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Blended Cognitive Behavioral Therapy Shows Promising Results for Depression

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The integration of digital mental health programs with traditional face-to-face therapy has been a topic of keen interest, particularly in enhancing the therapeutic alliance between clients and therapists. This study delves into the comparative effectiveness of blended cognitive behavioral therapy (bCBT) versus treatment as usual (TAU) for individuals diagnosed with major depressive disorder. Conducted across nine European countries, the research offers a comprehensive analysis of how combining digital and traditional therapy can influence clinical outcomes and the working alliance.

The study’s primary aim was to examine differences in working alliance scores between bCBT and TAU, and to assess the correlation between these scores and depression severity. Additionally, it explored the interaction between system usability and the working alliance in the bCBT group at the three-month mark.

Study Design and Methods

Researchers performed a secondary data analysis of the E-COMPARED trial, which included 945 participants aged 18 and above, all diagnosed with major depressive disorder. Participants were randomly assigned to either the bCBT (476) or TAU (467) groups. The bCBT intervention included 6-20 sessions combining face-to-face therapy with an internet-based program, whereas TAU involved routine care for depression. Data were collected from primary care and specialized services between April 2015 and December 2017.

The main metrics evaluated were the working alliance (measured by the Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (measured by the Patient Health Questionnaire-9 [PHQ-9]) at three months post-randomization. System usability scores (System Usability Scale-Client [SUS-C]) were also recorded and analyzed using linear regression models adjusted for baseline variables.

Key Findings

Results indicated that bCBT was associated with significantly higher WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). Additionally, an inverse relationship was found between WAI-SR-C and PHQ-9 scores in both groups, suggesting that higher working alliance scores correlated with reduced depression severity. Notably, a significant interaction was observed between SUS-C and WAI-SR-C in the bCBT group, indicating that better system usability further enhanced the positive impact of the working alliance on clinical outcomes (b=-0.030, 95% CI -0.05 to -0.01; P=.005).

User-Usable Inferences

  • bCBT can significantly enhance the therapeutic working alliance compared to traditional care.
  • Higher working alliance scores are linked to lower depression severity.
  • Good usability of digital components boosts the effectiveness of bCBT.

The study concludes that integrating internet-delivered CBT with face-to-face therapy can substantially improve the therapeutic alliance and clinical outcomes for depression. Enhanced system usability of digital programs further augments these benefits, highlighting the importance of user-friendly digital interfaces in blended mental health interventions.

These findings underscore the potential for blended therapy models to provide more effective mental health care, offering a promising alternative to traditional therapy alone.

Original Article: J Med Internet Res. 2024 May 31;26:e47515. doi: 10.2196/47515.

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