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Toward a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study

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Version 2 2023-06-12, 09:28
Version 1 2023-06-09, 21:31
journal contribution
posted on 2023-06-12, 09:28 authored by Asmae Doukani, Caroline Free, Daniel Michelson, Ricardo Araya, Jesús Montero-Marin, Sarah Smith, Arlinda Cerga Pashoja, Ritsuko Kakuma
Objectives To examine and adapt a conceptual framework of the working alliance (WA) in the context of a low-intensity blended (psychological well-being practitioner (PWP) plus computerised program) cognitive behavioural therapy intervention (b-CBT) for depression. Design Patient involvement was enlisted to collaboratively shape the design of the project from the onset, before data collection. In-depth semi-structured interviews were carried out with participants who experienced b-CBT as part of the E-compared trial. A thematic analysis was conducted using a constant comparative method informed by grounded theory. Setting Recruitment was carried out in four psychological primary care services across the UK. Participants Nineteen trial participants with major depressive disorder who completed at least one computerised program and face-to-face session with a PWP in the b-CBT arm were recruited to the study. Results Qualitative interviews that were guided by WA theory and patient involvement, revealed four themes: (1) a healthcare provider (PWP and computerised program) with good interpersonal competencies for building a working relationship with the client (‘bond’); (2) collaborative efforts between the client and the provider to appropriately identify what the client hopes to achieve through therapy (‘goals’); (3) the selection of acceptable therapeutic activities that address client goals and the availability of responsive support (‘task’) and (4) the promotion of active engagement and autonomous problem solving (‘usability heuristics’). Participants described how the PWP and computerised program uniquely and collectively contributed to different WA needs. Conclusions This study is the first to offer a preliminary conceptual framework of WA in b-CBT for depression, and how such demands can be addressed through blended PWP-computerised program delivery. These findings can be used to promote WA in technological design and clinical practice, thereby promoting engagement to b-CBT interventions and effective deployment of practitioner and program resources.

History

Publication status

  • Published

File Version

  • Published version

Journal

BMJ Open

ISSN

1759-2151

Publisher

BMJ Publishing Group

Issue

9

Volume

10

Page range

1-13

Article number

a036299

Department affiliated with

  • Psychology Publications

Full text available

  • No

Peer reviewed?

  • Yes

Legacy Posted Date

2020-09-04

First Open Access (FOA) Date

2020-09-29

First Compliant Deposit (FCD) Date

2020-09-04

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