Background: The role of working alliance remains unclear for many forms of internet-based interventions (IBIs), a set of effective psychotherapy alternatives that do not require synchronous interactions between patients and therapists. Objective: This study examined the conceptual invariance, trajectories, and outcome associations of working alliance across an unguided IBI and guided IBIs that incorporated clinician support through asynchronous text messaging or video messaging. Methods: Adults with high education attainment (n=145) with subclinical levels of anxiety, stress, or depressive symptoms were randomized to 1 of 3 treatment conditions for 7 weeks. All participants received treatments from MyCompass, an unguided IBI using cognitive behavior therapy. Participants in condition 2 and 3 received supplemental, asynchronous clinician support through text and video, respectively. Working alliance with the IBIs was measured weekly using select items from the 12-item version of the Agnew Relationship Measure. Symptom and functional outcomes were assessed at baseline, at the end of treatment, and 1-month follow-up. Results: Working alliance with the IBIs was conceptually invariant across the 3 conditions. Working alliance followed a quadratic pattern of change over time for all conditions and declined significantly only in the text-support condition. After controlling for baseline symptoms, higher baseline levels of working alliance predicted less depression and less functional impairment at follow-up, whereas faster increases in working alliance predicted less worry at the end of treatment and at follow-up, all of which only occurred in the video-support condition. Conclusions: Working alliance with the IBIs was generally established in the initial sessions. Although working alliance is conceptually invariant across IBIs with or without clinician support, the associations between working alliance and treatment outcomes among IBIs may differ depending on clinician involvement and the modalities of support. Trial Registration: ClinicalTrials.gov NCT05122429; https://clinicaltrials.gov/ct2/show/NCT05122429

中文翻译：

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无指导和有指导的基于互联网的心理干预中工作联盟的概念不变性、轨迹和结果关联：随机对照试验的二次分析

背景：对于许多形式的基于互联网的干预 (IBI)，工作联盟的作用仍不清楚，这是一组有效的心理治疗替代方案，不需要患者和治疗师之间的同步互动。目的：本研究检查了在非引导 IBI 和引导 IBI 中工作联盟的概念不变性、轨迹和结果关联，这些 IBI 通过异步文本消息或视频消息包含临床医生的支持。方法：具有亚临床水平的焦虑、压力或抑郁症状的受教育程度高的成年人 (n=145) 被随机分配到 3 种治疗条件中的 1 种，为期 7 周。所有参与者都接受了 MyCompass 的治疗，这是一种使用认知行为疗法的无引导 IBI。条件 2 和条件 3 的参与者分别通过文本和视频获得补充的异步临床医生支持。每周使用从 Agnew 关系测量的 12 项版本中选择的项目来测量与 IBI 的工作联盟。在基线、治疗结束和 1 个月随访时评估症状和功能结果。结果：与 IBI 的工作联盟在 3 个条件下在概念上是不变的。工作联盟在所有条件下都遵循随时间变化的二次模式，并且仅在文本支持条件下显着下降。在控制基线症状后，较高的工作联盟基线水平预示着随访时的抑郁症和功能障碍较少，而工作联盟的较快增加预示着治疗结束和随访时的担忧较少，所有这些仅发生在视频支持条件。结论：与 IBI 的工作联盟通常在最初的会议上建立。尽管有或没有临床医生支持的 IBI 之间的工作联盟在概念上是不变的，但 IBI 之间的工作联盟和治疗结果之间的关联可能会因临床医生的参与和支持的方式而有所不同。试验注册： ClinicalTrials.gov NCT05122429；https://clinicaltrials.gov/ct2/show/NCT05122429