Pihlaja Satu, Stenberg Jan-Henry, Joutsenniemi Kaisla, Mehik Heidi, Ritola Ville, Joffe Grigori
Hospital District of Helsinki and Uusimaa, Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, 00029 HUS, Finland.
Internet Interv. 2017 Nov 17;11:1-10. doi: 10.1016/j.invent.2017.11.005. eCollection 2018 Mar.
The role of internet therapy programs for mental disorders is growing. Those programs employing human support yield better outcomes than do those with no such support. Therapeutic alliance may be a critical element in this support. Currently, the significance of therapeutic alliance in guided, internet-delivered cognitive behavioral therapy programs (iCBT) remains unknown. This review aims to determine whether the therapeutic alliance influences outcome of iCBTs and if it does, what plausible factors underlie this association.
Towards that goal searches were made in PubMed, PsycINFO, SCOPUS, The Cochrane Library and CINAHL in May 2016 and January 2017.
From the 1658 relevant studies, only six studied the relationship of therapeutic alliance and outcome. All six studies showed a high level of client-therapist alliance; in the three most recent studies, the alliance was directly associated with outcome. No studies reported alliance-adherence associations.
Alliance research in iCBT for mental disorders is scarce. Therapeutic alliance seems to associate with outcomes. More studies are necessary to define the optimal support to strengthen alliance. iCBT is a feasible environment for alliance research both practically and theoretically. The impact of alliance on adherence to iCBT requires study.
互联网治疗项目在精神障碍治疗中的作用日益增强。那些提供人力支持的项目比没有此类支持的项目效果更好。治疗联盟可能是这种支持的关键要素。目前，治疗联盟在有指导的、通过互联网提供的认知行为治疗项目（iCBT）中的重要性尚不清楚。本综述旨在确定治疗联盟是否会影响iCBT的治疗效果，如果有影响，这种关联背后可能存在哪些因素。
为实现该目标，于2016年5月和2017年1月在PubMed、PsycINFO、SCOPUS、Cochrane图书馆和CINAHL中进行了检索。
在1658项相关研究中，仅有6项研究了治疗联盟与治疗效果的关系。所有6项研究均显示出较高水平的医患联盟；在最近的3项研究中，联盟与治疗效果直接相关。没有研究报告联盟与依从性的关联。
针对精神障碍的iCBT联盟研究较少。治疗联盟似乎与治疗效果相关。需要更多研究来确定加强联盟的最佳支持方式。iCBT在实践和理论上都是进行联盟研究的可行环境。联盟对iCBT依从性的影响有待研究。
