Comparison of Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe
Practical Solutions and Value
Increasing interest has focused on the working alliance in digital mental health interventions. This study aimed to compare the working alliance scores between blended cognitive behavioral therapy (bCBT) and treatment as usual (TAU) for depression, and to examine the association between working alliance and depression severity scores in both groups. The study also tested for an interaction between system usability and working alliance in bCBT at 3-month assessments.
We analyzed data from the E-COMPARED trial, which compared bCBT with TAU across 9 European countries. The main outcomes were scores of the working alliance and depressive symptoms at 3 months after randomization. The results showed that bCBT was associated with higher working alliance scores compared to TAU. Additionally, the study found an inverse association between working alliance scores and depression severity in both bCBT and TAU, indicating that as working alliance scores increased, depression scores decreased. There was also a significant interaction between system usability and working alliance in bCBT, suggesting that good program usability enhanced the association between working alliance and clinical improvements.
These findings suggest that bCBT may enhance the client working alliance compared to routine care for depression and that the working alliance in bCBT is associated with clinical improvements, particularly when supported by good program usability.
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