Abstract
BackgroundDigital mental health interventions offer unique advantages, and research indicates that these interventions are effective for a range of mental health concerns. Although these interventions are less established for individuals with serious mental illnesses, they demonstrate significant promise. A central consideration in traditional face-to-face therapies is the therapeutic alliance, whereas the nature of a digital therapeutic alliance and its relationship with outcomes requires further attention, particularly for individuals with serious mental illnesses.ObjectiveThis narrative review aims to encourage further consideration and critical evaluation of the therapeutic alliance in digital mental health, specifically for individuals with serious mental illnesses.MethodsA narrative review was conducted by combining 3 main areas of the literature: the first examining the evidence for digital mental health interventions for serious mental illnesses, the second illuminating the nature and role of the therapeutic alliance in digital interventions, and the third surrounding practical considerations to enhance a digital therapeutic alliance.ResultsResults indicated that a therapeutic alliance can be cultivated in digital interventions for those with serious mental illnesses, but that it may have unique, yet-to-be-confirmed characteristics in digital contexts. In addition, a therapeutic alliance appears to be less directly associated with outcomes in digital interventions than with those in face-to-face therapies. One possibility is that the digital therapeutic alliance is associated with increased engagement and adherence to digital interventions, through which it appears to influence outcomes. A number of design and implementation considerations may enhance the digital therapeutic alliance, including human support and technological features.ConclusionsMore research is required to further understand the nature and specific role of a therapeutic alliance in digital interventions for serious mental illnesses, particularly in informing their design. This review revealed several key research priorities to advance the therapeutic alliance in digital interventions.
Highlights
Sessio n Impact Scale score showed that those who completed therapy rated cCBT lower than F2F for developing understanding and building a therapeutic relationship
Unsu with symptoms Questionnaire pported of depression was lower for computerized CBTa
Sessio n Impact Scale score showed that those who completed therapy rated cCBT lower than F2F for developing understanding and building a therapeutic relationship et al [66] uterized healthy adults ratings were exercise with a desire to provided on program with increase the bond an embodied exercise
Summary
Unsu with symptoms Questionnaire pported of depression was lower for computerized CBTa Higher — et al [66] uterized healthy adults ratings were exercise with a desire to provided on program with increase the bond an embodied exercise (50 subscale of an relational women; mean adapted WAIe. Association with engagement or adherence — agent—a age 24.8 [SD with increases computer- 7.4] years) over time, animated when the avatar relational demonstratin agent was g complex used. Open trial adults with e therapeutic the ARM, Suppo depression CBT (none) years) version of the not ARMf), which associated were lower with across all changes to scales than depression. Those in F2F No therapy significant relationship was found between any subscale of the ARM and Bergman Nordgren et al [67]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
