Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study
Objectives To examine and adapt a conceptual framework of the working alliance (WA) in the context of a low-intensity blended (psychological well-being practitioner (PWP) plus computerised program) cognitive behavioural therapy intervention (b-CBT) for depression.Design Patient involvement was enlis...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-09-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e036299.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841554214849871872 |
|---|---|
| author | Sarah Smith Caroline Free Daniel Michelson Jesus Montero-Marin Ricardo Araya Asmae Doukani Arlinda Cerga-Pashoja Ritsuko Kakuma |
| author_facet | Sarah Smith Caroline Free Daniel Michelson Jesus Montero-Marin Ricardo Araya Asmae Doukani Arlinda Cerga-Pashoja Ritsuko Kakuma |
| author_sort | Sarah Smith |
| collection | DOAJ |
| description | Objectives To examine and adapt a conceptual framework of the working alliance (WA) in the context of a low-intensity blended (psychological well-being practitioner (PWP) plus computerised program) cognitive behavioural therapy intervention (b-CBT) for depression.Design Patient involvement was enlisted to collaboratively shape the design of the project from the onset, before data collection. In-depth semi-structured interviews were carried out with participants who experienced b-CBT as part of the E-compared trial. A thematic analysis was conducted using a constant comparative method informed by grounded theory.Setting Recruitment was carried out in four psychological primary care services across the UK.Participants Nineteen trial participants with major depressive disorder who completed at least one computerised program and face-to-face session with a PWP in the b-CBT arm were recruited to the study.Results Qualitative interviews that were guided by WA theory and patient involvement, revealed four themes: (1) a healthcare provider (PWP and computerised program) with good interpersonal competencies for building a working relationship with the client (‘bond’); (2) collaborative efforts between the client and the provider to appropriately identify what the client hopes to achieve through therapy (‘goals’); (3) the selection of acceptable therapeutic activities that address client goals and the availability of responsive support (‘task’) and (4) the promotion of active engagement and autonomous problem solving (‘usability heuristics’). Participants described how the PWP and computerised program uniquely and collectively contributed to different WA needs.Conclusions This study is the first to offer a preliminary conceptual framework of WA in b-CBT for depression, and how such demands can be addressed through blended PWP-computerised program delivery. These findings can be used to promote WA in technological design and clinical practice, thereby promoting engagement to b-CBT interventions and effective deployment of practitioner and program resources.Trial registration number ISRCTN12388725. |
| format | Article |
| id | doaj-art-d81d31470e84401b9e114b636d0ac79b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d81d31470e84401b9e114b636d0ac79b2025-01-08T18:20:10ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-036299Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative studySarah Smith0Caroline Free1Daniel Michelson2Jesus Montero-Marin3Ricardo Araya4Asmae Doukani5Arlinda Cerga-Pashoja6Ritsuko Kakuma7ALL_EARS@UoS, Patient and Public Involvement and Engagement Group, University of Southampton1 Department of Medical Statistics, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK2 Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King`s College London, London, UKDepartment of Psychiatry, Oxford University, Oxford, UKCentre for Global Mental Health and Primary Care Research, London, UKPopulation Health, London School of Hygiene and Tropical Medicine, London, UKFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKCentre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UKObjectives To examine and adapt a conceptual framework of the working alliance (WA) in the context of a low-intensity blended (psychological well-being practitioner (PWP) plus computerised program) cognitive behavioural therapy intervention (b-CBT) for depression.Design Patient involvement was enlisted to collaboratively shape the design of the project from the onset, before data collection. In-depth semi-structured interviews were carried out with participants who experienced b-CBT as part of the E-compared trial. A thematic analysis was conducted using a constant comparative method informed by grounded theory.Setting Recruitment was carried out in four psychological primary care services across the UK.Participants Nineteen trial participants with major depressive disorder who completed at least one computerised program and face-to-face session with a PWP in the b-CBT arm were recruited to the study.Results Qualitative interviews that were guided by WA theory and patient involvement, revealed four themes: (1) a healthcare provider (PWP and computerised program) with good interpersonal competencies for building a working relationship with the client (‘bond’); (2) collaborative efforts between the client and the provider to appropriately identify what the client hopes to achieve through therapy (‘goals’); (3) the selection of acceptable therapeutic activities that address client goals and the availability of responsive support (‘task’) and (4) the promotion of active engagement and autonomous problem solving (‘usability heuristics’). Participants described how the PWP and computerised program uniquely and collectively contributed to different WA needs.Conclusions This study is the first to offer a preliminary conceptual framework of WA in b-CBT for depression, and how such demands can be addressed through blended PWP-computerised program delivery. These findings can be used to promote WA in technological design and clinical practice, thereby promoting engagement to b-CBT interventions and effective deployment of practitioner and program resources.Trial registration number ISRCTN12388725.https://bmjopen.bmj.com/content/10/9/e036299.full |
| spellingShingle | Sarah Smith Caroline Free Daniel Michelson Jesus Montero-Marin Ricardo Araya Asmae Doukani Arlinda Cerga-Pashoja Ritsuko Kakuma Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study BMJ Open |
| title | Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study |
| title_full | Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study |
| title_fullStr | Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study |
| title_full_unstemmed | Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study |
| title_short | Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study |
| title_sort | towards a conceptual framework of the working alliance in a blended low intensity cognitive behavioural therapy intervention for depression in primary mental health care a qualitative study |
| url | https://bmjopen.bmj.com/content/10/9/e036299.full |
| work_keys_str_mv | AT sarahsmith towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy AT carolinefree towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy AT danielmichelson towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy AT jesusmonteromarin towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy AT ricardoaraya towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy AT asmaedoukani towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy AT arlindacergapashoja towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy AT ritsukokakuma towardsaconceptualframeworkoftheworkingallianceinablendedlowintensitycognitivebehaviouraltherapyinterventionfordepressioninprimarymentalhealthcareaqualitativestudy |