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Alliance With an Unguided Smartphone App: Validation of the Digital Working Alliance Inventory

Simon B. Goldberg, Scott A. Baldwin, Kevin M. Riordan, John Torous, Cortland J. Dahl, Richard J. Davidson, Matthew J. Hirshberg

Assessment May 18, 2021 DOI: 10.1177/10731911211015310 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Cross-sectional survey and randomized trial intervention arm Longitudinal Peer reviewed
Sample size 604
Population Meditation app users
Intervention smartphone-based meditation app
Topics Meditation
Keywords Discriminant validity Clinical psychology Confirmatory factor analysis Exploratory factor analysis Distress Psychological intervention Convergent validity Psychometrics Internal consistency Statistics Structural equation modeling
Citations 73
Key findings The Digital Working Alliance Inventory is a valid and reliable measure of working alliance in unguided smartphone-based meditation interventions, with predictive validity for app utilization and reductions in psychological distress when assessed after 3-4 weeks.

Abstract

The working alliance may be relevant in unguided smartphone-based interventions, but no validated measure exists. We evaluated the psychometric properties of the six-item Digital Working Alliance Inventory (DWAI) using a cross-sectional survey of meditation app users ( n = 290) and the intervention arm of a randomized trial testing a smartphone-based meditation app ( n = 314). Exploratory factor analysis suggested a single-factor solution which was replicated using longitudinal confirmatory factor analysis. The DWAI showed adequate internal consistency and test–retest reliability. Discriminant validity was supported by a lack of association with social desirability, psychological distress, and preference for a waitlist condition. Convergent validity was supported by positive associations with perceived app effectiveness and preference for an app condition. Supporting predictive validity, DWAI scores positively predicted self-reported and objective app utilization. When assessed at Weeks 3 or 4 of the intervention, but not earlier, DWAI scores predicted pre–post reductions in psychological distress.

Comparable studies

Other randomized controlled trials on meditation, most cited first.

Study Year Design Participants
Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment 2003 Randomized controlled trial n = 41
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients 2000 Randomized controlled trial n = 145
Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults 2008 Randomized controlled trial n = 139
Short-term meditation training improves attention and self-regulation Undergraduate Chinese students 2007 Randomized controlled trial n = 40
Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients 2004 Randomized controlled trial n = 73

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