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

Abstract

Objective: Although 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. Method: The 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. Results: Analyses 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%. Conclusion: The 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.

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

“…The use of techniques traditionally associated with CBT was not predictive of outcome, indicating that IPDT has a different pathway for treatment success compared to ICBT. Furthermore, improvements in emotion regulation have been found to predict subsequent improvements in depressive symptoms as a result of IPDT (Mechler et al, 2020).…”

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

“…It has also been found that increasing the capacity of adaptive emotion regulation acts as a mechanism of change across different psychiatric disorders and through different treatment modalities (Berking et al, 2019;Bjureberg et al, 2018;Wirtz et al, 2014). An increased capacity for affect regulation has also been described as a key focus in affect-focused psychodynamic psychotherapy (Frederickson et al, 2018) and furthermore seem to work as a time-varying predictor of subsequent changes in depression in the internet-based psychodynamic treatment used in this study (Mechler et al, 2020). A study of psychotherapy for women with alcohol use disorder showed that women with low confidence in their capacity to regulate emotions without using alcohol were more inclined to experience SGs after sessions targeting emotion regulation in relation to anxiety and depression (Holzhauer et al, 2017).…”

Therapeutic alliance is calming and curing—The interplay between alliance and emotion regulation as predictors of outcome in Internet-based treatments for adolescent depression.

“…Specifically, maladaptive emotion regulation has been theorized to underlie and maintain several forms of psychological problems. Improvements in emotion regulation have also been found to predict improvement in depressive symptoms in different psychological treatments such as Unified Protocol (Sauer-Zavala et al, 2012), Affect regulation training (Berking et al, 2019), group based CBT (Wirtz et al, 2014), and internet-based PDT (IPDT) for adolescents (Mechler et al, 2020). Remaining problems with emotion regulation have been suggested as a risk factor for relapse in depression after treatment (Visted et al, 2018).…”