Working Alliance in Blended Versus Face-to-Face Cognitive Behavioral Treatment for Patients with Depression in Specialized Mental Health Care.

Kooistra Kooistra,Van Oppen Van Oppen,Wiersma Wiersma,Ruwaard Ruwaard,Riper Riper

doi:10.3390/jcm9020347

Abstract

This study investigates working alliance in blended cognitive behavioral therapy (bCBT) for depressed adults in specialized mental health care. Patients were randomly allocated to bCBT (n = 47) or face-to-face CBT (n = 45). After 10 weeks of treatment, both patients and therapists in the two groups rated the therapeutic alliance on the Working Alliance Inventory Short-Form Revised (WAI-SR; Task, Bond, Goal, and composite scores). No between-group differences were found in relation to either patient or therapist alliance ratings, which were high in both groups. In the full sample, a moderate positive association was found between patient and therapist ratings on Task (ρ = 0.41, 95% CI 0.20; 0.59), but no significant associations emerged on other components or composite scores. At 30 weeks, within-and between-group associations between alliance and changes in depression severity (QIDS, Quick Inventory of Depressive Symptomatology) were analyzed with linear mixed models. The analyses revealed an association between depression over time, patient-rated alliance, and group (p < 0.001). In face-to-face CBT, but not in bCBT, lower depression scores were associated with higher alliance ratings. The online component in bCBT may have led patients to evaluate the working alliance differently from patients receiving face-to-face CBT only.

Highlights

Major depressive disorder (MDD) is a common and severely disabling illness [1], many individuals with major depressive disorder (MDD) have limited access to mental health care and trained therapists [2,3,4]
From the full trial sample of 102 patients, data on working alliance was available for 92 patients
Both the patient and therapist ratings had been obtained for 71 of them, whereas solely therapist ratings were obtained for 19 patients and patient ratings for 2 patients

Summary

Introduction

Major depressive disorder (MDD) is a common and severely disabling illness [1], many individuals with MDD have limited access to mental health care and trained therapists [2,3,4] This has prompted development of interventions requiring less therapist involvement, such as self-help interventions [5,6], and online psychotherapy [7,8]. The past few years have seen growing interest in hybrid treatment approaches, which either combine or integrate face-to-face and online therapy [16]. As this is a relatively new form of treatment, evidence on effectiveness is still scarce. Initial evaluations suggest that blended treatment can be effective in decreasing depression severity [17,18,19,20,21,22,23,24]

Methods

Results

Discussion

Conclusion