Computerised Cognitive Behavioural Therapy in an Adult Mental Health Service: A Pilot Study of Outcomes and Alliance

Abstract

This pilot study aimed to explore the clinical outcomes and therapeutic relationship for clients of an adult mental health service using Beating the Blues, a computerised cognitive behaviour therapy (CCBT) package. Sixteen participants completed the programme and reported a significant reduction in Beck Depression Inventory scores posttreatment. Participants' mean item ratings on the relationship measure were above the neutral midpoint, but no association was found between the therapeutic relationship and outcome. The results are discussed in terms of the utility of CCBT as part of a stepped-care model and how further research might usefully explore the nature of the relationship formed between clients and CCBT programmes.

Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire (Preprint)

“…The app expects me to take responsibility rather than be dependent on it Other similar studies have focused on alliance ratings to computer programs for mild to moderate mental health problems [9][10][11]. These studies suggested that alliance ratings in relation to computer programs are similar to therapist alliance ratings; although, alliance ratings were slightly lower than typical ratings of therapists and alliance is a less important predictor of outcome.…”

“…We chose to adapt the ARM as this measure has been used in previous studies assessing TA in the context of computerised and mobile-based mental health interventions (e.g. [9,11,15]). The ARM assesses five concepts thought to comprise TA: bond, partnership, confidence, openness and client initiative.…”

“…These studies suggested that the concept of alliance may be a less robust predictor of outcomes than in traditional face-to-face interventions for mental health problems, particularly when the direct role of the therapist is minimal and service users are asked to comment on their relationship with a computer or mobile device rather than a therapist assisting with a computer-based intervention (e.g. [9][10][11]) However, there is some evidence that higher scores on e-health alliance measures are associated with more engagement with interventions [11].…”

Only connect: The working alliance in computer-based cognitive behavioral therapy

“…Most studies indicate alliance ratings with a clinician/therapist guiding/providing the technology-based intervention are in line with ratings found in face-to-face therapies (Andersson et al, 2012; Cook & Doyle, 2002; Kay-Lambkin, Baker, Lewin, & Carr, 2011; Knaevelsrud & Maercker, 2007; Preschl, Maercker, & Wagner, 2011; Sucala et al, 2012). However, a pilot study explored participants’ alliance ratings with a computerized CBT package for depression using a modified version of the Agnew Relationship Measure (Agnew-Davies, Stiles, Hardy, Barkham, & Shapiro, 1998), with the word “package” replacing “therapist” in the original scale, and found participants’ average ratings of alliance with the package were above the neutral midpoint, suggesting a positive relationship (Ormrod, Kennedy, Scott, & Cavanagh, 2010). Also, although significant decreases in depression were found after receiving the computerized CBT package, these outcomes were not related to the alliance with the computerized package (Ormrod et al, 2010).…”

“…However, a pilot study explored participants’ alliance ratings with a computerized CBT package for depression using a modified version of the Agnew Relationship Measure (Agnew-Davies, Stiles, Hardy, Barkham, & Shapiro, 1998), with the word “package” replacing “therapist” in the original scale, and found participants’ average ratings of alliance with the package were above the neutral midpoint, suggesting a positive relationship (Ormrod, Kennedy, Scott, & Cavanagh, 2010). Also, although significant decreases in depression were found after receiving the computerized CBT package, these outcomes were not related to the alliance with the computerized package (Ormrod et al, 2010). These were some of the first known reported results regarding a potential alliance with a computerized CBT program, as well as its relation to treatment outcomes, yet the study was limited by a small sample (n=16) and did not include a comparison condition.…”