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Cited by 74Digital Mental Health InterventionsPsychotherapy Techniques and ApplicationsMindfulness and Compassion Interventions

Alliance with an unguided smartphone app: validation of the digital working alliance inventory

Open access
Goldberg, Simon B., Baldwin, Scott A., Riordan, Kevin M., Torous, John, Dahl, Cortland J., Davidson, Richard J., Hirshberg, Matthew J.·2022·Assessment
DOI 10.1177/10731911211015310PMC PMC8599525
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Abstract

The working alliance may be relevant in unguided smartphone-based interventions, but no validated measure exists. We evaluated the psychometric properties of the six-item Digital Working Alliance Inventory (DWAI) using a cross-sectional survey of meditation app users ( n = 290) and the intervention arm of a randomized trial testing a smartphone-based meditation app ( n = 314). Exploratory factor analysis suggested a single-factor solution which was replicated using longitudinal confirmatory factor analysis. The DWAI showed adequate internal consistency and test–retest reliability. Discriminant validity was supported by a lack of association with social desirability, psychological distress, and preference for a waitlist condition. Convergent validity was supported by positive associations with perceived app effectiveness and preference for an app condition. Supporting predictive validity, DWAI scores positively predicted self-reported and objective app utilization. When assessed at Weeks 3 or 4 of the intervention, but not earlier, DWAI scores predicted pre–post reductions in psychological distress.

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Crossref · 10.1177/10731911211015310

Cites

65 of 65 references verified0 citation errors · 0 not checkable

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  • Previous studies did not show consistent and reliable correlations between DTA and clinical outcomes in the context of fully automated apps.

    “In addition, previous studies did not show consistent and reliable correlations between DTA and clinical outcomes in the context of fully automated apps (14, 49).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [49]

    The Results > Validity section reports that alliance scores in this unguided app predicted reduced psychological distress at Weeks 3 and 4, but not at Weeks 1 and 2, supporting a narrower point about inconsistency over time. The Alliance in Mobile Health section does not establish that previous studies of fully automated apps generally lacked reliable correlations; it says several earlier studies found the expected alliance–outcome association and notes that prior unguided interventions included human support or a virtual therapist. Page numbers are unavailable in our copy. (LLM, conf=0.79)

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  • The Mobile Agnew Relationship Measure (mARM) and the Digital Working Alliance Inventory (DWAI) have been proposed to measure the DTA in fully automated mental health apps.

    “In addition, two measurements, the Mobile Agnew Relationship Measure (mARM) (48) and the Digital Working Alliance Inventory (DWAI) (49) have been proposed to measure the DTA in fully automated mental health apps.”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [49]

  • Goldberg et al. assessed the DTA by using the DWAI in fully automated meditation apps and found that DWAI scores at weeks 3 or 4 only correlated with reductions in psychological distress (βs = −0.17 and −0.13).

    “Goldberg et al. (49) assessed the DTA by using the DWAI in fully automated meditation apps and found that DWAI scores at weeks 3 or 4 only correlated with reductions in psychological distress (βs = −0.17 and −0.13).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [49]

  • Goldberg et al. found that in fully automated meditation apps, DWAI scores significantly positively related to app utilization, which was measured by either self-reported user frequency (r = 0.42) or usage data gathered from the app (rs = 0.17-0.22).

    “Goldberg et al. (49) found that in fully automated meditation apps, DWAI scores significantly positively related to app utilization, which was measured by either self-reported user frequency (r = 0.42) or usage data gathered from the app (rs = 0.17–0.22).”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [49]

  • Goldberg et al. adopted self-report usage frequency as engagement in study 1, and adopted usage data in study 2.

    “In addition, Goldberg et al. (49) adopted self-report usage frequency as engagement in study 1, and adopted usage data in study 2.”

    From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [49]

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Research works printed but not linked: 2

  1. Cohen S, & Williamson G (1988). Perceived stress in a probability sample of the United States. In Spacapan S & Oskamp S (Eds.), The social psychology of health: Claremont Symposium on Applied Social Psychology (pp. 31– 67). Newbury Park, CA: Sage.
  2. Muthén LK, & Muthén BO (1998–2017). Mplus User’s Guide. Eight Edition. Los Angeles, CA: Muthén & Muthén.

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Authors
Goldberg, S. B., Baldwin, S. A., Riordan, K. M., Torous, J., Dahl, C. J., Davidson, R. J., & Hirshberg, M. J.
Affiliations
  • University of Wisconsin–Madison (US)
  • Brigham Young University (US)
  • Harvard University (US)
Corresponding author
Goldberg, Simon B.
ORCID
Venue
Assessment
Publisher
SAGE Publications
Published
2021-05-18
Volume
29
Issue
6
Pages
1331-1345
ISSN
  • 1073-1911 (ISSN-L)
  • 1552-3489
DOI
10.1177/10731911211015310
PMC
PMC8599525
OpenAlex
W3161767528
Cited by
74
References
64
Citations by year
2026: 14 · 2025: 23 · 2024: 10 · 2023: 17 · 2022: 10
FWCI
8.22
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Assessment (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Center for Advancing Translational Sciences (UL1TR002373)
  • National Center for Complementary and Integrative Health (K23AT010879)
  • Chan Zuckerberg Initiative (2020-218037)
  • National Institute of Mental Health (R01MH43454)
  • National Academy of Education (Spencer Postdoctoral Fellowship)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
therapeutic relationship, mobile application, meditation apps, psychometric validation, factor structure, psychological distress, digital mental health interventions
MeSH terms
Smartphone, Cross-Sectional Studies, Humans, Psychometrics, Reproducibility of Results, Mobile Applications

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