Addressing Interpersonal Difficulties in Digital Communication in Psychotherapy for Adults With Chronic Depression

Digital communication via messaging applications and social media is central to everyday interactions. It can also reflect dysfunctional interpersonal patterns, which are particularly relevant in chronic depression and are addressed by the cognitive-behavioral analysis system of psychotherapy (CBASP). However, digital interactions remain understudied in psychotherapy. The authors introduced the electronic situational analysis (eSA) intervention to address digital communication in psychotherapy for chronic depression.

Patients with chronic depression were recruited from a university hospital in Germany and received a 10-week CBASP inpatient program with individual and group sessions. Participants could additionally join the eSA intervention, an in-person psychotherapy group that analyzed digital communication by adapting the situational analysis used in CBASP. Depression symptoms and digital communication (i.e., screen time, social media use, digital contacts, and digital conflicts) were assessed at admission and discharge.

Complete data were available for 74 adults. Baseline data showed severe depression symptoms (Beck Depression Inventory-II [BDI-II] score: mean±SD=31.7±10.2). Digital conflicts occurred several times per week for 23% of participants. Forty-four participants opted into the eSA group. Across the sample, decreases occurred in depression symptoms (BDI-II: B=-8.15), social media use (B=-0.19), and digital conflicts (B=-0.16). Compared with non-eSA participants, eSA participants demonstrated greater screen time reductions (B=-116.08, p=0.005). Other outcomes did not differ significantly.

Digital communication difficulties represent prevalent interpersonal problems in chronic depression. The eSA intervention, which was widely adopted, facilitated the integration of patients' digital interactions into psychotherapy. These findings indicate potential therapeutic effects of this intervention, but controlled studies are needed.