Working Alliance and Subjective Engagement with a Digital Avatar CBT Platform (RITch^®CBT): Comparing Young Adults...

Digital mental health interventions (DMHIs) can help bridge treatment gaps experienced by young adults with co-occurring substance misuse and depression. However, it remains unclear whether engagement with these interventions differs for young adults with co-occurring conditions compared to those experiencing substance misuse or depression alone. To investigate this issue, we assessed working alliance and subjective engagement with a digital avatar-assisted cognitive-behavioral therapy (CBT) treatment platform (RITch^®CBT), comparing young adults with substance use, depression, and the co-occurrence of the two. A secondary data analysis was conducted on a sample of 99 young adults aged 18-28 years who presented at an urban university clinic. Participants rated their alliance and engagement following two brief sessions of the RITch^®CBT platform. Participants were then categorized into behavioral health groups. Repeated exposure to the program had a greater impact on subjective engagement and usability across diagnostic conditions, but there was no difference in working alliance reported across sessions or behavioral health groups. Further, participants' depressive symptoms were significantly correlated with the number of sessions they expressed they were willing to engage in and attend. Our findings suggest that digital tools may support early engagement in treatment for young adults, regardless of presenting problem.