Tong Fangziyun, Lederman Reeva, D'Alfonso Simon, Berry Katherine, Bucci Sandra
School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia.
Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.
Front Psychiatry. 2022 Jun 22;13:819623. doi: 10.3389/fpsyt.2022.819623. eCollection 2022.
Fully automated mental health smartphone apps show strong promise in increasing access to psychological support. Therefore, it is crucial to understand how to make these apps effective. The therapeutic alliance (TA), or the relationship between healthcare professionals and clients, is considered fundamental to successful treatment outcomes in face-to-face therapy. Thus, understanding the TA in the context of fully automated apps would bring us insights into building effective smartphone apps which engage users. However, the concept of a digital therapeutic alliance (DTA) in the context of fully automated mental health smartphone apps is nascent and under-researched, and only a handful of studies have been published in this area. In particular, no published review paper examined the DTA in the context of fully automated apps. The objective of this review was to integrate the extant literature to identify research gaps and future directions in the investigation of DTA in relation to fully automated mental health smartphone apps. Our findings suggest that the DTA in relation to fully automated smartphone apps needs to be conceptualized differently to traditional face-to-face TA. First, the role of bond in the context of fully automated apps is unclear. Second, human components of face-to-face TA, such as empathy, are hard to achieve in the digital context. Third, some users may perceive apps as more non-judgmental and flexible, which may further influence DTA formation. Subdisciplines of computer science, such as affective computing and positive computing, and some human-computer interaction (HCI) theories, such as those of persuasive technology and human-app attachment, can potentially help to foster a sense of empathy, build tasks and goals and develop bond or an attachment between users and apps, which may further contribute to DTA formation in fully automated smartphone apps. Whilst the review produced a relatively limited quantity of literature, this reflects the novelty of the topic and the need for further research.
全自动心理健康智能手机应用程序在增加心理支持的可及性方面显示出巨大潜力。因此，了解如何使这些应用程序有效至关重要。治疗联盟（TA），即医疗保健专业人员与客户之间的关系，被认为是面对面治疗取得成功治疗结果的基础。因此，在全自动应用程序的背景下理解TA将使我们深入了解如何构建能吸引用户的有效智能手机应用程序。然而，在全自动心理健康智能手机应用程序背景下的数字治疗联盟（DTA）概念尚不成熟且研究不足，该领域仅发表了少数几项研究。特别是，没有已发表的综述论文在全自动应用程序的背景下研究DTA。本综述的目的是整合现有文献，以确定在与全自动心理健康智能手机应用程序相关的DTA研究中的研究空白和未来方向。我们的研究结果表明，与传统面对面TA相比，与全自动智能手机应用程序相关的DTA需要以不同方式进行概念化。首先，在全自动应用程序背景下联系的作用尚不清楚。其次，面对面TA的人际因素，如同感，在数字环境中难以实现。第三，一些用户可能认为应用程序更具无偏见性和灵活性，这可能会进一步影响DTA的形成。计算机科学的子学科，如情感计算和积极计算，以及一些人机交互（HCI）理论，如说服技术和人机依恋理论，可能有助于培养同理心、构建任务和目标，并在用户与应用程序之间建立联系或依恋，这可能会进一步促进全自动智能手机应用程序中DTA的形成。虽然本综述产生的文献数量相对有限，但这反映了该主题的新颖性以及进一步研究的必要性。
