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Only connect: The working alliance in computer-based cognitive behavioral therapy.

Brian D Kiluk1, Kelly Serafini1, Tami Frankforter1

  • 1Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.

Behaviour Research and Therapy
|December 3, 2014
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Summary

Clients may form a working alliance with computer programs in therapy. A new scale (WAI-Tech) showed promise, though alliance

Keywords:
CBT4CBTSubstance use treatmentTechnology-based interventionsTherapeutic allianceWorking alliance

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Area of Science:

  • Psychology
  • Psychiatry
  • Human-Computer Interaction

Background:

  • Technology-based interventions are increasingly used in mental health.
  • The role of the therapist is limited in some digital health tools.
  • This raises questions about the client's therapeutic alliance with technology.

Purpose of the Study:

  • To evaluate the psychometric properties of an adapted Working Alliance Inventory for technology-based interventions (WAI-Tech).
  • To examine the relationship between working alliance and treatment outcomes in cocaine-dependent individuals using Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT).

Main Methods:

  • A subsample (n=66) of cocaine-dependent individuals in a randomized trial completed the WAI-Tech.
  • Participants were receiving Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) as an adjunct to treatment as usual (TAU).
  • The Working Alliance Inventory (WAI) was administered to those in the TAU group.

Main Results:

  • The WAI-Tech demonstrated similar psychometric properties to the standard WAI.
  • Lower 'bond' subscale scores were observed on the WAI-Tech compared to the WAI.
  • WAI-Tech scores did not correlate with cocaine use outcomes.
  • WAI scores in the TAU group were associated with increased days abstinent from cocaine.

Conclusions:

  • The WAI-Tech appears to be a valid measure for assessing therapeutic alliance in technology-based interventions.
  • Technology-based interventions did not negatively impact the alliance with a therapist.
  • The concept of working alliance may extend to computer-based CBT, but its function might differ from traditional psychotherapy.