Accepted for/Published in: JMIR Mental Health
Date Submitted: Nov 26, 2024
Open Peer Review Period: Nov 26, 2024 - Jan 21, 2025
Date Accepted: Jan 17, 2025
(closed for review but you can still tweet)
Does the Digital Therapeutic Alliance Exist?: An Integrative Review
ABSTRACT
Background:
Mental health disorders significantly impact global populations, prompting the rise of digital mental health interventions like artificial intelligence-powered chatbots to address gaps in access to care. This review explores the potential for a "digital therapeutic alliance," emphasizing empathy, engagement, and alignment with traditional therapeutic principles to enhance user outcomes.
Objective:
The primary objective of this review was to identify key concepts underlying the digital therapeutic alliance in AI-driven psychotherapeutic interventions for mental health. The secondary objective was to propose an initial definition of the digital therapeutic alliance based on these identified concepts.
Methods:
The PRISMA for Scoping Reviews and Tavares de Souza's integrative review methodology were followed, encompassing systematic literature searches in Medline, Web of Science, PsycNet, and Google Scholar. Data from eligible studies were extracted and analyzed using Horvath et al.'s conceptual framework on therapeutic alliance, focusing on goal alignment, task agreement, and the therapeutic bond, with quality assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool.
Results:
A total of 23 studies were identified from an initial pool of 1,227 articles after excluding duplicates and ineligible studies. These studies informed the development of a conceptual framework for Digital Therapeutic Alliance, encompassing key elements such as goal alignment, task agreement, therapeutic bond, user engagement, and the facilitators and barriers affecting therapeutic outcomes. The interventions primarily focused on AI-powered chatbots, digital psychotherapy, and other digital tools.
Conclusions:
The findings of this integrative review provide a foundational framework for the concept of Digital Therapeutic Alliance, and reported its potential to replicate key therapeutic mechanisms such as empathy, trust, and collaboration in artificial intelligence-driven psychotherapeutic tools. While promising for enhancing accessibility and engagement in mental health care, further research and innovation are needed to address challenges like personalization, ethical concerns, and long-term impact.
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.