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.

Adolescent major depressive disorder (MDD) is a common and debilitating disorder, associated with clinically significant distress and impairment in functioning. A vast array of negative consequences of adolescent MDD have also been found to extend into adulthood. Still, the majority of affected youths do not receive adequate treatment. Internet-delivered interventions address many barriers to treatment, for instance stigma and lack of qualified psychiatric care. However, the most studied internet-delivered treatment, internet-delivered cognitive behavioural therapy (ICBT), leads to clinically meaningful change in somewhat less than 50% of participants. These results indicate the need for treatment alternatives. This thesis consists of three empirical studies examining a newly developed such alternative, internet-delivered psychodynamic treatment (IPDT). Study 1 (n = 272) was a randomised controlled trial, testing whether IPDT was non-inferior to ICBT for depressed adolescents (15–19 years). Results indicated that both treatments were effective, with large within-group effects, and that IPDT was non-inferior to ICBT. No significant differences were noted on primary or secondary outcomes in the intent-to-treat analyses. Study 2 (n = 67) tested emotion regulation as a baseline predictor of rate of change, and whether intra-individual change in emotion regulation was a mechanism of change in IPDT. Results indicated that patients with relatively more severe deficits in emotion regulation had a steeper trajectory towards improvement. Intra-individual changes in emotion regulation also predicted improvements in the subsequent week, indicating that emotion regulation acted as a mechanism of change in IPDT. Study 3 (n = 66) tested whether sudden gains (SGs) and large intersession improvements (LIIs; defined as SGs without demanding symptom stability pre- and post-gain) were associated with superior outcome. LIIs were associated with improved outcome at post-treatment and at follow-up, whilst SGs were not. Overall, the above findings suggest that IPDT is a viable alternative to ICBT for depressed adolescents, that IPDT partly works through increases in emotion regulation and that patients who improve suddenly, between consecutive weeks in IPDT, are more likely to benefit from treatment.

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.