Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial.

Autor:	Doukani A; Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom., Quartagno M; Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom., Sera F; Department of Statistics, Computer Science and Applications 'G. Parenti', University of Florence, Florance, Italy., Free C; Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom., Kakuma R; Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom., Riper H; Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands., Kleiboer A; Department Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.; Amsterdam Public Health Institute, Amsterdam, Netherlands., Cerga-Pashoja A; Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom., van Schaik A; Department of Psychiatry, Amsterdam University Medial Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.; Academic Department for Depressive Disorders, Dutch Mental Health Care, Amsterdam, Netherlands., Botella C; Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.; Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain., Berger T; Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland., Chevreul K; Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France.; Health Economics Research Unit, Inserm, University of Paris, Paris, France., Matynia M; Faculty of Psychology, SWPS University, Warsaw, Poland., Krieger T; Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland., Hazo JB; Unité de Recherche Clinique in Health Economics, Assistance Publique-Hôpitaux de Paris, Paris, France.; Health Economics Research Unit, Inserm, University of Paris, Paris, France., Draisma S; Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands., Titzler I; Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany., Topooco N; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden., Mathiasen K; Department of Clinical Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.; Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark., Vernmark K; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden., Urech A; Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.; Department of Neurology, Inselspital Bern, Bern University Hospital, Bern, Switzerland., Maj A; Faculty of Psychology, SWPS University, Warsaw, Poland., Andersson G; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden., Berking M; Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany., Baños RM; Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain.; Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain., Araya R; Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Journal of medical Internet research [J Med Internet Res] 2024 May 31; Vol. 26, pp. e47515. Date of Electronic Publication: 2024 May 31.
DOI:	10.2196/47515
Abstrakt:	Background: Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. Objective: This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. Methods: We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Results: Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=-0.12, 95% CI -0.17 to -0.06) and TAU (B=-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=-0.030, 95% CI -0.05 to -0.01; P=.005). Conclusions: To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. Trial Registration: ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573. International Registered Report Identifier (irrid): RR2-10.1186/s13063-016-1511-1. (©Asmae Doukani, Matteo Quartagno, Francesco Sera, Caroline Free, Ritsuko Kakuma, Heleen Riper, Annet Kleiboer, Arlinda Cerga-Pashoja, Anneke van Schaik, Cristina Botella, Thomas Berger, Karine Chevreul, Maria Matynia, Tobias Krieger, Jean-Baptiste Hazo, Stasja Draisma, Ingrid Titzler, Naira Topooco, Kim Mathiasen, Kristofer Vernmark, Antoine Urech, Anna Maj, Gerhard Andersson, Matthias Berking, Rosa María Baños, Ricardo Araya. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 31.05.2024.)
Databáze:	MEDLINE
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