Presenting Author:

Christina Sauer, M.S.

Principal Investigator:

David Mohr, Ph.D.

Department:

Preventive Medicine

Keywords:

Therapeutic Alliance, Technology-based Intervention, Depression, Anxiety, Symptom Change

Location:

Third Floor, Feinberg Pavilion, Northwestern Memorial Hospital

PH49 - Public Health & Social Sciences

Therapeutic alliance and treatment outcome in technology-based intervention

Objective: Therapeutic alliances in technology-based interventions are formed differently than alliances in traditional face-to-face treatment, which may change the way therapeutic alliance interacts with treatment outcome. This analysis examines how therapeutic alliance relates to treatment outcomes in a technology-based intervention for depression and anxiety. Methods: A secondary analysis of data from a field trial of Intellicare, a suite of Android skills-based apps aimed at treating depression and anxiety, was conducted. Therapeutic alliance was assessed in the end of treatment Working Alliance Inventory - Short Form Revised (WAI-SR), measured in goals, task, and bond subscales as well as a total score. Primary outcomes were symptoms of depression and anxiety, measured at beginning (baseline) and end of treatment on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7), respectively. Spearman’s correlations were run for WAI-SR and changes in primary outcome measures, calculated as the difference between end of treatment and baseline scores. Correlations were run for all subjects (N=86), as well as for a subgroup of participants who reported stronger coaching reactions (N=25). Participants with stronger coaching reactions are defined as those with end of treatment total WAI-SR scores at least one standard deviation above or below mean. Results: Overall, results suggest positive correlations between therapeutic alliance and symptom change. Regarding change in anxiety symptoms, a weak positive association between total WAI-SR and change on the GAD-7 (r=-0.22, p=.046), as well as a moderate positive association between WAI-SR goals subscale and GAD-7 change (r=-0.32, p=.0025) were found for all subjects. For the stronger coaching reactions subgroup, a moderate positive correlation between WAI-SR task subscale scores and GAD-7 change (r=-0.43, p=0.0335) was found. Regarding depression, the total WAI-SR score was not significantly associated with change in depressive symptoms for all subjects. However, a weak positive correlation between PHQ-9 change and the WAI-SR goals (r=-0.26, p=.0145) and task (r=-0.22, p=.041) subscales. For subjects reporting a stronger reaction to the coaching relationship, no correlation was found between any WAI-SR score and change on the PHQ-9. Conclusions: While total WAI-SR, goals and task WAI-SR subscales were related to some symptom change, bond subscale correlations were not significant. Further research into coaching support in use of app-based interventions may benefit from a focus on coaching toward goals and task relevance.