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Working alliance with an avatar: How far can we go with internet interventions?

ABSTRACT: Objective:To examine the working alliance between users and an avatar and users' treatment expectations in an unguided Internet intervention for the treatment of insomnia. Methods:The sample included participants from the treatment condition (N?=?29) of a randomised controlled trial. The task and goal subscales of the Working Alliance Inventory Short Revised (WAI-SR) were applied in week three. Five items of the Bern Post-Session Report and one question about the extent to which users had missed a human therapist were administered after each session. Treatment expectations were measured with the Credibility Expectancy Questionnaire (CEQ), and the Insomnia Severity Index (ISI) was used as the primary outcome measure. Results:The mean scores for the WAI-SR task and goal subscales were relatively high (M?=?3.24, SD?=?0.79; M?=?3.16, SD?=?0.91, respectively). The mean score of the five Bern Post-Session Report items remained stable over time, but some users increasingly indicated that they missed a real therapist over the course of the intervention, with a strong linear effect (t(87)?=?3.16, p?

SUBMITTER: Heim E

PROVIDER: S-EPMC6084819 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Working alliance with an avatar: How far can we go with internet interventions?

Heim Eva E Rötger Alexander A Lorenz Noah N Maercker Andreas A

Internet interventions 20180205

<h4>Objective</h4>To examine the working alliance between users and an avatar and users' treatment expectations in an unguided Internet intervention for the treatment of insomnia.<h4>Methods</h4>The sample included participants from the treatment condition (<i>N</i> = 29) of a randomised controlled trial. The <i>task</i> and <i>goal</i> subscales of the Working Alliance Inventory Short Revised (WAI-SR) were applied in week three. Five items of the Bern Post-Session Report and one question about ...[more]

PMID: 30135758

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Project description:BackgroundThe role of working alliance remains unclear for many forms of internet-based interventions (IBIs), a set of effective psychotherapy alternatives that do not require synchronous interactions between patients and therapists.ObjectiveThis study examined the conceptual invariance, trajectories, and outcome associations of working alliance across an unguided IBI and guided IBIs that incorporated clinician support through asynchronous text messaging or video messaging.MethodsAdults with high education attainment (n=145) with subclinical levels of anxiety, stress, or depressive symptoms were randomized to 1 of 3 treatment conditions for 7 weeks. All participants received treatments from MyCompass, an unguided IBI using cognitive behavior therapy. Participants in condition 2 and 3 received supplemental, asynchronous clinician support through text and video, respectively. Working alliance with the IBIs was measured weekly using select items from the 12-item version of the Agnew Relationship Measure. Symptom and functional outcomes were assessed at baseline, at the end of treatment, and 1-month follow-up.ResultsWorking alliance with the IBIs was conceptually invariant across the 3 conditions. Working alliance followed a quadratic pattern of change over time for all conditions and declined significantly only in the text-support condition. After controlling for baseline symptoms, higher baseline levels of working alliance predicted less depression and less functional impairment at follow-up, whereas faster increases in working alliance predicted less worry at the end of treatment and at follow-up, all of which only occurred in the video-support condition.ConclusionsWorking alliance with the IBIs was generally established in the initial sessions. Although working alliance is conceptually invariant across IBIs with or without clinician support, the associations between working alliance and treatment outcomes among IBIs may differ depending on clinician involvement and the modalities of support.Trial registrationClinicalTrials.gov NCT05122429; https://clinicaltrials.gov/ct2/show/NCT05122429.

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Working alliance with an avatar: How far can we go with internet interventions?

Publications

Working alliance with an avatar: How far can we go with internet interventions?

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