Objective: Psychodynamic “talking” therapies have been adapted to be delivered over the internet, with remote guidance from a therapist. The aim of this study is to explore participants’ experiences of change during an internet-delivered psychodynamic psychotherapy (iPDT), with findings discussed in the light of psychodynamic theory. Method: Interviews were conducted with fifteen university students who had taken part in a 10-week therapist-supported iPDT programme for low mood. Data was analysed using Reflexive Thematic Analysis. Results: Participants described several experiences which fit closely with the hypothesized change mechanisms for iPDT, including: increased capacity for self-observation, learning to directly feel and accept difficult emotions, coming to recognize and change maladaptive defences, making sense of how early experiences had contributed to the development of these defences, and experimenting with new ways of relating to others and self. Conclusion: Overall, participants’ experiences of change and self-discovery align with psychodynamic theory. This journey was described by many as an empowering yet challenging process. Trial registration:ClinicalTrials.gov identifier: NCT06133582.

Internet-delivered psychodynamic treatments (IPDT) have a shorter history and smaller research base than those based on CBT, but the number of studies is rapidly growing. This chapter introduces the theoretical background and main principles of those IPDT treatments researched as of yet. Furthermore, it presents an overview of the research base for IPDT for different psychiatric disorders, where IPDT shows promising results for adult depression, adolescent depression, and several anxiety disorders in adulthood, as well as an adjunct treatment for inpatients with mixed disorders. Lastly, the chapter provides an illustrative case example of a treatment process in IPDT for adolescent depression.

Internalizing and externalizing psychiatric disorders among children are common and debilitating, affecting family interactions, learning and peer relations. The aim of the present quasi-randomised pilot-study was to investigate preliminary effects of a mentalization-based time-limited treatment (MBT-C) for children with mixed psychiatric disorders. The trial comprised 17 children, aged 4–11 with mixed disorders, and their parents, admitted to an outpatient psychotherapy clinic. Quasi-randomization allocated patients to 12 sessions MBT-C with parallel parent support, or wait-list control. Compared to wait-list controls, significant improvements were observed in child pathology (d = 1.23, p =.006), therapist-rated global functioning (d = 1.73, p =.002), parent-perceived overall distress and impairment (d = 1.42, p =.017), and child-perceived emotional distress (d = 1.32, p =.024). No significant effects were observed for parent-perceived symptoms (d = 0.41, p =.28). Within-group changes and long-term effects were calculated for all participants including the wait-list after being crossed-over to treatment. Results were either maintained or further improved at 6- and 12-months follow-ups. This trial provides preliminary support for MBT-C in children with mixed disorders.

There is a growing interest in clinical interventions targeting emotion regulation difficulties across mental health conditions. Experiential dynamic therapies (EDTs) are transdiagnostic, affect-focused, short-term psychodynamic therapy models that emphasize in-session emotional processing. This review provides a 10-year update on the efficacy of EDTs for mood, anxiety, personality and somatic symptom disorders in adults and children/adolescents. A comprehensive search identified 57 randomized controlled trials (n = 4330) conducted in Western (k = 38; n = 3178) and non-Western countries (k = 19; n = 1152) between 1978 and 2024. Random-effects meta-analyses on primary outcomes indicated large, significant effects for EDTs compared to inactive controls at post-treatment (Hedge's g = −0.96; k = 41) and follow-up (g = −1.11; k = 20). Compared to active controls, effects were small and non-significant post-treatment (g = −0.17; k = 27) but became significant at follow-up (g = −0.40; k = 19), suggesting a potential modest long-term advantage of EDTs. Despite substantial heterogeneity (I2 > 75%), results remained robust in sensitivity analyses. Moderator analyses revealed few significant findings, indicating relative consistency across diagnostic groups, treatment formats and active comparators. Non-Western and lower quality studies reported larger effects compared to inactive, but not active, controls. While cautious interpretation is warranted due to unexplained heterogeneity, findings support EDTs as efficacious transdiagnostic interventions for emotional disorders, with sustained benefits over time. Future research should prioritize large-scale, methodologically rigorous trials that explore mechanisms of change, optimize treatment delivery and identify moderators of long-term outcomes.

INTRODUCTION: Social Anxiety Disorder (SAD) is a highly prevalent and debilitating disorder. While effective treatments exist, they are not always easily accessible or helpful for all patients. This highlights the need for accessible treatment alternatives. The aim of the STePS study was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist support, compared to a waitlist control condition, in the treatment of adults with SAD. METHODS: In this randomized clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old, scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) without meeting any exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n=60), IPDT without guidance (n=61), or waitlist (n=60). The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptom severity measured weekly by the LSAS-SR. Primary analyses were conducted on an intention-to-treat sample, including all randomly assigned participants. Secondary outcomes included depressive symptoms, generalized anxiety, quality of life, emotion regulation, and defensive functioning. RESULTS: During the conference, results obtained from the study at post-treatment, as well as at 6- and 12-month follow-ups will be presented. CONCLUSION: This is the second RCT to investigate the efficacy of IPDT in the treatment of SAD. If found efficacious, IPDT should be compared to existing evidence-based internet-delivered treatments.

Social Anxiety Disorder (SAD) is highly prevalent and debilitating disorder. Treatments exist but are not accessible and/or helpful for all patients, indicating a need for accessible treatment alternatives. The aim of the present trial was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist guidance, compared to a waitlist control condition, in the treatment of adults with SAD.

In this randomized, clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old and scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) whilst not fulfilling any of the exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n = 60), IPDT without guidance (n = 61), or waitlist (n = 60).

The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptoms severity measured weekly by the LSAS-SR. Primary analyses were calculated on an intention-to-treat sample including all participants randomly assigned. Secondary outcomes were depressive symptoms, generalized anxiety, quality of life, emotion regulation and defensive functioning. At post-treatment, both active treatments were superior to the waitlist condition with guided treatment exhibiting larger between group effects than unguided treatment (d = 1.07 95% CI [0.72, 1.43], p < .001 and d = 0.61, 95% CI [0.25, 0.98], p = .0018) on the LSAS-SR respectively.

Guided IPDT lead to larger improvements than unguided IPDT (d = 0.46, 95% CI [0.11, 0.80], p < .01). At post-treatment, guided IPDT was superior to waitlist on all secondary outcome measures. Unguided IPDT was superior to waitlist on depressive symptoms and general anxiety, but not on emotion regulation, self-compassion or quality of life. Guided IPDT was superior to unguided PDT on depressive symptoms, with a trend towards superiority on a measure of generalized anxiety. At six and twelve month follow-up there were no significant differences between guided and unguided IPDT.

In conclusion, IPDT shows promising effects in the treatment of SAD, with larger benefits from guided IPDT compared to non-guided, at least at post-treatment. This finding increases the range of accessible and effective treatment alternatives for adults suffering from SAD.

The study was prospectively registered at ClinicalTrials (NCT05015166).

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.

INTRODUCTION: Guided self-help based on psychodynamic principles (IPDT) has shown efficacy for adolescent depression and non-inferiority to ICBT. Two randomized controlled trials have shown promising results for IPDT in Social Anxiety Disorder (SAD). There is little known regarding predictors of outcome in IPDT. This presentation focuses on predictors of  outcome in IPDT for SAD. METHODS: In this randomized controlled trial (n = 181), participants were randomized to guided IPDT, unguided IPDT or waitlist. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old, scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) without meeting any exclusion criteria. The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptom severity measured weekly by the LSAS-SR. Baseline measures such as comorbid symptoms of depression, anxiety, self-compassion, emotion regulation and defensive functioning were all tested as potential predictors of outcome. RESULTS: Preliminary findings will be presented at the conference. DISCUSSION: This is the second predictor study on IPDT and the first on IPDT for SAD. Finding predictors of outcome could lead to improved outcomes in terms of matching patients to the most effective treatment given their baseline characteristics.