Ashur Ohad, Saar Chen R, Brandes Or, Baumel Amit
Department of Community Mental Health, University of Haifa, Haifa, IL, Israel.
Internet Interv. 2024 Oct 28;38:100783. doi: 10.1016/j.invent.2024.100783. eCollection 2024 Dec.
Therapeutic alliance (TA) is a well-established predictor of clinical outcomes in traditional psychotherapy. However, its association with outcomes in eHealth interventions has been inconsistent, which might be due to the absence of measurements specifically designed to capture TA in eHealth settings. The eHealth Therapeutic Alliance Inventory (ETAI) incorporates conventional as well as unique eHealth TA subscales, enabling to examine the contribution of new facets of TA beyond traditional concepts. This study investigates the predictive contribution of eHealth TA subscales compared to conventional TA subscales on clinical outcomes and evaluates the concurrent criterion validity of the ETAI. The study was conducted within the framework of a randomized controlled trial involving a 10-week digital parent training program aimed at addressing child disruptive behaviors. Parents were randomly assigned to either an enhanced-quality or a standard-quality program. Parents from 68 families completed the ETAI at five weeks' post-program initiation and at the post-intervention phase. The primary outcome was the improvement in child behavior, measured by the Eyberg Child Behavior Inventory. Positive Pearson correlations were found between all ETAI subscales covering unique eHealth TA aspects, measured at the 5-week time-point, and improvement in child behavior at post-intervention ( ≥ 0.23, < 0.03). The conventional TA subscale showed no significant Pearson correlation with improvement in child behavior. When examining the unique contributions of ETAI-subscales to explain the improvement in child behavior, only ETAI-Perceived Emotional Investment subscale was found to have a unique contribution ( = 0.29, = 0.019). In addition, scores on most ETAI subscales were significantly higher among parents using the enhanced-quality program compared with the standard program (Cohen's > 0.48), reinforcing ETAI's criterion validity. The development of TA scales that incorporates unique eHealth TA subscales show initial promise in predicting outcomes. Further research is needed to better understand how different factors of eHealth TA relate to clinical outcomes across diverse clinical targets and programs.
治疗联盟（TA）是传统心理治疗中临床疗效的一个公认预测指标。然而，它与电子健康干预效果的关联并不一致，这可能是由于缺乏专门为在电子健康环境中测量TA而设计的方法。电子健康治疗联盟量表（ETAI）纳入了传统以及独特的电子健康TA子量表，能够检验TA新方面对传统概念的贡献。本研究调查了与传统TA子量表相比，电子健康TA子量表对临床疗效的预测贡献，并评估了ETAI的同时效度。该研究是在一项随机对照试验的框架内进行的，该试验涉及一个为期10周的数字家长培训项目，旨在解决儿童破坏性行为问题。家长被随机分配到高质量或标准质量项目中。来自68个家庭的家长在项目启动后五周和干预后阶段完成了ETAI。主要结果是儿童行为的改善，通过艾伯格儿童行为量表进行测量。在5周时间点测量的涵盖独特电子健康TA方面的所有ETAI子量表与干预后儿童行为的改善之间发现了正皮尔逊相关性（≥0.23，<0.03）。传统TA子量表与儿童行为改善之间未显示出显著的皮尔逊相关性。在检查ETAI子量表对解释儿童行为改善的独特贡献时，仅发现ETAI-感知情感投入子量表有独特贡献（=0.29，=0.019）。此外，与标准项目相比，使用高质量项目的家长在大多数ETAI子量表上的得分显著更高（科恩>0.48），这加强了ETAI的效度。纳入独特电子健康TA子量表的TA量表在预测结果方面显示出初步前景。需要进一步研究以更好地理解电子健康TA的不同因素如何与不同临床目标和项目的临床结果相关。
