Robert JohanssonTreating depression and its comorbidity From individualized Internet-delivered cognitive behavior therapy to aect-focused psychodynamic psychotherapy
AbstractDepression is a major health problem which lowers the quality of life for the individual and generates huge costs for society. Comorbidity between depression and anxiety disorders seems to be the rule rather than the exception. Evidence shows that comorbidity has consistently been associated with a poorer prognosis and greater demands for professional help. Prevalence studies show that many individuals with depression lack access to adequate treatment. Delivering psychological treatments through the Internet in the format of guided self-help is an innovative treatment strategy that has the potential to reach a large number of people. A majority of these treatments have been Internetdelivered cognitive behavior therapy (ICBT). The treatments contain structured material and interventions in the form of self-help text and are accompanied with online support from a therapist. The overarching goal of this thesis has been to enhance Internet-delivered psychological treatments for depression and its comorbidity. To this end, three randomized controlled trials (Study II, III and IV) with a total of 313 participants were conducted. A prevalence study (Study I) was also conducted to provide an up-to-date estimate of the prevalence of depression, anxiety disorders, and their comorbidity in the Swedish general population.In Study II, the efficacy of an individualized ICBT intervention that directly targeted depression and comorbid symptoms was tested. The treatment was compared to a standardized ICBT protocol and an active control group in the form of an online discussion group.Recent meta-analyses support the efficacy of psychodynamic psychotherapy in the treatment of depression. An Internet-based treatment protocol for depression, which was based on psychodynamic psychotherapy rather than CBT, was developed. In Study III, the efficacy of that protocol was evaluated in the treatment of depression.Preliminary evidence indicates that a focus on affect experience and expression may enhance psychodynamic therapies. In Study IV, a new Internet-based psychodynamic protocol was developed that had a strong focus on affect. It targeted both depression and anxiety disorders. The efficacy of that treatment was evaluated in a sample with mixed depression and anxiety.Study I showed that more than every sixth individual in Sweden suffers from symptoms of depression and/or anxiety. Comorbidity between depression and anxiety was substantial and associated with higher symptom burden and lower health-related quality of life. Study II showed that the tailored ICBT protocol was effective in reducing symptoms of depression when compared to the control group. Among individuals with more severe depression and comorbidities, the tailored ICBT treatment worked better than standardized ICBT. Study III showed that the psychodynamic Internet-based psychotherapy was highly effect...