van Seters Miriam L F M, Rasing Sanne P A, Huvenaars Mireille J, Vermulst Ad, Bodden Denise H M, Stikkelbroek Yvonne A J
GGZ Oost Brabant, Child and Adolescent Psychiatry, 5427, EM, Boekel, the Netherlands.
Behavioural Science Institute, Radboud University, 6500, HE, Nijmegen, the Netherlands.
Internet Interv. 2024 Sep 14;38:100776. doi: 10.1016/j.invent.2024.100776. eCollection 2024 Dec.
A depressive disorder during adolescence is a serious and disabling disorder, which has a high impact on the development of adolescents. Blended treatment, combining online and face-to-face sessions, is effective and can reduce some of the barriers for adolescents to use mental health care. There is a lack of knowledge about whether therapeutic alliance is established in blended treatment for adolescents and young adults suffering from a depressive disorder. This study examines whether the quality of the therapeutic alliance differs when cognitive behavior therapy (CBT) is delivered in combination with online intervention (b-CBT) compared to solely face-to-face (FtF-CBT) and the extent to which a stronger therapeutic alliance is associated with better treatment outcome.
A pragmatic quasi-experimental design was used. Data collected within two separate studies were combined. A total of 85 participants (80 % female), aged 13-22 (mean = 16.63, SD = 1.92) were recruited within mental health care institutions and diagnosed with a depressive disorder (using K-SADS). Assessments were done at pre-treatment (T0), after five weeks (T1), after ten weeks (T2), post-treatment (T3) and one to four weeks after treatment (T4) and included measures of depressive symptomatology (CDI-2). The therapeutic alliance was measured at T1, T2 and T3 by the TASC. -tests for independent samples were used to test differences in therapeutic alliance rates between b-CBT and FtF-CBT at post-treatment. A linear growth model for depressive symptoms based on five time points with Latent Growth Curve Analysis (LGCA) was used to test whether the therapeutic alliance is associated with depressive symptoms.
No differences in therapeutic alliance between b-CBT and FtF-CBT were found on either client-rated or therapist-rated therapeutic alliance. For both intervention groups, no significant association between the therapeutic alliance and depressive outcome was found.
This study shows that providing part of CBT using an online environment does not have a negative impact on the therapeutic alliance. In contrast to earlier research, no association was found between the therapeutic alliance and therapy outcome in neither the b-CBT nor the FtF-CBT intervention.
青少年期的抑郁症是一种严重且致残的疾病，对青少年的发育有很大影响。将在线和面对面治疗相结合的混合治疗是有效的，并且可以减少青少年获得心理健康护理的一些障碍。对于患有抑郁症的青少年和年轻人，在混合治疗中是否能建立治疗联盟，目前尚缺乏相关了解。本研究探讨了与单纯面对面认知行为疗法（FtF-CBT）相比，认知行为疗法（CBT）与在线干预相结合（b-CBT）时治疗联盟的质量是否存在差异，以及更强的治疗联盟与更好的治疗效果之间的关联程度。
采用实用的准实验设计。将两项独立研究中收集的数据合并。在心理健康机构招募了85名参与者（80%为女性），年龄在13 - 22岁之间（平均 = 16.63，标准差 = 1.92），并诊断为抑郁症（使用K-SADS）。在治疗前（T0）、五周后（T1）、十周后（T2）、治疗后（T3）以及治疗后一至四周（T4）进行评估，包括抑郁症状测量（CDI-2）。在T1、T2和T3通过TASC测量治疗联盟。采用独立样本t检验来检验治疗后b-CBT和FtF-CBT在治疗联盟率上的差异。基于五个时间点使用潜在增长曲线分析（LGCA）的抑郁症状线性增长模型，用于检验治疗联盟是否与抑郁症状相关。
在患者自评或治疗师评定的治疗联盟方面，未发现b-CBT和FtF-CBT之间存在差异。对于两个干预组，均未发现治疗联盟与抑郁结局之间存在显著关联。
本研究表明，使用在线环境提供部分CBT对治疗联盟没有负面影响。与早期研究不同，在b-CBT和FtF-CBT干预中，均未发现治疗联盟与治疗效果之间存在关联。
