Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 25, 2019
Date Accepted: Mar 2, 2020
The Therapeutic Alliance in technology-based interventions for the treatment of depression: a systematic review
ABSTRACT
Background:
There is growing evidence, that technology-based psychological interventions (TBIs) are effective for the treatment of depression. As TBIs are gaining acceptance, the question arises, if good therapeutic alliance, considered a key aspect of psychotherapy, can be established without / with minimal face-to-face contact or rather changes if blended concepts are applied. While therapeutic alliance has been studied extensively in the context of face-to-face therapy, only a few studies have reviewed the evidence on alliance ratings in TBIs.
Objective:
The purpose of this paper is to examine the therapeutic alliance in technology-based psychological interventions for the treatment of depression.
Methods:
We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PSYNDEX, CINAHL, clinical trial registers, and sources of grey literature for RCTs on TBIs in the treatment of adults with unipolar depression. All publications were selected according to pre-specified criteria. Data were extracted by two independent review authors.
Results:
A total of eight out of 98 studies included in the review on TBIs for depression considered the therapeutic alliance as part of their evaluation (9.5%). The available data covered eight different treatment conditions, four stand-alone treatments (face-to-face psychotherapy, email, telephone, internet program), and four combined treatments (face-to-face psychotherapy plus a smartphone application, an internet program combined with either face-to-face psychotherapy, care-as-usual, or email/ telephone). On average, patients rated the alliance positively across all groups. Importantly, no statistically significant group differences regarding the therapeutic alliance sum scores were found in any of the studies. Five studies investigated the relationship between patients’ alliance ratings and treatment outcome, revealing mixed results.
Conclusions:
Our results suggest that it is possible to establish a positive therapeutic alliance across a variety of different technology-based interventions for depression, but are based on a small number of studies. Future research needs to address on what basis therapeutic alliance is formed in settings that do not allow for additional non-verbal cues, perhaps with adapted instruments to measure the therapeutic alliance. Clinical Trial: CRD42016050413
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