized controlled trials. One more trial will be carried out within the project.

The ERiCA project evaluates internet-delivered affect-focused psychodynamic therapy (IPDT) for adolescent depression in a series of three clinical trials. The project started 2019 with a randomized controlled pilot study, in which I-PDT was compared against internet-delivered brief non-specific supportive contact. The pilot study included 76 adolescents aged 15-18 suffering major depressive disorder. IPDT was superior compared to supportive contact with regard to depressive symptoms, anxiety symptoms, emotion regulation and self-compassion. Process-outcome studies have been published.

Project description

The main study of the project was a randomized controlled trial with a non-inferiority design, in which IPDT was compared against internet-delivered cognitive behavioral therapy (ICBT). The study included 272 adolescents aged 15-19 with major depressive disorder, with treatments conducted during the years 2019-2020. Both treatments had a duration of 10 weeks and comprised of self-help material in the form of text, films and homework assignments, as well as therapist support in the form of weekly chat sessions and messages. Primary outcome was self-reported depressive symptoms at post-treatment. Secondary outcomes included anxiety symproms, emotion regulation, self-compassion, and cost-effectiveness.

Outcome results were that IPDT was non-infererior to ICBT and that both treatments had large within-group effects on depression, anxiety, emotion regulation, and self-compassion. The main outcome paper was published in Lancet Digital Health in 2022. The study included weekly measurements of depression, emotion regulation, and alliance, which enabled mediator analyses. One such analysis showed that alliance predicted depressive symptoms the next week, and also that alliance predicted emotion regulation that mediated change in depressive symptoms.

Another goal of the study is to investigate which treatment works for whom (i.e. moderator analyses), based on factors such as attachment style, expectations, and personality traits. The study includes follow-up measurements up to 12 months post-treatment, as well as qualitative interviews post-treatment.

The last planned study within the project, in 2024, will be a randomized controlled trial of IPDT with feedback to therapists compared against IPDT without feedback to therapists, for adoiescent depression. Analyses of predictors and change trajectories in the non-inferiority trial will be used for developing algoritms which will the basis for feedback to therapists whether a certain participant’s change trajectory predicts positive or negative outcome. The same measures will be used as in the non-inferiority trial.

Project members

Project managers

Björn Philips

Professor

Department of Psychology

08-16 20 10

bjorn.philips@psychology.su.se

See profile page for Björn Philips

Members

Gerhard Andersson

Professor

Linköping University

gerhard.andersson@liu.se

Publications

Journal of Infant, Child, and Adolescent Psychotherapy, online 26 April 2024

Internet-Delivered Affect-Focused Psychodynamic Therapy for Adolescent Depression: Treatment Principles and Clinical Application in the ERiCA Project.

Journal of Consulting and Clinical Psychology, 91(7), 426–437

Therapeutic Alliance Is Calming and Curing—The Interplay Between Alliance and Emotion Regulation as Predictors of Outcome in Internet-Based Treatments for Adolescent Depression.

The Lancet - Digital Health, 4(8), E594-E603

Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial.

Internet Interventions, 30:100592

“Good job!”: Therapists' encouragement, affirmation, and personal address in internet-based cognitive behavior therapy for adolescents with depression.

Psychotherapy Research, online 6 December 2022

“I didn’t have to look her in the eyes”—participants’ experiences of the therapeutic relationship in internet-based psychodynamic therapy for adolescent depression.

Journal Of Medical Internet Research, 22(3): e18047

Affect-focused psychodynamic internet-based therapy for adolescent depression: randomized controlled trial.

Trials, 21: 587

Internet-based psychodynamic versus cognitive behaviour therapy for adolescents with depression: study protocol for a non-inferiority randomized controlled trial (the ERiCA study).

Psychotherapy Research, 31, 455-467

Sudden gains and large intersession improvements in internet-based psychodynamic treatment (IPDT) for depressed adolescents.

Frontiers in Psychiatry, 11: 671

Emotion regulation as a time-invariant and time-varying covariate predicts outcome in an internet-based psychodynamic treatment targeting adolescent depression.