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Working alliance and its link to guidance in an internet-based intervention for depressive disorders: a secondary analysis of a randomized controlled trial.

作者信息

Haaf Raoul, Schefft Cora, Krämer Rico, Klein Jan Philipp, Köhler Stephan

机构信息

Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.

Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany.

出版信息

Front Psychiatry. 2024 Sep 11;15:1448823. doi: 10.3389/fpsyt.2024.1448823. eCollection 2024.


DOI:10.3389/fpsyt.2024.1448823
PMID:39323963
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11422127/
Abstract

BACKGROUND: Guided Internet-based interventions (IBIs) are typically found to be more effective than unguided ones, but the reasons behind this are not well understood. The therapist-client working alliance, crucial in face-to-face psychotherapy, is also increasingly recognized as an important factor in IBIs. This study examines trajectories of the working alliance and its relationship to therapeutic guidance through a secondary analysis of a randomized controlled trial (RCT) on Selfapy, a 12-week IBI based on cognitive behavioral therapy for depressive disorders. The trial compared a therapist-guided version (with weekly calls) to an unguided version (n = 301, mean age 37 years, 83% female, mean BDI-II = 30.09). METHODS: Based on an intention-to-treat approach, this study investigates within- and between-group differences in the quality of the working alliance, assessed with the WAI-SR questionnaire at mid- and post-treatment via repeated measures ANOVA. Furthermore, correlations and mediation analyses were conducted to explore the relationship between the working alliance and outcomes, as well as adherence parameters. RESULTS: Findings indicate that the IBI was successful in fostering a robust working alliance in both intervention groups, with similar ratings at mid-treatment but significantly higher ratings in the guided group at post-treatment (Cohen's d = -0.38). Post-treatment working alliance scores were positively linked to symptom reduction at post-treatment (guided: r = .25, unguided r = .15) and follow-up (guided: r = .25, unguided: r = .17). In the unguided group, the association was primarily driven by the subscale task. Serial mediation analysis indicated that the relationship between guidance and outcomes at follow-up was mediated by working alliance (b = 0.59; 95% CI: 0.14, 1.22) and a link between working alliance and adherence (b = 0.15; 95% CI: 0.04, 0.34). CONCLUSIONS: Considering limitations like using a questionnaire developed for face-to-face therapy, findings support the importance of the working alliance in guided IBIs, while also providing new insights into its role and formation in unguided IBIs. The potential benefits of a strong working alliance, notably by improving adherence, may prove crucial for integrating guided as well as unguided IBIs into routine use, indicating the need for additional research in this context. CLINICAL TRIAL REGISTRATION: https://tinyurl.com/2p9h5hnx, German Clinical Trials Register DRKS00017191.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/11422127/a6642da648c1/fpsyt-15-1448823-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/11422127/7633580122f2/fpsyt-15-1448823-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/11422127/a6642da648c1/fpsyt-15-1448823-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/11422127/7633580122f2/fpsyt-15-1448823-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/11422127/a6642da648c1/fpsyt-15-1448823-g002.jpg

相似文献

[1]
Working alliance and its link to guidance in an internet-based intervention for depressive disorders: a secondary analysis of a randomized controlled trial.

Front Psychiatry. 2024-9-11

[2]
Working alliance and adherence mediate the effect of guidance in a web-based program for participants with mild to moderate depressive symptoms: A secondary mediation analysis.

Internet Interv. 2022-11-26

[3]
Conceptual Invariance, Trajectories, and Outcome Associations of Working Alliance in Unguided and Guided Internet-Based Psychological Interventions: Secondary Analysis of a Randomized Controlled Trial.

JMIR Ment Health. 2022-6-21

[4]
Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial.

J Med Internet Res. 2024-5-31

[5]
Efficacy of a Web-Based Intervention for Depressive Disorders: Three-Arm Randomized Controlled Trial Comparing Guided and Unguided Self-Help With Waitlist Control.

JMIR Form Res. 2022-4-4

[6]
Evaluation of the internet-based intervention "Selfapy" in participants with unipolar depression and the impact on quality of life: a randomized, parallel group study.

Qual Life Res. 2024-5

[7]
The Association of Therapeutic Alliance With Long-Term Outcome in a Guided Internet Intervention for Depression: Secondary Analysis From a Randomized Control Trial.

J Med Internet Res. 2020-3-24

[8]
The working alliance in a randomized controlled trial comparing online with face-to-face cognitive-behavioral therapy for depression.

BMC Psychiatry. 2011-12-6

[9]
Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults.

Cochrane Database Syst Rev. 2016-3-12

[10]
Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults.

Cochrane Database Syst Rev. 2015-3-5

本文引用的文献

[1]
Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial.

J Med Internet Res. 2024-5-31

[2]
Measuring Alliance and Symptom Severity in Psychotherapy Transcripts Using Bert Topic Modeling.

Adm Policy Ment Health. 2024-7

[3]
Evaluation of the internet-based intervention "Selfapy" in participants with unipolar depression and the impact on quality of life: a randomized, parallel group study.

Qual Life Res. 2024-5

[4]
Therapeutic alliance is calming and curing-The interplay between alliance and emotion regulation as predictors of outcome in Internet-based treatments for adolescent depression.

J Consult Clin Psychol. 2023-7

[5]
Working alliance in low-intensity internet-based cognitive behavioral therapy for depression in primary care in Spain: A qualitative study.

Front Psychol. 2023-3-29

[6]
The alliance in mental health care: conceptualization, evidence and clinical applications.

World Psychiatry. 2023-2

[7]
"I didn't have to look her in the eyes"-participants' experiences of the therapeutic relationship in internet-based psychodynamic therapy for adolescent depression.

Psychother Res. 2024-6

[8]
Working alliance and adherence mediate the effect of guidance in a web-based program for participants with mild to moderate depressive symptoms: A secondary mediation analysis.

Internet Interv. 2022-11-26

[9]
Conceptual Invariance, Trajectories, and Outcome Associations of Working Alliance in Unguided and Guided Internet-Based Psychological Interventions: Secondary Analysis of a Randomized Controlled Trial.

JMIR Ment Health. 2022-6-21

[10]
Efficacy of a Web-Based Intervention for Depressive Disorders: Three-Arm Randomized Controlled Trial Comparing Guided and Unguided Self-Help With Waitlist Control.

JMIR Form Res. 2022-4-4

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