AUTHOR=Barceló-Soler Alberto , García-Campayo Javier , Araya Ricardo , Doukani Asmae , Gili Margalida , García-Palacios Azucena , Mayoral Fermín , Montero-Marin Jesus 

TITLE=Working alliance in low-intensity internet-based cognitive behavioral therapy for depression in primary care in Spain: A qualitative study

JOURNAL=Frontiers in Psychology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1024966

DOI=10.3389/fpsyg.2023.1024966

ISSN=1664-1078

ABSTRACT=<sec><title>Introduction</title><p>Psychotherapies delivered <italic>via</italic> the Internet have been promoted as an alternative for improving access to psychological treatments. A conceptual working alliance model of blended (i.e., traditional face-to-face consultation combined with Internet-delivered psychotherapy) cognitive-behavioral therapy (b-CBT) for depression has been developed in the UK. However, little is known about how this important therapeutic process, namely the working alliance (WA), is developed and maintained in Internet-delivered cognitive-behavioral therapy without face-to-face consultation (i-CBT). The aim of this study was to evaluate the validity of the WA model of b-CBT in Spanish patients with depression receiving i-CBT.</p></sec><sec><title>Methods</title><p>Forty-one patients suffering from mild-moderate depression were interviewed to assess their experiences of an i-CBT program. Interviews were conducted with participants who received a self-guided application (<italic>n</italic> = 9), and low-intensity support (<italic>n</italic> = 10). Three group interviews were also conducted with patients who either did not start the program (<italic>n</italic> = 8) or did not complete it (<italic>n</italic> = 6), and with patients who did complete it (<italic>n</italic> = 8).</p></sec><sec><title>Results</title><p>Qualitative thematic content analysis was performed using the constant comparative method, which revealed four main themes: “bond,” “goals,” “task,” and “usability heuristics,” all consistent with the existing literature. However, a new subcategory emerged, called “anonymity,” which may highlight the social stigma that mental illness still has in the Spanish context.</p></sec><sec><title>Conclusion</title><p>Results suggest that the development and maintenance of the WA through i-CBT could offer a better experience of the therapeutic process and improve the clinical impact.</p></sec><sec><title>Clinical Trial Registration</title><p><ext-link xlink:href="http://Clinicaltrials.gov" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">Clinicaltrials.gov</ext-link>, identifier: NCT01611818.</p></sec>