Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders – A systematic review

Pihlaja, Satu; Stenberg, Jan-Henry; Joutsenniemi, Kaisla; Mehik, Heidi; Ritola, Ville; Joffe, Grigori

doi:10.1016/j.invent.2017.11.005

Cited by 114 publications

(79 citation statements)

References 62 publications

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“…Therapeutic alliance from the client perspective increased significantly from pre to post for those who completed the scheduled intervention, while no change was observed in the case of those who dropped out before finishing their scheduled sessions. The positive alliance outcomes for completers showed that a strong therapeutic alliance can be established and maintained online (30,31). These results further align with client perceptions of the role of support in iCBT, where different studies have shown that clients found it helpful and motivating during the intervention period (71,72).…”

Section: Discussionsupporting

confidence: 74%

“…Psychotherapy research findings indicate that alliance is related to therapeutic change (26)(27)(28) and overall satisfaction with care (29). In the field of internet interventions, research on therapeutic alliance with online supporters is scarce (30). A recent narrative review concluded that a positive therapeutic alliance can be formed in guided iCBT, with client ratings similar to those found in face-to-face treatment (31).…”

Section: Introductionmentioning

confidence: 99%

“…There is opportunity to explore further the nature of the therapeutic alliance online and its relative contribution to outcomes. Given the established importance of the relationship between client and supporter in alliance and outcomes, it could be valuable to consider both client and clinician ratings to provide a comprehensive picture and inform the development and accurate deployment of iCBT as part of stepped care (30,(33)(34)(35). Also, some authors suggest that there is a need for studies that measure therapeutic alliance ratings at different points of treatment, as this could provide important information about alliance development (36).…”

Section: Introductionmentioning

confidence: 99%

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Internet-Delivered Cognitive Behavior Therapy as a Prequel to Face-To-Face Therapy for Depression and Anxiety: A Naturalistic Observation

et al. 2020

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Background: The UK's Improving Access to Psychological Therapies (IAPT) program is a stepped-care model treating individuals with depression and anxiety disorders. Internetdelivered cognitive behavioral therapy (iCBT) is routinely offered to individuals with mild to moderate symptoms, but its applicability to individuals with severe clinical symptoms and requiring a high-intensity intervention is relatively unknown. The current study sought to investigate the potential impacts of using iCBT as a prequel for patients requiring highintensity treatment (HIT; face-to-face) for depression and anxiety in IAPT. Methods: The study utilized an open study design. One hundred and twenty-four participants who were on a waiting list for high-intensity, face-to-face psychological treatment were offered iCBT. Psychometric data on symptoms of depression, anxiety, and functioning were collected from participants before starting and on finishing iCBT and at the point of service exit. Therapeutic alliance data were collected from patients and clinicians during treatment. Patient pathway data, such as number of treatment sessions and time in treatment, was also collected and incorporated into the analysis. Results: Significant reductions across primary outcome measures of depression and anxiety, as well as improved functioning, were observed from baseline to iCBT treatment exit, and from iCBT exit to service exit. Analysis of the therapeutic alliance data for patients and clinicians illustrated differences in outcome for those who dropped out and those who completed treatment. Discussion: This study illustrates the potential for using iCBT as a prequel to highintensity therapy for depression and anxiety disorders and is the first of its kind to do so within IAPT stepped care. The results show that iCBT is a valuable option reducing waiting times and enhancing clinical efficiency. The study contributes to the well-established evidence on online psychological treatments worldwide, but further clinical and service development research is necessary to scale these treatments appropriately.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Internet-Delivered Cognitive Behavior Therapy as a Prequel to Face-To-Face Therapy for Depression and Anxiety: A Naturalistic Observation

et al. 2020

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“…Several studies have investigated the role of therapeutic alliance in ICBT, with a focus on agreement with regard to tasks and goals as well as the bond between the therapist and the client. While some studies show a small but statistically significant association between early alliance ratings and outcome in ICBT, other studies fail to find this.…”

Section: Treatment Approachmentioning

confidence: 99%

Internet‐delivered psychological treatments: from innovation to implementation

et al. 2019

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Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

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“…Web-based therapist-guided cognitive therapy has advantages for both patients and providers and effects appear comparable to traditional face-to-face therapy in treating distress in patients with cancer [47,48]. Evidence suggests that guided web-based interventions are superior to unguided interventions [49].…”

Section: Introductionmentioning

confidence: 99%

Study protocol: a randomized controlled trial comparing the efficacy of therapist guided internet-delivered cognitive therapy (TG-iConquerFear) with augmented treatment as usual in reducing fear of cancer recurrence in Danish colorectal cancer survivors

Lyhne¹,

Smith

Frostholm

et al. 2020

BMC Cancer

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Background: Cognitive therapy has been shown to reduce fear of cancer recurrence (FCR), mainly in breast cancer survivors. The accessibility of cognitive behavioural interventions could be further improved by Internet delivery, but self-guided interventions have shown limited efficacy. The aim of this study is to test the efficacy of a therapist guided internet-delivered intervention (TG-iConquerFear) vs. augmented treatment as usual (aTAU) in Danish colorectal cancer survivors. Methods/design: A population-based randomized controlled trial (RCT) comparing TG-iConquerFear with aTAU (1:1) in n = 246 colorectal cancer survivors who suffer from clinically significant FCR (Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) ≥ 22 and semi-structured interview). Evaluation will be conducted at 2 weeks, 3 and 6 months post-treatment and between-group differences will be evaluated. Long-term effects will be evaluated after one year. Primary outcome will be post-treatment FCR (FCRI-SF). Secondary outcomes are global overall health and global quality of life (Visual Analogue Scales 0-100), bodily distress syndrome (BDS checklist), health anxiety (Whiteley-6), anxiety (SCL4-anx), depression (SCL6-dep) and sickness absence and health expenditure (register data). Explanatory outcomes include: Uncertainty in illness (Mishels uncertainty of illness scale, short form, MUIS), metacognitions (MCQ-30 negative beliefs about worry subscale), and perceived risk of cancer recurrence (Visual analogue Scale 1-100).

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Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders – A systematic review

Cited by 114 publications

References 62 publications

Internet-Delivered Cognitive Behavior Therapy as a Prequel to Face-To-Face Therapy for Depression and Anxiety: A Naturalistic Observation

Internet-Delivered Cognitive Behavior Therapy as a Prequel to Face-To-Face Therapy for Depression and Anxiety: A Naturalistic Observation

Internet‐delivered psychological treatments: from innovation to implementation

Study protocol: a randomized controlled trial comparing the efficacy of therapist guided internet-delivered cognitive therapy (TG-iConquerFear) with augmented treatment as usual in reducing fear of cancer recurrence in Danish colorectal cancer survivors

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