Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial.
Study Goal
The researchers aimed to explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, compare the development of therapeutic alliance in both conditions, and examine its relationship with psychological distress reduction and mental well-being improvement.
Results Summary
The study found that therapeutic alliance develops similarly in eMBCT and MBCT, early alliance did not predict dropout, and stronger alliance predicted reduced psychological distress and increased mental well-being in both conditions, with a stronger relationship in group-based MBCT.
Population
Distressed cancer patients
Effective Dosage
Not specified
Duration
9 weeks
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Mindfulness-based cognitive therapy (MBCT) | decrease | depressive and anxiety symptoms | oncology | - | resulting in reduction | #1 |
Internet-based MBCT (eMBCT) | neutral | - | - | - | has been found to be an effective alternative | #2 |
therapeutic alliance | increase | psychological treatment outcomes | - | - | is known to have a significant impact | #3 |
therapeutic alliance | no change | treatment dropout | distressed cancer patients | - | did not predict treatment dropout | #4 |
therapeutic alliance | increase | therapeutic alliance | distressed cancer patients | - | increased over time | #5 |
therapeutic alliance | decrease | psychological distress | distressed cancer patients | - | predicted reduced psychological distress | #6 |
therapeutic alliance | increase | mental well-being | distressed cancer patients | - | predicted increased mental well-being | #7 |
therapeutic alliance | increase | treatment outcome | - | - | appeared to be more related to treatment outcome | #8 |
BACKGROUND: Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs. OBJECTIVE: This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions. METHODS: This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form. RESULTS: The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=-.39; P=.21). Therapeutic alliance increased over time in both conditions (F CONCLUSIONS: A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT. TRIAL REGISTRATION: ClinicalTrials.gov NCT02138513; https://clinicaltrials.gov/ct2/show/NCT02138513.