Online Transdiagnostic Emotion Regulation Treatment for Adolescents With Mental Health Problems: A Randomized Clinical Trial

IMPORTANCE Mental health problems are common during adolescence, but access to effective treatments is limited. Transdiagnostic treatments could address this treatment gap, but their feasibility, acceptability, and effectiveness remain unknown. OBJECTIVE To test the feasibility and acceptability of an online emotion regulation treatment for adolescents with mental health problems and investigate the preliminary effects on clinical outcomes and the target mechanism, emotion regulation. DESIGN, SETTING, AND PARTICIPANTS This single-blind randomized clinical trial was conducted between October 16, 2022, and July 28, 2023, in a primary care setting in Sweden. Participants in the intention-to-treat analysis were adolescents aged 12 to 17 years with mental health problems and their parents. INTERVENTION Participants were randomized 1:1 to 6 weeks of therapist-guided online transdiagnostic emotion regulation treatment or an active control condition consisting of 6 weeks of online supportive treatment. MAIN OUTCOMES AND MEASURES The primary outcomes were feasibility and acceptability measures, including consent rate, completion of assessments, adherence, credibility and expectancy ratings (Credibility/Expectancy Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire), immediately after treatment. Clinical outcomes, rated by blinded assessor, included global symptom severity and improvement, symptoms of depression and anxiety, global functioning, and emotion regulation. RESULTS A total of 30 adolescents (mean [SD] age, 14.2 [1.48] years; 28 females [93%]) were randomized to experimental treatment (n = 15) or active control treatment (n = 15). The consent rate (30 of 37 eligible participants [81%]) and rate of assessment completion immediately after treatment (28 [93%]) were high. Adherence, credibility, expectancy, and satisfaction in both groups were adequate. Participation in the experimental condition, but not the control condition, was associated with large within-group reductions in symptom severity (effect size, 1.30; 95% CI, 0.73-1.86) and symptoms of anxiety and depression (Cohen d, 1.07; 95% CI, 0.37-1.84), improved global functioning (Cohen d, 1.26; 95% CI, 0.66-1.85), and reductions in maladaptive cognitive coping (Cohen d, 1.10; 95% CI, 0.52-1.70) immediately after treatment. CONCLUSION AND RELEVANCE In this randomized clinical trial, a brief online transdiagnostic emotion regulation treatment targeting adolescents with mental health problems was found to be feasible, acceptable, and potentially efficacious in primary care and may increase treatment outreach and accessibility for this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05032547

Katja Sjöblom, Katri Frankenstein, Lars Klintwall, Jannike Nilbrink, Maria Zetterqvist, Hugo Hesser, Erik Hedman-Lagerlöf, James J. Gross, Clara Hellner, Martin Bellander, Johan Bjureberg