Motivation and treatment credibility predict alliance in cognitive behavioral treatment for youth with anxiety disorders in community clinics

Fjermestad, Krister W.; Lerner, Matthew D.; McLeod, Bryce D.; Wergeland, Gro Janne; Haugland, Bente Storm Mowatt; Havik, Odd E.; Öst, Lars‐Göran; Silverman, Wendy K.

doi:10.1002/jclp.22551

Cited by 19 publications

(8 citation statements)

References 49 publications

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“…One limitation relates to the representability of the samples in all phases. Given that interviews were voluntary, the more enthusiastic and motivated individuals might have signed up, hence resulting in bias when reporting their platform experience ( 76 ). Nonetheless, the significant amount of retrieved usability problems and suggestions offer a great starting point for improvement.…”

Section: Discussionmentioning

confidence: 99%

Moderated digital social therapy for young people with emerging mental health problems: A user-centered mixed-method design and usability study

Doorn

Monsanto

Boeschoten

et al. 2023

Front. Digit. Health

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IntroductionOver 25% of Dutch young people are psychologically unhealthy. Individual and societal consequences that follow from having mental health complaints at this age are substantial. Young people need care which is often unavailable. ENgage YOung people earlY (ENYOY) is a moderated digital social therapy-platform that aims to help youngsters with emerging mental health complaints. Comprehensive research is being conducted into the effects and to optimize and implement the ENYOY-platform throughout the Netherlands. The aim of this study is to explore the usability and user experience of the ENYOY-platform.MethodsA user-centered mixed-method design was chosen. 26 young people aged 16–25 with emerging mental health complaints participated. Semi-structured interviews were conducted to explore usability, user-friendliness, impact, accessibility, inclusivity, and connection (Phase 1). Phase 2 assessed usability problems using the concurrent and retrospective Think Aloud-method. User experience and perceived helpfulness were assessed using a 10-point rating scale and semi-structured interviews (Phase 3). The Health Information Technology Usability Evaluation Scale (Health-ITUES; Phase 1) and System Usability Scale (SUS; Phase 2 and 3) were administered. Qualitative data was analyzed using thematic analysis. Task completion rate and time were tracked and usability problems were categorized using the Nielsen's rating scale (Phase 2).ResultsAdequate to high usability was found (Phase 1 Health-ITUES 4.0(0.34); Phase 2 SUS 69,5(13,70); Phase 3 SUS 71,6(5,63)). Findings from Phase 1 (N = 10) indicated that users viewed ENYOY as a user-friendly, safe, accessible, and inclusive initiative which helped them reduce their mental health complaints and improve quality of life. Phase 2 (N = 10) uncovered 18 usability problems of which 5 of major severity (e.g. troubles accessing the platform). Findings from Phase 3 (N = 6) suggested that users perceived the coaching calls the most helpful [9(0.71)] followed by the therapy content [6.25(1.41)]. Users liked the social networking aspect but rated it least helpful [6(2.1)] due to inactivity.ConclusionThe ENYOY-platform has been found to have adequate to high usability and positive user experiences were reported. All findings will be transferred to the developmental team to improve the platform. Other evaluation methods and paring these with quantitative outcomes could provide additional insight in future research.

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Section: Discussionmentioning

confidence: 99%

Moderated digital social therapy for young people with emerging mental health problems: A user-centered mixed-method design and usability study

Doorn

Monsanto

Boeschoten

et al. 2023

Front. Digit. Health

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“…Some client characteristics may draw more alliance-enhancing behaviors from a therapist, whereas other characteristics may suggest a client who is harder to engage and thus pushes a therapist away. Youth clients who have the most pretreatment interpersonal strengths and positive relationships (e.g., support, attachments) are more motivated and have more positive beliefs about treatment and/or a potential relationship with a therapist tend to have more positive alliances (Eltz, Shirk, & Sarlin, 1995; Fjermestad et al, 2018; Karver, Handelsman, Fields, & Bickman, 2005; Levin, Henderson, & Ehrenreich-May, 2012). Conversely, youths who make more external attributions about their problems, distrust authority figures, lack interpersonal skills or past positive interpersonal experiences, and are noncooperative or confrontational have been found to have worse alliances with the therapist (Ayotte, Lanctôt, & Tourigny, 2016; Bickman et al, 2004; Gallagher, Kurtz, & Blackwell, 2010; Simpson, 2008).…”

Section: Patient Contributionsmentioning

confidence: 99%

Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy.

et al. 2018

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In the youth treatment literature, the alliance has been defined and measured as a consensual or collaborative bond. In this article, we review varied definitions of the alliance, enumerate its frequent measures, and present clinical examples. We provide a meta-analytic review on the relation between the therapeutic alliance and treatment outcome in child and adolescent psychotherapy. In particular, this review only includes prospective studies of youth therapy that used an explicit measure of alliance. The meta-analysis of 28 studies revealed a weighted random effect size of r ϭ .19 (k ϭ 28, N ϭ 2419, p Ͻ .01, 95% confidence interval [.13, .25]), which is a small to medium effect (equivalent to d ϭ 0.39) consistent with the adult alliance literature and with prior youth meta-analyses. Given that a mediumlarge amount of heterogeneity was observed in effect sizes (I 2 ϭ 64.19%), theory-and method-based moderators were examined. Multiple moderators of the alliance-outcome association were found, including diagnosis class, type of therapy, study design (randomized controlled trials [RCT] vs. nonrandomized trials [non-RCT]), and treatment setting (inpatient vs. outpatient). Research limitations, patient contributions, and diversity considerations follow. The article concludes with research-informed practices for building and maintaining the therapeutic alliance with youth. Clinical Impact StatementAlthough many youth treatments have been found effective, less is known about treatment processes that may explain variability in treatment outcomes. Question: This study examined the strength of the correlation between the alliance and youth treatment outcome. Findings: This meta-analysis showed that the therapeutic alliance has a small to medium association to outcome that varies depending upon diagnosis, type of therapy, study design, and treatment setting. Meaning: Alliance formation and maintenance over the course of treatment has the potential to aid clinicians in achieving positive outcomes in youth psychotherapy across disorders. Next Steps: To investigate the effects on the alliance and treatment outcome of clinicians attending to youth and parent characteristics and their own behaviors when attempting to engage them in treatment.

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“…For example, participants expressed their trust in the capability of a therapist, but the confusing instructions were a reason to question the therapist's reliability. This is an important finding, as treatment credibility and therapist reliability predict the therapeutic alliance (Fjermestad et al, 2018). A strong therapeutic alliance is associated with patient attendance (Shirk et al, 2011) and it increases the chance of a positive therapy outcome (Owen et al, 2015).…”

Section: Discussionmentioning

confidence: 98%

Psychological Myths as Therapeutic Instructions in Eye Movement Desensitization and Reprocessing

Houben

Otgaar

Roelofs

2021

The Journal of Psychology

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The Dutch protocol for Eye Movement Desensitization and Reprocessing (EMDR) uses two psychological myths as part of the therapeutic instruction: memory works as a video camera and individuals can have a photographic memory. This study explored how participants experience and evaluate such instructions and if these instructions affect their beliefs on memory. Participants received a video, photo, or a control instruction. Participants indicated on a visual analog scale how vivid and emotional they expected to recall the traumatic memory, how credible the therapeutic instruction was, and how reliable they would consider a therapist providing such an instruction. Next, participants completed a memory belief survey. Participants who received the video instruction were most likely to expect to vividly recall a memory. The credibility of the instructions and the reliability of the therapist providing the instruction were at chance level, which might pose problems for the therapeutic alliance and therapy outcome.

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Motivation and treatment credibility predict alliance in cognitive behavioral treatment for youth with anxiety disorders in community clinics

Abstract: Conclusion Efforts to enhance youth motivation and treatment credibility early in treatment could facilitate the formation of a strong YT alliance.

Cited by 19 publications

References 49 publications

Moderated digital social therapy for young people with emerging mental health problems: A user-centered mixed-method design and usability study

Moderated digital social therapy for young people with emerging mental health problems: A user-centered mixed-method design and usability study

Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy.

Psychological Myths as Therapeutic Instructions in Eye Movement Desensitization and Reprocessing

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