Development of the therapeutic alliance and its association with treatment outcome in internet-based Mindfulness-Based Cognitive Therapy (eMBCT) compared to group-based MBCT (MBCT) for distressed cancer patients (Preprint)
Else Bisseling, Linda Cillessen, Philip Spinhoven, Melanie P. J. Schellekens, Felix R. Compen, Marije L. van der Lee, Anne E. M. Speckens
Study at a glance
AI-extracted from the abstract| Characteristics | Multicentre randomized controlled trial |
|---|---|
| Sample size | 245 |
| Population | Distressed cancer patients |
| Interventions | Internet-based Mindfulness-Based Cognitive Therapy (eMBCT) Mindfulness-Based Cognitive Therapy (MBCT) |
| Topics | Meditation |
| Registration | NCT02138513 |
| Key findings | Early therapeutic alliance predicted reduced psychological distress and increased mental well-being at post-treatment in both eMBCT and MBCT, but the relationship with distress reduction was stronger in group-based MBCT than in eMBCT. |
Abstract
Background: Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based Mindfulness-based Cognitive Therapy (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance, i.e. the bond between therapist and patient, is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist-assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs.
Objective: The objectives of the present study were: (1) to explore whether early therapeutic alliance predicts treatment dropout in (e)MBCT; (2) to compare the development of the therapeutic alliance during eMBCT and MBCT; and (3) to examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at post-treatment in both conditions.
Methods: The present study was part of a multicentre randomized controlled trial (RCT; n=245) on the effectiveness of (e)MBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (i.e. early therapeutic alliance), week 5 and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale (HADS) and mental-wellbeing, measured with the Mental Health Coninuum-short form (MHC-SF).
Results: The strength of early therapeutic alliance did not predict treatment dropout in (e)MBCT (B=-0.39, p=.21). Therapeutic alliance increased over time in both conditions (F=16.46,Wilks’ λ=.732, p<.001). This increase did not differ between eMBCT and MBCT (F=0.114, p=.74). Therapeutic alliance at week 2 predicted a reduction of psychological distress (B=-.126, t=-2.656, p=.01) and an increase of in mental well-being (B=.234, t=2.651, p=.01) at post-treatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at post-treatment in MBCT but not in eMBCT(B=.217, t=2.261, p=.03).
Conclusions: A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at post-treatment in both conditions. Interestingly, the strength of therapeutic alliance is appeared to be more related to treatment outcome in group-based MBCT than in eMBCT. CLINICALTRIAL NCT02138513 https://clinicaltrials.gov/ct2/show/NCT02138513
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 |