Research project EaRly internet-based interventions for Children and Adolescents (ERiCA)
The ERiCA project evaluates internet-delivered affect-focused psychodynamic therapy (IPDT) for adolescent depression in a series of three clinical trials. The project started 2019 with a randomized controlled pilot study, in which I-PDT was compared against internet-delivered brief non-specific supportive contact. The pilot study included 76 adolescents aged 15-18 suffering major depressive disorder. IPDT was superior compared to supportive contact with regard to depressive symptoms, anxiety symptoms, emotion regulation and self-compassion. Process-outcome studies have been published.
The main study of the project was a randomized controlled trial with a non-inferiority design, in which IPDT was compared against internet-delivered cognitive behavioral therapy (ICBT). The study included 272 adolescents aged 15-19 with major depressive disorder, with treatments conducted during the years 2019-2020. Both treatments had a duration of 10 weeks and comprised of self-help material in the form of text, films and homework assignments, as well as therapist support in the form of weekly chat sessions and messages. Primary outcome was self-reported depressive symptoms at post-treatment. Secondary outcomes included anxiety symproms, emotion regulation, self-compassion, and cost-effectiveness.
Outcome results were that IPDT was non-infererior to ICBT and that both treatments had large within-group effects on depression, anxiety, emotion regulation, and self-compassion. The main outcome paper was published in Lancet Digital Health in 2022. The study included weekly measurements of depression, emotion regulation, and alliance, which enabled mediator analyses. One such analysis showed that alliance predicted depressive symptoms the next week, and also that alliance predicted emotion regulation that mediated change in depressive symptoms.
Another goal of the study is to investigate which treatment works for whom (i.e. moderator analyses), based on factors such as attachment style, expectations, and personality traits. The study includes follow-up measurements up to 12 months post-treatment, as well as qualitative interviews post-treatment.
The final study in the project was conducted in 2024, a randomized controlled trial comparing IPDT with therapist feedback to IPDT without therapist feedback for adolescents with depression. Analyses of predictors and treatment outcomes in the non-inferiority study have been used to develop algorithms that provided feedback to therapists on whether a particular participant's course predicts positive or negative outcomes. The same measures were used as in the main study. Analysis and report writing will take place in 2025.