comunitat-uji-handle:10234/9
comunitat-uji-handle2:10234/8033
comunitat-uji-handle3:10234/8636
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INVESTIGACION
Metadatos
Título
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
Fecha de publicación
2024-05-31
Editor
JMIR Publications
ISSN
1438-8871
Cita bibliográfica
Doukani A, Quartagno M, Sera F, Free C, Kakuma R, Riper H, Kleiboer A, Cerga-Pashoja A, van Schaik A, Botella C, Berger T, Chevreul K, Matynia M, Krieger T, Hazo J, Draisma S, Titzler I, Topooco N, Mathiasen K, Vernmark K, Urech A, Maj A, Andersson G, Berking M, Baños R, Araya R 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 J Med Internet Res 2024;26:e47515 URL: https://www.jmir.org/2024/1/e47515 DOI: 10.2196/47515
Tipo de documento
info:eu-repo/semantics/article
Versión
info:eu-repo/semantics/publishedVersion
Palabras clave / Materias
Resumen
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 ... [+]
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. [-]
Publicado en
J Med Internet Res 2024;26:e47515
Derechos de acceso
info:eu-repo/semantics/openAccess
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