Working alliance and adherence mediate the effect of guidance in a web-based program for participants with mild to moderate depressive symptoms: A secondary mediation analysis

Bur, Oliver Thomas; Krauss, Samantha; Häfliger, Andrea; Krieger, Tobias; Berger, Thomas

doi:10.1016/j.invent.2022.100593

Cited by 7 publications

(12 citation statements)

References 52 publications

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“…This aligns with previous studies highlighting increased adherence in guided versus automated message/unguided conditions for various mental health interventions 34 . A recent study in people suffering from depressive symptom further showed that both therapeutic alliance and adherence mediated the effect of guidance 40 . However, in the aforementioned studies, adherence was operationalized as the completion rate of modules 34 or as a composite score consisting of number of clicks, number of topics worked on, number of completed exercises, and time spent within the program 40 , respectively.…”

Section: Discussionmentioning

confidence: 98%

“…A recent study in people suffering from depressive symptom further showed that both therapeutic alliance and adherence mediated the effect of guidance 40 . However, in the aforementioned studies, adherence was operationalized as the completion rate of modules 34 or as a composite score consisting of number of clicks, number of topics worked on, number of completed exercises, and time spent within the program 40 , respectively. The number of modules accessed yielded non-significant differences between study groups in the current study.…”

Section: Discussionmentioning

confidence: 98%

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Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial

Seewer,

Skoko,

Käll

et al. 2024

Sci Rep

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Loneliness is a prevalent and stigmatized phenomenon associated with adverse (mental) health outcomes. However, evidence-based interventions to alleviate loneliness are scarce. This randomized controlled trial (ClinicalTrials.gov-ID: NCT04655196) evaluated the efficacy of an internet-based cognitive behavioral self-help intervention (ICBT) to reduce loneliness by comparing two intervention groups with guidance or automated messages against a waitlist control group. Adults (N = 243) suffering from loneliness were recruited from the general public and then randomly assigned (2:2:1) to a 10-week ICBT with human guidance (GU) or automated messages (AM) or to a waitlist control group (WL). Loneliness, assessed with the UCLA-9, was the primary outcome. Outcomes were assessed at baseline and 10 weeks (post) and analyzed using mixed-effects models. The pooled intervention conditions resulted in lower loneliness scores at post-assessment than the WL (Cohen’s d = 0.57, 95% CI [0.25; 0.89]) and reduced depressive symptoms, social anxiety, social avoidance behavior, and rejection sensitivity (d = 0.32–0.52). The GU group had lower loneliness scores at post-assessment than the AM group (d = 0.42, 95% CI [0.13; 0.70]). ICBT effectively alleviated loneliness, and guidance increased the reduction in loneliness compared to automated messages. Alleviating loneliness with ICBT further seems to reduce the overall burden of psychopathological symptoms.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial

Seewer,

Skoko,

Käll

et al. 2024

Sci Rep

Self Cite

View full text Add to dashboard Cite

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“…Research incorporating the perspectives of those who use IPIs may provide insight into these mechanisms. Given the importance of resource allocation, more work is needed to understand the specific mechanisms that account for the effect of support, and qualitative methods are central to this endeavor [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Within the growing body of literature examining the therapeutic alliance in IPIs in general [ 16 , 18 ] and those examining depression outcomes specifically [ 10 ], some studies explore the alliance between participants and the computerized content [ 19 ], whereas others examine the alliance between participants and the support personnel [ 20 , 21 ]. In general, ratings of alliance in IPIs have been found to be similar to those in FTF therapies, and these ratings are positively associated with outcomes, although they do not reach statistical significance in some studies [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Current literature examining the alliance commonly uses the Working Alliance Inventory (WAI) [ 30 ], which was developed for FTF therapy. Recent literature suggests that the task and goal subscales of the therapeutic alliance are more important than the therapeutic bond subscale in supported IPIs [ 10 , 17 , 18 , 31 ]. However, the literature has yet to examine the psychometric properties of the WAI, specifically with IPI users.…”

Section: Introductionmentioning

confidence: 99%

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Relationship Factors in Internet-Delivered Psychological Interventions for Veterans Experiencing Postpartum Depression: Qualitative Analysis

et al. 2023

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Background Internet-delivered psychological interventions (IPIs) have been shown to be effective for a variety of psychological concerns, including postpartum depression. Human-supported programs produce better adherence and larger effect sizes than unsupported programs; however, what it is about support that affects outcomes is not well understood. Therapeutic alliance is one possibility that has been found to contribute to outcomes; however, the specific mechanism is not well understood. Participant perspectives and qualitative methodology are nearly absent from the IPI alliance research and may help provide new directions. Objective In this study, we aimed to provide participant perspectives on engagement with an IPI for postpartum depression to help inform alliance research, development of new IPIs, and inform resource allocation. Methods A qualitative methodology was used to explore participant perspectives of veteran women’s engagement with the MomMoodBooster program, a human-supported internet-delivered intervention for postpartum depression. Participants were asked 4 open-ended questions with the 3-month postintervention survey, “In what ways did you find the MomMoodBooster most helpful?” “How do you think the MomMoodBooster could have been improved?” “In what ways did you find the personal coach calls to be helpful?” and “How do you think the personal coach calls could have been improved?” Results Data were collected from 184 participants who responded to at least 1 of the open-ended questions. These were analyzed using thematic analysis and a process of reaching a consensus among coders. The results suggest that not only the engagement with the support person is perceived as a significant contributor to participant experiences while using the MomMoodBooster content but also the relationship factors are particularly meaningful. The results provide insights into the specific qualities of the support person that were perceived as most impactful, such as warmth, empathy and genuineness, and feeling normalized and supported. In addition, the results provide insight into the specific change processes that can be targeted through support interactions, such as encouraging self-reflection and self-care and challenging negative thinking. Conclusions These data emphasize the importance of relationship factors between support persons and an IPI program for postpartum depression. The findings suggest that focusing on specific aspects of the alliance and the therapeutic relationship could yield fruitful directions for the training of support personnel and for future alliance-based research of internet-delivered treatments.

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Human contact in internet-based interventions for depression: A pre-registered replication and meta-analysis of randomized trials

Krieger¹,

Bur²,

Weber³

et al. 2023

Internet Interventions

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Working alliance and adherence mediate the effect of guidance in a web-based program for participants with mild to moderate depressive symptoms: A secondary mediation analysis

Cited by 7 publications

References 52 publications

Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial

Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial

Relationship Factors in Internet-Delivered Psychological Interventions for Veterans Experiencing Postpartum Depression: Qualitative Analysis

Human contact in internet-based interventions for depression: A pre-registered replication and meta-analysis of randomized trials

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