Working alliance as a predictor of change in depression during blended cognitive behaviour therapy
Open accessAbstract
Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.
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Vernmark et al. (2019) found that therapist-rated alliance correlated more strongly with outcomes in a blended CBT treatment than patient-rated alliance.
“Vernmark et al. (2019) found that therapist‐rated alliance correlated more strongly with outcomes in a blended CBT treatment than patient‐rated alliance.”
From Internet‐Based Acceptance and Commitment Therapy With Interoceptive Exposure for Panic Disorder: A Randomized Controlled Trial and Working Alliance Analysis. (2026) · cites this paper as Vernmark et al. (2019)
Previous e-Compared findings found that only therapist-rated TA, but not patient-rated TA, was predictive of changes in depression scores during blended treatment in a sample of 73 patients.
“previous findings found that only therapist-rated TA (but not patient-rated TA) was predictive of changes in depression scores during a blended treatment in a sample of 73 patients [30].”
This study explored only client-reported ratings of alliance, versus therapist, observer, and friend or family ratings, whereas other studies, such as a recent blended Internet-based CBT treatment for depression, found only therapist-rated alliance results to be significant with outcome.
“Finally, this study explored only client-reported ratings of alliance, versus therapist, observer, and friend or family ratings, whereas other studies, such as a recent blended Internet-based CBT treatment for depression, found only therapist-rated alliance results to be significant with outcome [59].”
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- Authors
- Vernmark, K., Hesser, H., Topooco, N., Berger, T., Riper, H., Luuk, L., Backlund, L., Carlbring, P., & Andersson, G.
- Affiliations
- Linköping University (SE)
- University of Bern (CH)
- Vrije Universiteit Amsterdam (NL)
- Stockholm University (SE)
- Corresponding author
- Vernmark, Kristofer
- ORCID
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2018-10-29
- Volume
- 48
- Issue
- 4
- Pages
- 285-299
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- OpenAlex
- W2898946785
- Cited by
- 59
- References
- 56
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 10 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 2
- FWCI
- 6.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Cognitive Behaviour Therapy (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-nc-nd)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Open Access CRIS of the University of Bern
- Funders
- Seventh Framework Programme (603098)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- therapeutic relationship, depression, online therapy
- MeSH terms
- Therapeutic Alliance, Adult, Major Depressive Disorder, Female, Humans, Male, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult
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