%0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64959 %T Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies %A Snipes,Cassandra %A Dorner‑Ciossek,Cornelia %A Hare,Brendan D %A Besedina,Olya %A Campellone,Tim %A Petrova,Mariya %A Lakhan,Shaheen E %A Pratap,Abhishek %+ Boehringer Ingelheim International GmbH, Binger Straße 173, Ingelheim am Rhein, 55216, Germany, 49 (7351) 54 97758, cornelia.dorner-ciossek@boehringer-ingelheim.com %K therapeutic alliance %K digital working alliance %K experiential negative symptoms %K schizophrenia %K digital therapeutics %K digital literacy %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Evidence-based digital therapeutics represent a new treatment modality in mental health, potentially providing cost-efficient, accessible means of augmenting existing treatments for chronic mental illnesses. CT-155/BI 3972080 is a prescription digital therapeutic under development as an adjunct to standard of care treatments for patients 18 years of age and older with experiential negative symptoms (ENS) of schizophrenia. Individual components of CT-155/BI 3972080 are designed based on the underlying principles of face-to-face treatment. A positive therapeutic alliance between patients and health care providers is linked with improved clinical outcomes in mental health. Likewise, establishing a similar therapeutic alliance with a digital therapeutic (ie, digital working alliance [DWA]) may be important for engagement and treatment effectiveness of this modality. Objective: This study aimed to investigate the establishment and maintenance of a DWA between a beta version of CT-155/BI 3972080 (CT-155 beta) and adults with ENS of schizophrenia. Methods: Two multicenter, exploratory, single-arm studies (study 1: CT-155-C-001 and study 2: CT-155-C-002) enrolled adults with schizophrenia and ENS receiving stable antipsychotic medication (≥12 weeks). Participants had access to CT-155 beta and were presented with daily in-app activities during a 3-week orientation phase that included lessons designed to facilitate building of a DWA. In study 2, the 3-week orientation phase was followed by an abbreviated active 4-week phase. Digital literacy at baseline was evaluated using the Mobile Device Proficiency Questionnaire (MDPQ). The mobile Agnew Relationship Measure (mARM) was used to assess DWA establishment after 3 weeks in both studies, and after 7 weeks in study 2 to assess DWA maintenance. Participant safety, digital literacy, and correlations between negative symptom severity and DWA were assessed in both studies. Results: Of the enrolled participants, 94% (46/49) and 86% (43/50) completed studies 1 and 2, respectively. Most were male (study 1: 71%, 35/49; study 2: 80%, 40/50). The baseline digital literacy assessed through MDPQ score was comparable in both studies (study 1: mean 30.56, SD 8.06; study 2: mean 28.69, SD 8.31) indicating proficiency in mobile device use. After 3 weeks, mARM scores (study 1: mean 5.16, SD 0.8; study 2: mean 5.36, SD 1.06) indicated that a positive DWA was established in both studies. In study 2, the positive DWA established at week 3 was maintained at week 7 (mARM: mean 5.48, SD 0.97). There were no adverse events (AEs) in study 1, and 3 nonserious and nontreatment-related AEs in study 2. Conclusions: A positive DWA was established between participants and CT-155 beta within 3 weeks. The second 7-week study showed maintenance of the DWA to the end of the study. Results support the establishment and maintenance of a DWA between adults with ENS of schizophrenia and a beta version of CT-155/BI 3972080, a prescription digital therapeutic under development to target these symptoms. Trial Registration: Clinicaltrials.gov NCT05486312; https://clinicaltrials.gov/study/NCT05486312 %M 39869902 %R 10.2196/64959 %U https://mental.jmir.org/2025/1/e64959 %U https://doi.org/10.2196/64959 %U http://www.ncbi.nlm.nih.gov/pubmed/39869902 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e31385 %T The Digital Therapeutic Alliance: Prospects and Considerations %A Lederman,Reeva %A D'Alfonso,Simon %+ School of Computing and Information Systems, The University of Melbourne, Melbourne Connect, 700 Swanston Street, Carlton, 3053, Australia, 61 390355511, dalfonso@unimelb.edu.au %K therapeutic alliance %K digital therapeutic alliance %K digital mental health %K mental health apps %K teletherapy %K chatbots %D 2021 %7 20.7.2021 %9 Editorial %J JMIR Ment Health %G English %X The growing prevalence of digital approaches to mental health care raises a range of questions and considerations. A notion that has recently emerged is that of the digital therapeutic alliance, prompting consideration of whether and how the concept of therapeutic alliance, which has proven to be a central ingredient of successful traditional psychotherapy, could translate to mental health care via digital technologies. This special issue editorial article outlines the topic of digital therapeutic alliance and introduces the five articles that comprise the special issue. %M 34283035 %R 10.2196/31385 %U https://mental.jmir.org/2021/7/e31385 %U https://doi.org/10.2196/31385 %U http://www.ncbi.nlm.nih.gov/pubmed/34283035 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e25998 %T Impact of Jointly Using an e–Mental Health Resource (Self-Management And Recovery Technology) on Interactions Between Service Users Experiencing Severe Mental Illness and Community Mental Health Workers: Grounded Theory Study %A Williams,Anne %A Fossey,Ellie %A Farhall,John %A Foley,Fiona %A Thomas,Neil %+ Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, PO Box 218, Hawthorn, Melbourne, 3122, Australia, 61 92144415, annewilliams@swin.edu.au %K digital mental health %K tablet computers %K therapeutic relationship %K recovery narratives %K lived experience video %K personal recovery %K schizophrenia %K mobile phone %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: e–Mental health resources are increasingly available for people who experience severe mental illness, including those who are users of community mental health services. However, the potential for service users (SUs) living with severe mental illness to use e–mental health resources together with their community mental health workers (MHWs) has received little attention. Objective: This study aims to identify how jointly using an interactive website called Self-Management And Recovery Technology (SMART) in a community mental health context influenced therapeutic processes and interactions between SUs and MHWs from their perspective. Methods: We conducted a qualitative study using a constructivist grounded theory methodology. Data were collected through individual semistructured interviews with 37 SUs and 15 MHWs who used the SMART website together for 2 to 6 months. Data analysis involved iterative phases of coding, constant comparison, memo writing, theoretical sampling, and consultation with stakeholders to support the study’s credibility. Results: A substantive grounded theory, discovering ways to keep life on track, was developed, which portrays a shared discovery process arising from the SU-worker-SMART website interactions. The discovery process included choosing to use the website, revealing SUs’ experiences, exploring these experiences, and gaining new perspectives on how SUs did and could keep their lives on track. SUs and MHWs perceived that their three-way interactions were enjoyable, beneficial, and recovery focused when using the website together. They experienced the shared discovery process as relationship building—their interactions when using the website together were more engaging and equal. Conclusions: Jointly using an e–mental health resource elicited recovery-oriented interactions and processes between SUs and MHWs that strengthened their therapeutic relationship in real-world community mental health services. Further work to develop and integrate this novel use of e–mental health in community mental health practice is warranted. %M 34132647 %R 10.2196/25998 %U https://mental.jmir.org/2021/6/e25998 %U https://doi.org/10.2196/25998 %U http://www.ncbi.nlm.nih.gov/pubmed/34132647 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e19004 %T A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review %A Cataldo,Francesco %A Chang,Shanton %A Mendoza,Antonette %A Buchanan,George %+ School of Computing and Information Systems, University Of Melbourne, Parkville, VIC, Melbourne, 3010, Australia, 61 444 574 920, fcataldo@student.unimelb.edu.au %K videoconference %K psychotherapy %K professional-patient relations %K client-psychologist relationships %K therapeutic alliance %K telehealth %K mobile phone %D 2021 %7 19.2.2021 %9 Review %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. Objective: This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. Methods: We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. Results: Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. Conclusions: It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients. %M 33605891 %R 10.2196/19004 %U http://mental.jmir.org/2021/2/e19004/ %U https://doi.org/10.2196/19004 %U http://www.ncbi.nlm.nih.gov/pubmed/33605891 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e21895 %T The Digital Therapeutic Alliance and Human-Computer Interaction %A D'Alfonso,Simon %A Lederman,Reeva %A Bucci,Sandra %A Berry,Katherine %+ School of Computing and Information Systems, University of Melbourne, Doug McDonell Building, Parkville, 3010, Australia, 61 3 9035 5511, dalfonso@unimelb.edu.au %K therapeutic alliance %K digital mental health %K affective computing %K persuasive computing %K positive computing %K mobile phone %K mHealth %D 2020 %7 29.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps. %M 33372897 %R 10.2196/21895 %U http://mental.jmir.org/2020/12/e21895/ %U https://doi.org/10.2196/21895 %U http://www.ncbi.nlm.nih.gov/pubmed/33372897 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e17204 %T The Therapeutic Alliance in Digital Mental Health Interventions for Serious Mental Illnesses: Narrative Review %A Tremain,Hailey %A McEnery,Carla %A Fletcher,Kathryn %A Murray,Greg %+ Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, John St, Hawthorn, 3122, Australia, 61 4039966 9100, htremain@swin.edu.au %K mental health %K mHealth %K eHealth %K telehealth %K psychosis %K bipolar disorder %K mobile phone %D 2020 %7 7.8.2020 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health interventions offer unique advantages, and research indicates that these interventions are effective for a range of mental health concerns. Although these interventions are less established for individuals with serious mental illnesses, they demonstrate significant promise. A central consideration in traditional face-to-face therapies is the therapeutic alliance, whereas the nature of a digital therapeutic alliance and its relationship with outcomes requires further attention, particularly for individuals with serious mental illnesses. Objective: This narrative review aims to encourage further consideration and critical evaluation of the therapeutic alliance in digital mental health, specifically for individuals with serious mental illnesses. Methods: A narrative review was conducted by combining 3 main areas of the literature: the first examining the evidence for digital mental health interventions for serious mental illnesses, the second illuminating the nature and role of the therapeutic alliance in digital interventions, and the third surrounding practical considerations to enhance a digital therapeutic alliance. Results: Results indicated that a therapeutic alliance can be cultivated in digital interventions for those with serious mental illnesses, but that it may have unique, yet-to-be-confirmed characteristics in digital contexts. In addition, a therapeutic alliance appears to be less directly associated with outcomes in digital interventions than with those in face-to-face therapies. One possibility is that the digital therapeutic alliance is associated with increased engagement and adherence to digital interventions, through which it appears to influence outcomes. A number of design and implementation considerations may enhance the digital therapeutic alliance, including human support and technological features. Conclusions: More research is required to further understand the nature and specific role of a therapeutic alliance in digital interventions for serious mental illnesses, particularly in informing their design. This review revealed several key research priorities to advance the therapeutic alliance in digital interventions. %M 32763881 %R 10.2196/17204 %U https://mental.jmir.org/2020/8/e17204 %U https://doi.org/10.2196/17204 %U http://www.ncbi.nlm.nih.gov/pubmed/32763881 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e18990 %T Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study %A Valentine,Lee %A McEnery,Carla %A Bell,Imogen %A O'Sullivan,Shaunagh %A Pryor,Ingrid %A Gleeson,John %A Bendall,Sarah %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Rd, Melbourne, 3052, Australia, 61 17398175, lee.valentine@orygen.org.au %K Blended Treatment %K Psychotic Disorders %K Digital Intervention %K Adolescent %K Young Adults %K mHealth %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: A small number of studies have found that digital mental health interventions can be feasible and acceptable for young people experiencing first-episode psychosis; however, little research has examined how they might be blended with face-to-face approaches in order to enhance care. Blended treatment refers to the integration of digital and face-to-face mental health care. It has the potential to capitalize on the evidence-based features of both individual modalities, while also exceeding the sum of its parts. This integration could bridge the online–offline treatment divide and better reflect the interconnected, and often complementary, ways young people navigate their everyday digital and physical lives. Objective: This study aimed to gain young people’s perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment. Methods: This qualitative study was underpinned by an end-user development framework and was based on semistructured interviews with 10 participants aged 19 to 28 (mean 23.4, SD 2.62). A thematic analysis was used to analyze the data. Results: Three superordinate themes emerged relating to young people’s perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment: (1) blended features, (2) cautions, and (3) therapeutic alliance. Conclusions: We found that young people were very enthusiastic about the prospect of blended models of mental health care, in so far as it was used to enhance their experience of traditional face-to-face treatment but not to replace it overall. Aspects of blended treatment that could enhance clinical care were readily identified by young people as increasing accessibility, continuity, and consolidation; accessing posttherapy support; strengthening the relationship between young person and clinician; and tracking personal data that could be used to better inform clinical decision making. Future research is needed to investigate the efficacy of blended models of care by evaluating its impact on the therapeutic alliance, clinical and social outcomes, cost-effectiveness, and engagement. %M 32720904 %R 10.2196/18990 %U http://mental.jmir.org/2020/7/e18990/ %U https://doi.org/10.2196/18990 %U http://www.ncbi.nlm.nih.gov/pubmed/32720904