title: Only connect: The working alliance in computer-based cognitive behavioral therapy.
abstract: The limited role of therapists in some technology-based interventions raises questions as to whether clients may develop a 'working alliance' with the program, and the impact on relationships with a therapist and/or treatment outcomes. In this study, the Working Alliance Inventory (WAI), and an adapted version for technology-based interventions (WAI-Tech), were administered within a subsample (n = 66) of cocaine-dependent individuals participating in a randomized trial evaluating the efficacy of Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) as an adjunct to treatment as usual (TAU). Results suggest the WAI-Tech has relatively similar psychometric characteristics as the standard WAI; however the 'bond' subscale scores were lower on the WAI-Tech [F(1,52) = 5.78, p < .05]. Scores on the WAI-Tech were not associated with cocaine use outcomes, whereas total scores on the WAI for those assigned to TAU were associated with the percentage of days abstinent from cocaine (r = .43, p < .05). There was little evidence that adding a technology-based intervention adversely affected the working alliance with a therapist in this sample. These preliminary findings suggest some concepts of working alliance may apply to computer-based CBT, yet the function of the alliance may be different in technology-based interventions than in face-to-face psychotherapies.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA. Electronic address: brian.kiluk@yale.edu.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kiluk
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Serafini
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.
authors.forename: Tami
authors.initials: T
authors.lastname: Frankforter
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
mesh_terms: D000328:Adult; D001292:Attitude to Computers; D019970:Cocaine-Related Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011594:Psychometrics; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: CBT4CBT; Substance use treatment; Technology-based interventions; Therapeutic alliance; Working alliance