Department of Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestr. 14/17, 8050 Zürich, Switzerland.
BMC Psychiatry. 2011 Dec 6;11:189. doi: 10.1186/1471-244X-11-189.
BACKGROUND: Although numerous efficacy studies in recent years have found internet-based interventions for depression to be effective, there has been scant consideration of therapeutic process factors in the online setting. In face-to face therapy, the quality of the working alliance explains variance in treatment outcome. However, little is yet known about the impact of the working alliance in internet-based interventions, particularly as compared with face-to-face therapy. METHODS: This study explored the working alliance between client and therapist in the middle and at the end of a cognitive-behavioral intervention for depression. The participants were randomized to an internet-based treatment group (n = 25) or face-to-face group (n = 28). Both groups received the same cognitive behavioral therapy over an 8-week timeframe. Participants completed the Beck Depression Inventory (BDI) post-treatment and the Working Alliance Inventory at mid- and post- treatment. Therapists completed the therapist version of the Working Alliance Inventory at post-treatment. RESULTS: With the exception of therapists' ratings of the tasks subscale, which were significantly higher in the online group, the two groups' ratings of the working alliance did not differ significantly. Further, significant correlations were found between clients' ratings of the working alliance and therapy outcome at post-treatment in the online group and at both mid- and post-treatment in the face-to-face group. Correlation analysis revealed that the working alliance ratings did not significantly predict the BDI residual gain score in either group. CONCLUSIONS: Contrary to what might have been expected, the working alliance in the online group was comparable to that in the face-to-face group. However, the results showed no significant relations between the BDI residual gain score and the working alliance ratings in either group. TRIAL REGISTRATION: ACTRN12611000563965.
背景:尽管近年来有大量疗效研究发现基于互联网的抑郁症干预措施有效,但在线环境中很少考虑治疗过程因素。在面对面治疗中,工作联盟的质量可以解释治疗结果的差异。然而,对于基于互联网的干预措施,特别是与面对面治疗相比,工作联盟的影响知之甚少。
方法:本研究探讨了认知行为疗法治疗抑郁症中期和结束时客户与治疗师之间的工作联盟。参与者被随机分配到基于互联网的治疗组(n = 25)或面对面治疗组(n = 28)。两组均在 8 周的时间内接受相同的认知行为治疗。参与者在治疗后完成贝克抑郁量表(BDI),并在治疗中期和结束时完成工作联盟量表。治疗师在治疗后完成治疗师版工作联盟量表。
结果:除了在线组的任务分量表评分明显较高外,两组对工作联盟的评分没有显著差异。进一步,在线组中客户对工作联盟的评分与治疗后结果之间存在显著相关性,而面对面组中则在治疗中期和结束时均存在显著相关性。相关分析显示,工作联盟评分在两组中均未显著预测 BDI 残差增益评分。
结论:与预期相反,在线组的工作联盟与面对面组相当。然而,两组的 BDI 残差增益评分与工作联盟评分之间均无显著关系。
试验注册:ACTRN12611000563965。
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