Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 27;11(1):e23.
doi: 10.1192/bjo.2024.844.

Therapeutic alliance in a stepped digital psychosocial intervention for breast cancer patients: findings from a multicentre randomised controlled trial

Aida Flix-Valle  1 , Joan Carles Medina  2 , Arnau Souto-Sampera  1 , Alejandra Arizu-Onassis  1 , Eva Juan-Linares  3 , Maria Serra-Blasco  4 , Laura Ciria-Suárez  5 , Guillem Feixas  6 , Cristian Ochoa-Arnedo  1
Affiliations

Therapeutic alliance in a stepped digital psychosocial intervention for breast cancer patients: findings from a multicentre randomised controlled trial

Aida Flix-Valle et al. BJPsych Open. .

Abstract

Background: Action mechanisms of therapeutic alliance in stepped and digital interventions remain unclear.

Aims: (a) To compare the development of therapeutic alliance between psychosocial treatment as usual (PTAU) and a stepped digital intervention designed to prevent distress in cancer patients; (b) to analyse the level of agreement between patients' and therapists' therapeutic alliance ratings; and (c) to explore variables associated with therapeutic alliance in the digital intervention.

Method: A multicentre randomised controlled trial with 184 newly diagnosed breast cancer women was conducted. Patients were assigned to digital intervention or PTAU. Therapeutic alliance was assessed at 3, 6 and 12 months after inclusion using the working alliance inventory for patients and therapists. Age, usability (system usability scale), satisfaction (visual analogue scale), type and amount of patient-therapist communication were analysed as associated variables.

Results: Patients and therapists established high therapeutic alliance in the digital intervention, although significantly lower compared with PTAU. The development of patients' therapeutic alliance did not differ between interventions, unlike that of the therapists. No agreement was found between patients' and therapists' therapeutic alliance ratings. Patients' therapeutic alliance was associated with usability and satisfaction with app, whereas therapists' therapeutic alliance was associated with satisfaction with monitoring platform.

Conclusions: A stepped digital intervention for cancer patients could develop and maintain strong therapeutic alliance. Neither the type nor amount of communication affected patients' therapeutic alliance, suggesting that flexible and available digital communication fosters a sense of care and connection. The association between usability and satisfaction with digital tools highlights their importance as key therapeutic alliance components in digital settings.

Keywords: Cancer survivor; mHealth; psycho-oncology; stepped-care; therapeutic alliance.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Stepped digital psychosocial intervention ICOnnecta't: intervention levels and stepped protocol. Adapted from a previous ICOnnecta't protocol with permission from the authors and the publisher.
Fig. 2
Fig. 2
Participants’ flowchart. PTAU, psychosocial treatment as usual; WAI-S-P, working alliance inventory short form, patient version; WAI-S-T, working alliance inventory short form, therapist version.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Hollis C, Sampson S, Simons L, Davies EB, Churchill R, Betton V, et al. Identifying research priorities for digital technology in mental health care: results of the James Lind Alliance Priority Setting Partnership. Lancet Psychiatry 2018; 5(10): 845–54. - PubMed
    1. Bordin ES. The generalization of the psychoanalytic concept of the working alliance. Psychotherapy 1976; 16(3): 252–60.
    1. Flückiger C, Del Re AC, Wampold BE, Symonds D, Horvath AO. How central is the alliance in psychotherapy? a multilevel longitudinal meta-analysis. J Couns Psychol 2012; 59(1): 10–17. - PubMed
    1. Bisseling E, Cillessen L, Spinhoven P, Schellekens M, Compen FR, van der Lee ML, et al. 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. J Med Internet Res 2019; 21(10): e14065. - PMC - PubMed
    1. World Health Organization. Adherence to long-term therapies: evidence for action. WHO, 2003. (https://iris.who.int/handle/10665/42682 [cited 23 Oct 2024]).

LinkOut - more resources