The aim of the present study was to evaluate the feasibility and analyze preliminary data of the effectiveness of affect phobia therapy (APT) adapted to a structured group format. APT is a treatment that targets emotional avoidance and deficiency in emotion regulation that often leads to psychological dysfunction. The target group was patients with comorbid substance use disorder (SUD) and ADHD with core features of affect phobia/emotion dysregulation. Patients in three group treatments with the aim of having eight participants in each group (n = 22) were included in an open design, where targeted symptoms psychological distress, craving, affect phobia, self-compassion, emotion dysregulation, and substance use were evaluated, with repeated measurements every week from the start of therapy to follow-up 4 weeks after the end of treatment. The results showed an increase in self-compassion and a decrease in affect phobia, but no change in symptoms of psychological distress or emotional dysregulation. No reliable reduction in alcohol or drug use could be related to treatment. Craving fluctuated throughout the study period and patients' drinking patterns changed toward more social drinking. The main finding of the study was that affect phobia therapy in a structured group format is a feasible treatment for the patient group and that the therapy showed preliminary effectiveness in increasing adaptive affective functioning and self-compassion. Future randomized controlled trials are needed for conclusive evidence on efficacy, also examining whether the therapy can help reduce substance use.

Background  Research investigating executive functions in opioid-dependent patients undergoing opioid maintenance treatment (OMT) is scarce. This study aimed to assess executive function in patients with opioid use disorder at treatment initiation and one-year follow-up, exploring its correlation with psychiatric comorbidity within the patient group. Additionally, associations between executive functions and factors such as age at substance use initiation, duration of substance use, and current substance use were explored.

Methods  Forty-nine adults (mean age: 40.6 [11.4]) with opioid use disorder initiating OMT participated in a naturalistic study with a one-year follow up. Participants underwent subtests of the Delis-Kaplan Executive Function System (D-KEFS) and self-assessed their cognitive function using the BRIEF-A form. Psychiatric diagnoses were determined using MINI, while symptoms of personality disorders were assessed using the SCID II screening form. Blood and saliva samples were collected for alcohol and drug markers.

Results  Most participants exhibited impaired Cognitive flexibility (67%), with varying levels of impairment in Verbal fluency and problem-solving functions (25–30%). The majority rated their executive functions as poor. At the one-year follow-up, Verbal fluency had improved (p <.05), but other executive functions remained unchanged. Stimulant use was associated with reduced Verbal fluency and Cognitive flexibility (p <.1). Older age and longer substance use duration correlated with poorer Verbal fluency (p <.05), while earlier onset of substance use correlated with poorer self-reported executive functioning (p <.05) but unexpectedly with better Cognitive flexibility (p <.1). Symptoms of borderline personality disorder was related to poorer self-reported executive functioning (p <.001), symptoms of Narcissistic Personality Disorder was related to poorer Cognitive flexibility (p <.1), and symptoms of Antisocial Personality Disorder was related to better problem-solving (p <.1).

Conclusions  Executive function impairment is common in patients starting OMT, with specific functions more affected. The varied results of correlations between psychiatric comorbidity, substance use, and executive function indicate patient heterogeneity. While some executive functions show slight improvement over time, complex functions appear resistant to change, suggesting lasting damage which may influence treatment outcomes. Overall, patient variability in executive function highlights the need for personalized treatment approaches in OMT.

Objectives: The objective of this study was to explore therapists' new-found experiences of what works in successful cases of teletherapy. Design: This was a qualitative study of therapists' experiences, making their implicit knowledge explicit and systematised. Methods: Twelve therapists were recruited via posts on social media and via the interviewers' professional networks. The therapists were interviewed at their office or via Zoom using a semi-structured interview guide. The interviews were analysed using inductive, reflexive thematic analysis. Results: The therapists described a number of interacting favourable factors, together contributing to successful remote treatments. Establishing a good therapeutic relationship and cooperation was a general success factor common to in-person and remote treatments. Specific factors included well-functioning communication technology, co-creating a sense of co-presence, safeguarding therapeutic boundaries adjusted to the remote setting, finding ways of compensating for the loss of several cues available in an in-person setting and the patient being motivated for a remote therapeutic endeavour. Conclusions: In the successful cases, therapists in this study seem to have developed specific skills to counteract the inherent challenges and to benefit from the advantages specific to the remote setting. In the post-pandemic era, when hybrid and remote therapeutic modalities become increasingly common, these specific skills and mechanisms have to be included in psychotherapy training programmes, supervision and continuing education.

Dear Editor, In the article authored by Juul et al. [1] and recently published in Psychotherapy and Psychosomatics, the authors conducted a randomized trial comparing two treatment lengths of mentalization-based therapy (MBT) for borderline personality disorder (BPD). However, there are some shortcomings in the trial design and the drawn conclusions that deserve further consideration.The treatment the authors call “long-term MBT” had substantially shorter duration and frequency than standard MBT. In the MBT manual for BPD [2], the treatment is scheduled to last 18 months with individual therapy weekly and group therapy weekly, a format which was used in the largest and most well-conducted trial of MBT for BPD [3]. However, “long-term MBT” in the study by Juul et al. [1] lasted 13.5 months with individual therapy every second week and group therapy weekly. Furthermore, patients were absent from many therapy sessions. In “long-term MBT,” patients attended in average 17 individual sessions and 24 group sessions, while patients in short-term MBT attended in average 12 individual sessions and 14 group sessions. In the Bateman and Fonagy [3] study, the mean number of clinical meetings in MBT was 92 (SD = 38). Thus, it would be more appropriate to name the treatments by their actual content, i.e., “6-month MBT versus 13-month MBT.”

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.

Internet-delivered, therapist-guided, self-help programs are novel ways to deliver psychotherapeutic interventions adapted from established therapy models. Such programs can be easily accessed online and may offer an important treatment option for patients who struggle with barriers to seeking out and engaging in face-to-face psychotherapy, including depressed adolescents. While there are evidence-based Internet-delivered self-help programs based on cognitive-behavioral therapies (i.e. ICBT) for adolescent depression, a program based on psychodynamic principles (i.e. IPDT) has so far been lacking. In this article we describe the IPDT program developed within the ERiCA project, which has so far been evaluated in two randomized controlled trials (RCTs). We further provide a case example from one of the trials to illustrate the treatment process and therapeutic interaction in detail. Given the novelty of the approach, we will particularly highlight and discuss how a psychodynamic understanding of adolescent development and depressive dynamics as well as affect-focused treatment principles inform the treatment, including the therapist’s role, tasks, and choice of interventions. The potential implications and utility of IPDT for regular clinical practice are elaborated as well as potential research directions for the future.

Aim: The aim of the TRAbee study was to compare the effectiveness of two transdiagnostic treatment modalities, Unified Protocol (Cognitive Behavior Therapy) and Affect Phobia Therapy (Psychodynamic Psychotherapy), in alleviating psychological distress and to examine the relative differences in the incidence of negative effects as assessed by the Negative Effects Questionnaire.

Methods: This study is a randomized controlled trial with 2,400 participants divided into 12 subgroups based on treatment modality (CBT vs. PDT vs. waitlist), duration (8 or 16 weeks of treatment), and discussion forum access (yes/no). Participants were randomly assigned and measured weekly during treatment, and then at 6, 12, and 24 months. Inclusion criteria were: age 18 years or older, ability to read/write Swedish, access to a smartphone/computer, GAD-7 score ≥5, and/or PHQ-9 score ≥10. Exclusion criteria included: current psychological treatment, recent medication change, severe depression/suicidality. Outcome measures included the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire 9-item scale (PHQ-9), the Personality Inventory for DSM-5 (PID-5), the Reflective Functioning Questionnaire 8-item scale (RFQ- 8), the Negative Effects Questionnaire (NEQ), and the Brunnsviken Brief Quality of Life scale (BBQ).

Results: Follow-up data is still being collected, but preliminary results, including 12-month follow-up, will be available at the ISRII conference. The results will report on the relative differences in the incidence of negative effects between the treatments as assessed by the NEQ scale.

Conclusions: The study will provide insights into the comparative effectiveness of Unified Protocol and Affect Phobia Therapy in addressing psychological disorders in a transdiagnostic manner, as well as shedding light on the differences in negative effects experienced by patients undergoing these treatments. This information may inform future treatment approaches and help to optimize patient outcomes.

Introduction: The shift from in-person therapy to telepsychotherapy during the COVID-19 pandemic was unprepared for, sudden, and inevitable. This study explored patients’ long-term experiences of transitions to telepsychotherapy and back to the office.

Methods: Data were collected approximately two years after the declaration of COVID-19 as a pandemic. Eleven patients were interviewed (nine women and two men, aged 28 to 56, six in psychodynamic psychotherapy, five in CBT). Treatments switched between in-person and video/telephone sessions. Interview transcripts were analyzed applying the qualitative methodology of inductive thematic analysis.

Results: (1) The patients experienced the process in telepsychotherapy as impeded. Interventions were difficult to understand and lost impact. Routines surrounding the therapy sessions were lost. Conversations were less serious and lost direction. (2) Understanding was made more difficult when the nuances of non-verbal communication were lost. (3) The emotional relationship was altered. Remote therapy was perceived as something different from regular therapy, and once back in the therapy room, the patients felt that therapy started anew. The emotional presence was experienced as weakened, but some of the patients found expressing their feelings easier in the absence of bodily co-presence. According to the patients, in-person presence contributed to their security and trust, whereas they felt that the therapists were different when working remotely, behaving in a more easygoing and familiar way, as well as more solution-focused, supportive and unprofessional, less understanding and less therapeutic. Despite this, (4) telepsychotherapy also gave the patients an opportunity to take therapy with them into their everyday lives.

Discussion: The results suggest that in the long run, remote psychotherapy was seen as a good enough alternative when needed. The present study indicates that format alternations have an impact on which interventions can be implemented, which can have important implications for psychotherapy training and supervision in an era when telepsychotherapy is becoming increasingly common.

En ny paraplyöversikt visar att psykodynamisk psykoterapi (PDT) är effektiv behandling vid depression, ångestsyndrom, personlighetssyndrom och funktionella somatiska tillstånd.

Vid sidan av ökad forskning har en betydande metodutveckling skett inom PDT under senaste decennierna.

PDT bör få en utökad plats inom både första linjens psykiatri och specialistpsykiatrin.

Objective: Therapeutic alliance is one of the most stable predictors of outcome in psychotherapy, regardless of theoretical orientation. The alliance–outcome relationship in internet-based treatments has been investigated with mixed results. There is preliminary evidence that emotion regulation can work as a mediator for the alliance–outcome relationship. The present study aimed to investigate whether alliance predicted outcome session by session in two internet-based treatments for adolescent depression, and whether this relationship was mediated by emotion regulation.

Method: Two hundred and seventy-two participants aged 15–19 years and diagnosed with depression were randomized to 10 weeks of internet-based psychodynamic or cognitive behavioral treatment. Both therapists and patients rated the alliance weekly. Patients also rated depressive symptoms and emotion regulation weekly. Analyses were made using cross-lagged panel modeling.

Results: Alliance, as rated by both therapist and patient, predicted depression scores the following week. Emotion regulation rated by the patient also predicted depression scores the following week. Furthermore, alliance scores predicted emotion regulation scores the following week, which in turn predicted depression scores the week after, supporting the hypothesis that alliance influences outcome partly through emotion regulation. There were no group differences in any of these relationships.

Conclusion: Alliance seems to play an important role in internet-based treatments, partly through emotion regulation. Clinicians working with text-based treatments should pay attention to the working alliance.