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Choosing between Internet-based psychodynamic versus cognitive behavioral therapy for depression: a pilot preference study

Robert Johansson1*, Anna Nyblom1, Per Carlbring2, Pim Cuijpers3 and Gerhard Andersson14

Author Affiliations

1 Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden

2 Department of Psychology, Stockholm University, Stockholm, Sweden

3 Department of Clinical Psychology and EMGO Institute, Vrije Universiteit, Amsterdam, The Netherlands

4 Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden

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BMC Psychiatry 2013, 13:268  doi:10.1186/1471-244X-13-268

Published: 18 October 2013



Major depression is a world-wide problem that can be treated with various forms of psychotherapy. There is strong research support for treating major depression using cognitive behavior therapy delivered in the format of guided self-help via the Internet (ICBT). Recent research also suggests that psychodynamic psychotherapy can be delivered as guided self-help via the Internet (IPDT) and that it seem to be as effective as ICBT for mild to moderate depression. However, no head-to-head comparison between the two treatments exists. In the field of Internet interventions it is largely unexplored if treatment preference affects outcome and adherence.


Participants were allocated to IPDT or ICBT based on their stated preference. More than half of the participants preferred ICBT (N = 30) over IPDT (N = 14). Differences in efficacy between treatments were explored. Correlations between strength of preference and treatment outcome, adherence to treatment and completion of the whole treatment program were explored. Data were collected before and after treatment, as well as in a 7-month follow-up.


During the treatment period, both programs performed equally well in reducing symptoms. More participants who received IPDT completed the entire program. At follow-up, mixed-effects models showed that participants who chose ICBT improved more in terms of quality of life. The ICBT group also had a significant increase in participants who recovered from their depression from post-treatment to follow-up. Exploratory analyses indicated that strength of preference was correlated with adherence to treatment and completion of the whole program, and long-term outcome for the ICBT group.


Few differences were found during the acute treatment phase, but the long-term effects are in favor of ICBT. Strength of preference for treatment seems to have a predictive value. Further research comparing the efficacy of ICBT and IPDT, and the effects of preference matching and strength of preference, is warranted.

Trial registration

This trial is a continuation of the study registered as NCT01324050 at

Depression; Psychodynamic therapy; Cognitive behavioral therapy; Internet-based psychotherapy; Treatment preferences