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  • Doukani, AsmaeLondon Sch Hyg & Trop Med, England (författare)

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

  • Artikel/kapitelEngelska2024

Förlag, utgivningsår, omfång ...

  • JMIR PUBLICATIONS, INC,2024
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:liu-205174
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-205174URI
  • https://doi.org/10.2196/47515DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

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Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Background: Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. Objective: This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3 -month assessments. Methods: We conducted a secondary data analysis of the E -COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment -as -usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory -Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire -9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale -Client [SUS -C]) at 3 months and baseline demographic information. Data from baseline and 3 -month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Results: Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU ( B =5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT ( B =-0.12, 95% CI -0.17 to -0.06) and TAU ( B =-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS -C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT ( b =-0.030, 95% CI -0.05 to -0.01; P =.005). Conclusions: To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence -based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Quartagno, MatteoUCL, England (författare)
  • Sera, FrancescoUniv Florence, Italy (författare)
  • Free, CarolineLondon Sch Hyg & Trop Med, England (författare)
  • Kakuma, RitsukoLondon Sch Hyg & Trop Med, England (författare)
  • Riper, HeleenVrije Univ Amsterdam, Netherlands (författare)
  • Kleiboer, AnnetVrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth Inst, Netherlands (författare)
  • Cerga-Pashoja, ArlindaLondon Sch Hyg & Trop Med, England (författare)
  • van Schaik, AnnekeVrije Univ Amsterdam, Netherlands; Dutch Mental Hlth Care, Netherlands (författare)
  • Botella, CristinaUniv Jaume 1, Spain; Inst Carlos III, Spain (författare)
  • Berger, ThomasUniv Bern, Switzerland (författare)
  • Chevreul, KarineAP HP, France; Univ Paris, France (författare)
  • Matynia, MariaSWPS Univ, Poland (författare)
  • Krieger, TobiasUniv Bern, Switzerland (författare)
  • Hazo, Jean-BaptisteAP HP, France; Univ Paris, France (författare)
  • Draisma, StasjaTrimbos Inst, Netherlands (författare)
  • Titzler, IngridFriedrich Alexander Univ Erlangen Nurnberg, Germany (författare)
  • Topooco, NairaLinköpings universitet,Psykologi,Filosofiska fakulteten(Swepub:liu)naito42 (författare)
  • Mathiasen, KimUniv Southern Denmark, Denmark; Mental Hlth Serv Southern Denmark, Denmark (författare)
  • Vernmark, KristoferLinköpings universitet,Psykologi,Filosofiska fakulteten(Swepub:liu)krive80 (författare)
  • Urech, AntoineBern Univ Hosp, Switzerland (författare)
  • Maj, AnnaSWPS Univ, Poland (författare)
  • Andersson, GerhardLinköpings universitet,Psykologi,Filosofiska fakulteten,Institutionen för biomedicinska och kliniska vetenskaper,Medicinska fakulteten,Karolinska Inst, Sweden(Swepub:liu)geran87 (författare)
  • Berking, MatthiasFriedrich Alexander Univ Erlangen Nurnberg, Germany (författare)
  • Banos, Rosa MariaInst Carlos III, Spain; Univ Valencia, Spain (författare)
  • Araya, RicardoKings Coll London, England (författare)
  • London Sch Hyg & Trop Med, EnglandUCL, England (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Journal of Medical Internet Research: JMIR PUBLICATIONS, INC261438-8871

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