Brotherdale Rebecca, Berry Katherine, Bucci Sandra
Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Digit Health. 2024 Dec 15;10:20552076241277712. doi: 10.1177/20552076241277712. eCollection 2024 Jan-Dec.
Digital mental health interventions are increasingly used to scale up access to mental health support, yet very few mental health apps are empirically supported, with high attrition rates. The therapeutic alliance between therapists and clients is a key factor in predicting psychological therapy retention and outcomes. Understanding how this concept translates to the digital context, the so-called digital therapeutic alliance (DTA), may help enhance retention and outcomes in digital mental health.
To explore and conceptualise the DTA with mental health interventions delivered by standalone apps. Specifically: (1) whether people with mental health difficulties form an alliance with mental health apps; (2) what constitutes the DTA; and (3) the similarities and differences across the traditional therapeutic alliance and DTA.
Qualitative semi-structured interviews were conducted with 17 individuals utilising mental health apps. Interview topic examples included rationale for app support, goals around app use and perceived connection. Interviews were analysed using thematic analysis.
Five core themes were identified: (1) connection with 'an other'; (2) accessibility; (3) choice and empowerment; (4) goals and expectations: having lower expectations than in-person support; and (5) safe place: non-judgemental, loyalty, trust.
The study strengthens support for the concept of the DTA but adds to existing knowledge by suggesting that the DTA needs to be conceived differently to the traditional therapeutic alliance. App developers can enhance alliance by paying particular attention to the use of human voice features, validating statements, personalised interfaces, and multiple options for activities and strategies.
数字心理健康干预措施越来越多地用于扩大心理健康支持的可及性，但很少有心理健康应用程序得到实证支持，且流失率很高。治疗师与客户之间的治疗联盟是预测心理治疗留存率和治疗效果的关键因素。了解这一概念如何转化到数字环境中，即所谓的数字治疗联盟（DTA），可能有助于提高数字心理健康领域的留存率和治疗效果。
探讨并概念化独立应用程序提供的心理健康干预措施中的数字治疗联盟。具体而言：（1）有心理健康问题的人是否会与心理健康应用程序建立联盟；（2）数字治疗联盟的构成要素是什么；（3）传统治疗联盟与数字治疗联盟的异同。
对17名使用心理健康应用程序的个人进行了定性半结构化访谈。访谈主题示例包括应用程序支持的基本原理、应用程序使用目标以及感知到的联系。采用主题分析法对访谈进行分析。
确定了五个核心主题：（1）与“他人”的联系；（2）可及性；（3）选择与赋权；（4）目标与期望：期望低于面对面支持；（5）安全场所：无评判、忠诚、信任。
该研究加强了对数字治疗联盟概念的支持，但通过表明数字治疗联盟需要与传统治疗联盟以不同方式来构想，增加了现有知识。应用程序开发者可以通过特别关注人工语音功能的使用、验证陈述、个性化界面以及活动和策略的多种选项来增强联盟。
