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Working alliance as a predictor of change in depression during blended cognitive behaviour therapy
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0003-4250-8868
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0002-9736-8228
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0001-5972-3041
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.ORCID iD: 0000-0002-2432-7791
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2019 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 48, no 4, p. 285-299Article in journal (Refereed) Published
Abstract [en]

Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.

Place, publisher, year, edition, pages
Routledge, 2019. Vol. 48, no 4, p. 285-299
Keywords [en]
Therapeutic alliance; depression; blended treatment; internet-based treatment; growth models
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-153321DOI: 10.1080/16506073.2018.1533577ISI: 000470850800002PubMedID: 30372653OAI: oai:DiVA.org:liu-153321DiVA, id: diva2:1270107
Funder
EU, FP7, Seventh Framework Programme, 603098
Note

We thank the E-COMPARED consortium forfinancialsupport.

Available from: 2018-12-12 Created: 2018-12-12 Last updated: 2019-07-15Bibliographically approved
In thesis
1. Therapeutic alliance and different treatment formats when delivering internet-based CBT for depression
Open this publication in new window or tab >>Therapeutic alliance and different treatment formats when delivering internet-based CBT for depression
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Terapeutisk allians och olika sätt att förmedla internetbehandling med KBT vid depression
Abstract [sv]

Depression är en funktionsnedsättande problematik som påverkar en stor del av den vuxna populationen varje år. Trots ett omfattande behov av hjälp så råder det brist på tillgång till effektiv behandling. Kognitiv Beteendeterapi (KBT) är en evidensbaserad metod som har stöd vid behandling av depression och förmedlad via internet skulle metoden kunna tillgängliggöras för fler. Dock är det i dagsläget oklart vilka format och vilket innehåll som kan användas när behandlingen förmedlas via internet, samt vilken betydelse den terapeutiska alliansen har för en behandling som till största del sker på distans. Syftet med denna avhandling var att undersöka effekterna för olika format av internetbehandling (epostterapi, guidad självhjälp och blended treatment) vid depression, samt alliansens roll i dessa format.

Studiernas resultat visar på att epostterapi och internetförmedlade självhjälpsprogram med behandlarstöd var effektiva metoder för att behandla depression. Alliansskattningar var höga, vilket visar att en positiv terapeutisk allians kan uppnås i internetbehandling. Patientskattningar av allians kunde inte predicera utfallet i någon av behandlingarna, men behandlarskattad allians predicerade förbättring på depressionsskattningar i blended treatment. Den här avhandlingen innehåller den första randomiserade kontrollerade studien på KBT-baserad epostterapi vid depression, samt det första internet-förmedlade självhjälpsprogrammet baserat på beteendeaktivering och ACT.

Abstract [en]

Depression is a debilitating disorder that affects a large part of the adult population every year. Yet there is still a lack of access to effective care for people in need. Cognitive Behaviour therapy (CBT) is an evidence-based method for treating depression that together with the increased availability of Internet services provides an opportunity to increase access to effective treatment. Internet-based interventions can be effective in the treatment of depression, but there is a lack of knowledge concerning which formats of delivery that can be used and if therapeutic alliance is of equal importance when providing treatment over the Internet. The overall aim of this thesis was to examine the effects of different treatment formats (email therapy, guided self-help, and blended treatment) in internet-based CBT for depression and to further examine the role of alliance in these treatment modalities.

Findings from this thesis show that email therapy and internetbased treatment programs were effective methods for treating depression. Alliance ratings were high, showing that a positive therapeutic alliance can be achieved in internet-based treatments. Patient-rated alliance could not predict outcome in any of the different treatment formats. However, therapist-rated alliance predicted change in depression during blended treatment. This thesis includes the first randomized controlled study on CBTbased email therapy, and the first internet-based behavioral activation program with ACT-components, for adult depression.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 90
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 725Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 201
Keywords
depression, internet-based treatment, cognitive behavioural therapy, therapeutic alliance, email therapy, depression, internetbehandling, kognitiv beteendeterapi, terapeutisk allians, epostterapi
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-142389 (URN)10.3384/diss.diva-142389 (DOI)9789176854365 (ISBN)
Public defence
2017-11-23, VAL, Hus Vallfarten, Campus Valla, Linköping, 13:00 (English)
Supervisors
Available from: 2017-10-30 Created: 2017-10-30 Last updated: 2019-09-26Bibliographically approved

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