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Cited by 54Psychotherapy Techniques and ApplicationsDigital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The Alliance-Outcome Relation in Internet-Based Interventions for Psychological Disorders: A Correlational Meta-Analysis

Open access
Probst, Greta Helene, Berger, Thomas, Flückiger, Christoph·2022·Verhaltenstherapie
DOI 10.1159/000503432
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Abstract

Background: The alliance between therapists and patients is one of the most investigated factors of psychotherapy and a robust predictor of treatment outcome in face-to-face interventions. The implementation of internet-based interventions for psychological disorders has become more and more relevant over the past years, particularly in European countries. Regarding the relevance of the alliance for therapy outcome in internet-based interventions, mixed results are reported. The present correlative meta-analysis systematically summarizes the relation between alliance and therapy outcome in internet-based interventions for psychological disorders. Methods: Based on a systematic search, we detected 18 internet-based studies with 23 independent samples (1,177 participants). Results: The omnibus revealed a moderate effect of r = 0.252, p < 0.001, 95% CI [0.19, 0.31]. The analyses of the subscales indicated that the task component (r = 0.28) was slightly more predictive than the bond component (rbond = 0.16; QM(3) = 26.85, p < 0.001). None of the investigated moderators indicated significance. Discussion: This meta-analysis underlines the assumption that the alliance is a robust facilitative factor across mental health treatments.

AI snapshot

Written from the paper’s full text.

TL;DR

This correlational meta-analysis of 18 internet-based studies (23 independent samples, 1,177 participants) found a moderate alliance-outcome correlation of r = 0.252. The task subscale (r = 0.28) was slightly more predictive than the bond subscale (r = 0.16), and no tested moderators were significant.

Key findings

  • The overall weighted average alliance-outcome effect was r = 0.252, p < 0.001, 95% CI [0.19, 0.31], k = 23, accounting for about 6% of outcome variability. Heterogeneity was not significant (Q(22) = 25.10, p = 0.29; I² = 12.35), and trim-and-fill added no studies for publication bias.
  • WAI subscale analysis (9 studies, 13 independent samples, 517 participants) found task r = 0.28, goal r = 0.22, and bond r = 0.16; task versus bond differed significantly, QM(3) = 26.85, p < 0.001.
  • No investigated moderator was significant: amount of therapeutic contact Qb(2) = 2.08, p = 0.35; face-to-face contact Qb(1) = 1.62, p = 0.20; specificity of outcome Qb(1) = 0.21, p = 0.64; time of alliance assessment Qb(3) = 4.43, p = 0.11; average age Qm(1) = 1.80, p = 0.18; treatment duration Qm(1) = 0.02, p = 0.89.
  • All included studies used CBT; 20 of 23 independent samples used the WAI, WAI-S, or a revised WAI; 14 of 18 studies (78%) were conducted in Europe.

Methods

  • Systematic search based on Flückiger et al. [2018b] identified 18 internet-based studies with 23 independent samples and 1,177 participants; inclusion required an alliance measure during treatment, extractable alliance-outcome data, adult participants, and an electronic/internet-based intervention, with one adolescent sample also included.
  • Effect sizes were correlation coefficients; regression or standardized beta values were converted to correlations, multiple within-study effects were aggregated to one effect per independent sample, and Fisher’s z values were analyzed with a random-effects model using R packages MAc and metafor.
  • Moderators coded were amount of therapeutic contact (3 categories), occurrence of face-to-face contact, average age, treatment duration in weeks, specificity of outcome, and time of alliance assessment (4 categories); 20% of coding was double-rated with 96% agreement. WAI subscales were analyzed via multilevel linear model.

Limitations

  • The paper states two main limitations: generalizability is restricted because most research comes from university/research contexts, homogeneous cultural contexts, CBT, and predominantly European internet-based CBT interventions; and client expectations, including possible skepticism toward internet-based interventions, may affect alliance building and alliance-outcome prediction.
  • The paper notes that most interventions were short (average treatment duration approximately 10 weeks), the late alliance-assessment category had 0 samples due to random selection, and the nonsignificant specificity-of-outcome result may reflect too-low power.
  • Evident from the text: the moderator categories contained different numbers of independent samples, which the authors say calls for caution in interpreting the amount-of-therapeutic-contact result; the reliance on CBT and mostly WAI measures also limits generalization to other treatment approaches and alliance instruments.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1159/000503432

Cites

56 of 56 references verified0 citation errors · 0 not checkable

Statistics

5 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 46 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The omnibus analysis revealed a moderate overall alliance-outcome effect of r = 0.252, p < 0.001, 95% CI [0.19, 0.31] in internet-based interventions.

    “The omnibus revealed a moderate effect of r = 0.252, p < 0.001, 95% CI [0.19, 0.31].”
    Quote in the paperSubstantial claim
  • Findingown data

    The meta-analysis included 18 studies with 23 independent samples and 1,177 participants.

    “Overall, resulting from the literature search there were 18 studies with 23 independent samples and 1,177 participants included in the meta-analysis.”
    Quote in the paperSubstantial claim
  • Findingown data

    None of the investigated moderators indicated significance.

    “None of the investigated moderators indicated significance.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The average treatment duration of the independent samples was approximately 10 weeks.

    “The average treatment duration of the independent samples was approximately 10 weeks.”
    Quote in the paperNot a substantial claim
  • Findingown data

    There were significant differences between the heterogeneity values of the separate WAI subscales (τ2 bond = 0.003, τ2 task = 0.028, τ2 goal = 0.023, QE(36) = 62.41, p = 0.004, k = 39).

    “The examination of significant differences between the summary effects of the separate subscales based on the multilevel linear model resulted in significant differences between the heterogeneity values of the separate subscales (τ 2 bond = 0.003, τ 2 task = 0.028, τ 2 goal = 0.023, QE(36) = 62.41, p = 0.004, k = 39).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: An unstructured variance-covariance matrix is assumed for the variance structure within studies.
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 26

  • May combine two claims.

    Findingown data

    In the subscale analysis, the task component (r = 0.28) was slightly more predictive of outcome than the bond component (r = 0.16), QM(3) = 26.85, p < 0.001.

    “The analyses of the subscales indicated that the task component (r = 0.28) was slightly more predictive than the bond component (r bond = 0.16; QM(3) = 26.85,p < 0.001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most interventions were short, so that differences among the time of alliance assessments were quite small.

    “However, most interventions were short, so that the differences among the time of the alliance assessments were quite small.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Andersson et al., 2012 (a), the alliance-outcome effect size was r = 0.09 (n = 25) for depression treated with ICBT, measured with WAI and BDI.

    “| Andersson et al., 2012 (a) | depression | ICBT | 8 | WAI | BDI | 0.09 25 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andersson et al., 2012 (a)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Anderson et al., 2012, the alliance-outcome effect size was r = 0.12 (n = 132) for anxiety disorders treated with ICBT, measured with WAI-S and CGAS.

    “| Anderson et al., 2012 | anxiety disorders | ICBT | 12 | WAI-S | CGAS | 0.12 132 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Anderson et al., 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Fourteen out of the 18 included studies (78%) were conducted in Europe.

    “Fourteen out of the 18 studies (78%) were conducted in Europe.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neither average age of participants nor treatment duration significantly accounted for variability of the effect sizes.

    “Neither the average age of participants as moderator variable with Qm(1) = 1.80, p = 0.18 and an unstandardized regression coefficient estimate of r = 0.004 nor the treatment duration with Qm(1) = 0.02, p = 0.89 and an unstandardized regression coefficient estimate of r = 0.001 significantly accounted for variability of the effect sizes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The alliance-outcome correlation of the bond subscale (r = 0.16) was significantly different from that of the task subscale (r = 0.28), QM(3) = 26.85, p < 0.001.

    “Regarding the differences of the allianceoutcome correlations among the separate WAI subscales, the results indicated a significant difference between the alliance-outcome correlation of the bond subscale (r bond = 0.16) and the task subscale (r task = 0.28) with QM(3) = 26.85,p < 0.001.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Andersson et al., 2015, the alliance-outcome effect size was r = 0.19 (n = 94) for OCD treated with ICBT, measured with WAI-S and Y-BOCS.

    “| Andersson et al., 2015 | OCD | ICBT | 10 | WAI-S | Y-BOCS | 0.19 94 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andersson et al., 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The WAI subscale analysis was based on 9 studies with 13 independent samples and 517 participants.

    “The investigation of the relation between the separate WAI subscales and therapy outcome was based on 9 studies with 13 independent samples and a total of 517 participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Andersson et al., 2012 (c), the alliance-outcome effect size was r = 0.13 (n = 35) for GAD treated with ICBT, measured with WAI-S and PSWQ.

    “| Andersson et al., 2012 (c) | GAD | ICBT | 8 | WAI-S | PSWQ | 0.13 35 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andersson et al., 2012 (c)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Andersson et al., 2012 (b), the alliance-outcome effect size was r = 0.20 (n = 24) for depression treated with ICBT, measured with WAI and BDI.

    “| Andersson et al., 2012 (b) | depression | ICBT | 8 | WAI | BDI | 0.20 24 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andersson et al., 2012 (b)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Andersson et al., 2012 (d), the alliance-outcome effect size was r = 0.10 (n = 90) for SAD treated with ICBT, measured with WAI-S and LSAS-SR.

    “| Andersson et al., 2012 (d) | SAD | ICBT | 9 | WAI-S | LSAS-SR | 0.10 90 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andersson et al., 2012 (d)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Berger et al., 2014 (a), the alliance-outcome effect size was r = 0.41 (n = 40) for anxiety disorders treated with standardized, disorder-specific ICBT, measured with WAI-SR and BAI.

    “| Berger et al., 2014 (a) | anxiety disorders | ICBT (standardized, | 8 | WAI-SR | BAI | 0.41 40 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Berger et al., 2014 (a)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Bergman et al., 2013, the alliance-outcome effect size was r = 0.47 (n = 25) for anxiety disorders treated with tailored ICBT, measured with WAI-S and CORE-OM.

    “| Bergman et al., 2013 | anxiety disorders | ICBT (tailored) | 10 | WAI-S | CORE-OM | 0.47 25 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bergman et al., 2013

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The analysis of face-to-face contact as a moderator yielded no significant moderation but showed a tendency consistent with the assumption that face-to-face contact positively affects the alliance-outcome relation.

    “This analysis yielded no significant moderation, but showed a tendency consistent with the assumption (Table 3).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The meta-analysis included 23 effect sizes (k = 23).

    “including all effect sizes (k = 23)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Greene et al., 2010, the alliance-outcome effect size was r = 0.35 (n = 112) for PTSD treated with anger management group therapy (CBT), measured with GTAS and STAXI-2 (anger expression subscale).

    “| Greene et al., 2010 | PTSD | anger management group | 12 | GTAS | STAXI-2 (anger expression | 0.35 112 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Greene et al., 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Berger et al., 2014 (b), the alliance-outcome effect size was r = 0.02 (n = 39) for anxiety disorders treated with tailored ICBT, measured with WAI-SR and BAI.

    “| Berger et al., 2014 (b) | anxiety disorders | ICBT (tailored) | 8 | WAI-SR | BAI | 0.02 39 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Berger et al., 2014 (b)

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The meta-analysis resulted in alliance-outcome correlations that differed significantly and distinctly from zero, both for the overall summary effect and for the separate subscales.

    “The meta-analysis resulted in alliance-outcome correlations that differed significantly and distinctly from zero, both for the overall summary effect and for the separate subscales.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All included studies belonged to cognitive behavior therapy (CBT) as the therapy approach, and in 20 out of 23 independent samples the WAI or a revised version was used as the alliance measure instrument.

    “All included studies belonged to cognitive behavior therapy (CBT) as the therapy approach, and in 20 out of 23 independent samples the WAI, respectively WAI-S or a revised version of the WAI, was used as the alliance measure instrument.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Dölemeyer et al., 2013, the alliance-outcome effect size was r = 0.26 (n = 49) for binge eating treated with ICBT, measured with WAI-S and EDE-Q, number of binge eating attacks.

    “| Dölemeyer et al., 2013 | binge eating | ICBT | 16 | WAI-S | EDE-Q, number of binge | 0.26 49 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dölemeyer et al., 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the independent sample Hedman et al., 2015, the alliance-outcome effect size was r = 0.21 (n = 151) for hypochondriasis treated with ICBT, measured with WAI-SR and HAI.

    “| Hedman et al., 2015 | hypochondriasis | ICBT | 12 | WAI-SR | HAI | 0.21 151 |”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hedman et al., 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The methodological conception of the present meta-analysis was conducted according to the MAP-24 checklist.

    “The methodological conception of the present meta-analysis was conducted according to the MAP-24 checklist [Flückiger et al., 2018a].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Flückiger et al., 2018a

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Findings for internet-based interventions, especially guided self-help approaches, indicate medium to large effects equivalent to face-to-face interventions.

    “Regarding the efficacy of internet-based interventions for psychological problems and disorders, findings, especially for guided self-help approaches, indicate medium to large effects which are equivalent to faceto-face interventions [Barak et al., 2008;Wagner and Maercker, 2011;Klasen et al., 2013;Andersson et al., 2014;Wagner et al., 2014;Berger, 2015;Carlbring et al.,”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Barak et al., 2008

      Not checked in the free run.

    • cites Wagner and Maercker, 2011

      Not checked in the free run.

    • cites Klasen et al., 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The literature search was based on an already conducted literature search of Flückiger et al. [2018b].

    “The literature search was based on an already conducted literature search of Flückiger et al. [2018b].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Flückiger et al., 2018b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The most used alliance measure instrument is the Working Alliance Inventory (WAI).

    “Out of the big amount of alliance measure instruments, the most used alliance measure is the Working Alliance Inventory (WAI) [Flückiger et al., 2018b].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Flückiger et al., 2018b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several systematic reviews and meta-analyses indicate a superiority of guided self-help over unguided self-help regarding efficacy.

    “Furthermore, several systematic reviews and metaanalyses indicate a superiority of guided self-help over unguided self-help regarding efficacy [Palmqvist et al., 2007;Spek et al., 2007;Baumeister et al., 2014].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Palmqvist et al., 2007

      Not checked in the free run.

    • cites Spek et al., 2007

      Not checked in the free run.

    • cites Baumeister et al., 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The overall weighted average effect size for the alliance-outcome association in face-to-face psychotherapy is r = 0.28, indicating alliance as a very robust predictor of treatment outcome.

    “The overall weighted average effect size of r = 0.28 for the alliance-outcome association indicates the alliance as a very robust predictor of treatment outcome and supports the pantheoretical conception of the alliance empirically [Norcross and Lambert, 2011;Flückiger et al., 2012;Norcross and Lambert, 2018].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Norcross and Lambert, 2011

      Not checked in the free run.

    • cites Flückiger et al., 2012

      Not checked in the free run.

    • cites Norcross and Lambert, 2018

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In face-to-face psychotherapies, the alliance-outcome relation was higher when the outcome measure was not disorder-specific but a general symptom measure and when alliance was measured later in therapy.

    “The relation between alliance and outcome was higher when the outcome measure was not disorder-specific but a general symptom measure and when the alliance was measured later in the therapy process.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Flückiger et al., 2018b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In face-to-face interventions, the time of alliance assessment was a significant moderator of the alliance-outcome relation.

    “The time of the alliance assessment also turned out to be a significant moderator variable of the relation between alliance and outcome in face-to-face interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Flückiger et al., 2018b

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premiseown data

    Recent studies hypothesize that agreements on therapeutic goals and consensus on tasks show higher predictability for treatment outcome of guided self-help approaches than the bond between client and therapist.

    “Regarding the analysis of the WAI subscales, recent studies hypothesize that the agreements on the therapeutic goals and the consensus on the tasks that make up therapy show higher predictability for treatment outcome of guided self-help approaches than the bond between the client and the therapist [Knaevelsrud and Maercker, 2006;Berger et al., 2014;Knaevelsrud et al., 2015;Meyer et al., 2015;Berg”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Knaevelsrud and Maercker, 2006

      Not checked in the free run.

    • cites Berger et al., 2014

      Not checked in the free run.

    • cites Berger, 2017

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mixed results exist regarding the influence of age on treatment outcome.

    “Mixed results exist regarding the influence of age on treatment outcome [Barak et al., 2008;Karyotaki et al., 2018].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Barak et al., 2008

      Not checked in the free run.

    • cites Karyotaki et al., 2018

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The publication bias examination resulted in no studies to be augmented to the observed data, so the funnel plot is more symmetric.

    “The examination of publication bias resulted in no studies to be augmented to the observed data so that the funnel plot is more symmetric.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The category of late alliance assessment was not included in the analysis due to the random selection procedure conducted.

    “In addition, it should be taken into account that the category of late alliance assessment was not included in the analysis due to the random selection procedure conducted.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The possibility to do the internet-based intervention at home in a familiar environment could implicate a sense of freedom, anonymity, and being yourself.

    “The possibility to do the internet-based intervention at home in a familiar environment could implicate a sense of freedom, anonymity, and being yourself [Gerhards et al., 2011].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gerhards et al., 2011

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The three categories of the amount of therapeutic contact moderator consist of different numbers of independent samples, which calls for caution in interpreting the result.

    “The fact that the three categories consist of a different number of independent samples deriving from the included studies calls for caution interpreting this result.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A random sample of 20% of the coding was coded by a second rater to evaluate interrater reliability, resulting in 96% accordance.

    “A random sample of the coding (20%) was coded by a second rater to evaluate the interrater reliability, resulting in an accordance of 96%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There are indications for a differential effect of the amount of therapeutic contact on the alliance-outcome relation, although meta-analytic confirmation of such interaction effects is lacking.

    “There are indications for the existence of a differential effect regarding the amount of therapeutic contact as moderator variable for the relation between alliance and treatment outcome [Berger et al., 2009[Berger et al., , 2011;;Berger, 2017], even though so far it has not been possible to confirm such interaction effects meta-analytically in the literature [Wampold et al., 2018].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Berger et al., 2009

      Not checked in the free run.

    • cites Berger, 2017

      Not checked in the free run.

    • cites Wampold et al., 2018

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    In face-to-face interventions, the alliance-outcome relation was higher when the alliance was measured later in the therapy process.

    “The alliance-outcome relation was higher when the alliance was measured later in the therapy process [Flückiger et al., 2018b].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Flückiger et al., 2018b

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    The homogeneity of the cultural context and the focus on CBT as a therapeutic approach restrict the generalizability of the results.

    “The homogeneity of the cultural context and the focus on CBT as a therapeutic approach also restrict the generalizability of the results.”
    Quote in the paperNot a substantial claim
40 of 40

  • The authors state this as an assumption.

    A face-to-face contact is conducive to building a therapeutic relationship and hence could moderate the relationship between alliance and outcome.

    “Beyond that, it is assumed that a face-to-face contact is conducive to the building of a therapeutic relationship and hence could moderate the relationship between alliance and outcome.”

  • The authors state this as an assumption.

    The moderating influences found in face-to-face psychotherapies also play a role in internet-based interventions.

    “It is assumed that these moderating influences also play a role in internet-based interventions.”

  • The authors state this as an assumption.

    Between-study variance is not due only to sampling error.

    “Regarding the distribution of the individual effect sizes, it is assumed that between-study variance is not due only to sampling error, wherefore a random-effects model was selected for calculating the summary effect.”

  • The authors state this as an assumption.

    An unstructured variance-covariance matrix is assumed for the variance structure within studies.

    “Regarding the specification of the variance structure within studies, an unstructured variance-covariance matrix is assumed.”

  • The authors state this as an assumption.

    The quality of the alliance and the relationship concepts behind internet-based communication may differ qualitative-conceptually.

    “Therefore, it is assumed that the quality of the alliance and the relationship concepts behind internet-based communication may differ qualitative-conceptually, even though the underlying items seems to be judgable over different settings.”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: Qb(3) = 4.43, p = .11

    Minor

    The paper reports p = .11 here; recomputing from the test statistic and its degrees of freedom gives p = .219. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .11 · recomputed p = .219

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upQ(3) = 4.43reported p = .11 · recomputed p = .219

    “Qb(3) = 4.43, p = .11”

  • ConsistentQ(22) = 25.1reported p = .29 · recomputed p = .292

    “Q(22) = 25.10,p = .29”

  • ConsistentQ(2) = 2.08reported p = .35 · recomputed p = .353

    “Qb(2) = 2.08, p = .35”

  • ConsistentQ(1) = 1.62reported p = .2 · recomputed p = .203

    “Qb(1) = 1.62, p = .20”

  • ConsistentQ(1) = 0.21reported p = .64 · recomputed p = .647

    “Qb(1) = 0.21, p = .64”

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Time-of-assessment moderator has an inconsistent degrees of freedom

    Minor

    The table has only three populated assessment-time categories because the late category has no samples. A comparison among three categories has 2, not 3, degrees of freedom; the reported p = 0.11 for Q = 4.43 is also consistent with 2 degrees of freedom.

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Authors
Probst, G. H., Berger, T., & Flückiger, C.
Affiliations
  • University of Zurich (CH)
  • University of Bern (CH)
ORCID
Venue
Verhaltenstherapie
Publisher
S. Karger AG
Published
2019-10-10
Volume
32
Issue
Suppl. 1
Pages
135-146
ISSN
  • 1016-6262 (ISSN-L)
  • 1423-0402
DOI
10.1159/000503432
OpenAlex
W2980345039
Semantic Scholar
37db80e3f9dceb2030340c3c4e25a4528757ef1a
Cited by
54
References
55
Citations by year
2026: 5 · 2025: 6 · 2024: 13 · 2023: 5 · 2022: 7 · 2021: 14 · 2020: 4
FWCI
7.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Verhaltenstherapie (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • BORIS (University Library Bern) (submittedVersion, cc-by)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
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, online intervention, online therapy, treatment outcomes, mental illness, predictors of treatment outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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