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Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0003-4753-6745
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Psykologpartners, Private Practice, Linköping.
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2012 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 9, 544-550 p.Article in journal (Refereed) Published
Abstract [en]

Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in several controlled trials, but the mechanisms of change are largely unknown. Therapeutic alliance is a factor that has been studied in many psychotherapy trials, but the role of therapeutic alliance in ICBT is less well known. The present study investigated early alliance ratings in three separate samples. Participants from one sample of depressed individuals (N = 49), one sample of individuals with generalized anxiety disorder (N = 35), and one sample with social anxiety disorder (N = 90) completed the Working Alliance Inventory (WAI) modified for ICBT early in the treatment (weeks 3-4) when they took part in guided ICBT for their conditions. Results showed that alliance ratings were high in all three samples and that the WAI including the subscales of Task, Goal and Bond had high internal consistencies. Overall, correlations between the WAI and residualized change scores on the primary outcome measures were small and not statistically significant. We conclude that even if alliance ratings are in line with face-to-face studies, therapeutic alliance as measured by the WAI is probably less important in ICBT than in regular face-to-face psychotherapy.

Place, publisher, year, edition, pages
Elsevier, 2012. Vol. 50, no 9, 544-550 p.
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-79399DOI: 10.1016/j.brat.2012.05.003ISI: 000307909100003PubMedID: 22728647OAI: oai:DiVA.org:liu-79399DiVA: diva2:541310
Available from: 2012-07-16 Created: 2012-07-16 Last updated: 2017-10-30Bibliographically 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. 90 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 725Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 201
Keyword
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: 2017-11-16Bibliographically approved

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Andersson, GerhardPaxling, BjörnVernmark, Kristofer

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