TY - JOUR AU - Snipes, Cassandra AU - Dorner?Ciossek, Cornelia AU - Hare, D. Brendan AU - Besedina, Olya AU - Campellone, Tim AU - Petrova, Mariya AU - Lakhan, E. Shaheen AU - Pratap, Abhishek PY - 2025/1/27 TI - Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies JO - JMIR Ment Health SP - e64959 VL - 12 KW - therapeutic alliance KW - digital working alliance KW - experiential negative symptoms KW - schizophrenia KW - digital therapeutics KW - digital literacy N2 - 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 UR - https://mental.jmir.org/2025/1/e64959 UR - http://dx.doi.org/10.2196/64959 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64959 ER - TY - JOUR AU - Lederman, Reeva AU - D'Alfonso, Simon PY - 2021/7/20 TI - The Digital Therapeutic Alliance: Prospects and Considerations JO - JMIR Ment Health SP - e31385 VL - 8 IS - 7 KW - therapeutic alliance KW - digital therapeutic alliance KW - digital mental health KW - mental health apps KW - teletherapy KW - chatbots UR - https://mental.jmir.org/2021/7/e31385 UR - http://dx.doi.org/10.2196/31385 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283035 ID - info:doi/10.2196/31385 ER - TY - JOUR AU - Williams, Anne AU - Fossey, Ellie AU - Farhall, John AU - Foley, Fiona AU - Thomas, Neil PY - 2021/6/16 TI - 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 JO - JMIR Ment Health SP - e25998 VL - 8 IS - 6 KW - digital mental health KW - tablet computers KW - therapeutic relationship KW - recovery narratives KW - lived experience video KW - personal recovery KW - schizophrenia KW - mobile phone N2 - 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. UR - https://mental.jmir.org/2021/6/e25998 UR - http://dx.doi.org/10.2196/25998 UR - http://www.ncbi.nlm.nih.gov/pubmed/34132647 ID - info:doi/10.2196/25998 ER - TY - JOUR AU - Cataldo, Francesco AU - Chang, Shanton AU - Mendoza, Antonette AU - Buchanan, George PY - 2021/2/19 TI - A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review JO - JMIR Ment Health SP - e19004 VL - 8 IS - 2 KW - videoconference KW - psychotherapy KW - professional-patient relations KW - client-psychologist relationships KW - therapeutic alliance KW - telehealth KW - mobile phone N2 - 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. UR - http://mental.jmir.org/2021/2/e19004/ UR - http://dx.doi.org/10.2196/19004 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605891 ID - info:doi/10.2196/19004 ER - TY - JOUR AU - D'Alfonso, Simon AU - Lederman, Reeva AU - Bucci, Sandra AU - Berry, Katherine PY - 2020/12/29 TI - The Digital Therapeutic Alliance and Human-Computer Interaction JO - JMIR Ment Health SP - e21895 VL - 7 IS - 12 KW - therapeutic alliance KW - digital mental health KW - affective computing KW - persuasive computing KW - positive computing KW - mobile phone KW - mHealth UR - http://mental.jmir.org/2020/12/e21895/ UR - http://dx.doi.org/10.2196/21895 UR - http://www.ncbi.nlm.nih.gov/pubmed/33372897 ID - info:doi/10.2196/21895 ER - TY - JOUR AU - Tremain, Hailey AU - McEnery, Carla AU - Fletcher, Kathryn AU - Murray, Greg PY - 2020/8/7 TI - The Therapeutic Alliance in Digital Mental Health Interventions for Serious Mental Illnesses: Narrative Review JO - JMIR Ment Health SP - e17204 VL - 7 IS - 8 KW - mental health KW - mHealth KW - eHealth KW - telehealth KW - psychosis KW - bipolar disorder KW - mobile phone N2 - 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. UR - https://mental.jmir.org/2020/8/e17204 UR - http://dx.doi.org/10.2196/17204 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763881 ID - info:doi/10.2196/17204 ER - TY - JOUR AU - Valentine, Lee AU - McEnery, Carla AU - Bell, Imogen AU - O'Sullivan, Shaunagh AU - Pryor, Ingrid AU - Gleeson, John AU - Bendall, Sarah AU - Alvarez-Jimenez, Mario PY - 2020/7/28 TI - Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study JO - JMIR Ment Health SP - e18990 VL - 7 IS - 7 KW - Blended Treatment KW - Psychotic Disorders KW - Digital Intervention KW - Adolescent KW - Young Adults KW - mHealth N2 - 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. UR - http://mental.jmir.org/2020/7/e18990/ UR - http://dx.doi.org/10.2196/18990 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720904 ID - info:doi/10.2196/18990 ER -