O'Kane Kiarah M K, Otamendi Thalia, Silverberg Noah D, Choi Esther, Sicard Veronik, Zemek Roger, Healey Katherine, Brown Olivier, Butterfield Lauren, Smith Andra, Goldfield Gary, Kardish Rachel, Saab Bechara J, Ledoux Andrée-Anne, Cairncross Molly
Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
JMIR Form Res. 2024 Mar 22;8:e49133. doi: 10.2196/49133.
Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence-the extent to which digital encounters feel like they are occurring in person-may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored.
This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents' development of therapeutic alliance and social presence with the intervention.
Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention.
Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by "developing a genuine connection" with their mindfulness guides and "sensing real people." Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides' "personal backgrounds and voices," such that participants felt more connected to the guides by knowing information about them and through the guides' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would.
Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment.
尽管自我引导式数字干预对脑震荡康复期青少年有诸多益处，但此类干预的损耗率很高。有证据表明，成年人可与自我引导式数字干预建立治疗联盟，而这又与干预参与度相关。然而，尚无研究探讨青少年是否能与自我引导式数字干预建立治疗联盟，以及哪些因素对其发展至关重要。此外，社交临场感——数字交流给人的亲身在场感——可能是理解青少年与自我引导式数字干预之间联系本质的另一个相关因素，不过这一点尚未得到探索。
这项定性研究探讨了脑震荡康复期青少年在使用基于正念的自我引导式干预过程中建立治疗联盟和社交临场感的程度。此外，本研究旨在确定对青少年与该干预建立治疗联盟和社交临场感至关重要的因素。
从两个地点招募了年龄在12至17.99岁之间的脑震荡青少年：一个儿科急诊科，在脑震荡后48小时内招募；一个三级护理诊所，在脑震荡后1个月以上招募，以涵盖脑震荡后既有急性症状又有持续症状的青少年。参与者（N = 10）通过智能手机应用程序完成了为期4周的基于正念的干预。在应用程序中，参与者收听正念指导者（配音演员）讲述心理教育和正念练习的录音。4周时，参与者完成了问卷和半结构化访谈，探讨他们在干预中与正念指导者建立治疗联盟和社交临场感的体验。
定性结果中确定的主题显示，参与者通过与正念指导者“建立真诚联系”和“感知真实的人”来建立治疗联盟和社交临场感。对治疗联盟和社交临场感的发展尤为重要的是正念指导者的“个人背景和声音”，这样参与者通过了解他们的信息以及通过录音中指导者平静的语气，感觉与指导者的联系更紧密。定量研究结果支持了定性结果；参与者治疗联盟的平均得分远高于量表中点，而社交临场感测量的混合结果与定性研究结果一致，即参与者感觉正念指导者看起来真实，但不如面对面交流那么真实。
我们的数据表明，青少年在使用无直接人际接触的数字干预时可以建立治疗联盟和社交临场感。通过在干预中增加类似人类的特质（如实音），可以促进青少年与自我引导式数字干预建立治疗联盟和社交临场感。最大化治疗联盟和社交临场感可能是减少自我引导式数字干预损耗率同时提供可及治疗的一种有前景的方法。
