A study found that guided internet-based cognitive behavioral therapy reduces both depression and insomnia symptoms, with success tied to strong therapist-patient relationships and effective therapeutic alliances.

Summary: A Hebrew University study, published in Psychotherapy Research, examined the effects of guided internet-based cognitive behavioral therapy (CBT) on depression and insomnia. The study involved 39 participants who underwent a six-module CBT program addressing depression and insomnia. Results showed significant improvements in both conditions, with the therapeutic alliance between therapist and patient being crucial for success. The study also found that avoidant attachment styles improved significantly, while anxious attachment styles did not. These findings underscore the importance of the therapist-patient relationship and attachment styles in the effectiveness of internet-based CBT.

Key Takeaways: 

  • Guided internet-based cognitive behavioral therapy (CBT) significantly reduces symptoms of both depression and insomnia, demonstrating its effectiveness as a treatment method.
  • The success of the therapy is closely linked to the strength of the therapeutic alliance between the therapist and the patient, highlighting the importance of this relationship in online therapy.
  • The study found significant improvements in avoidant attachment styles during the therapy, while anxious attachment styles showed no significant change, indicating varied impacts on different attachment styles.

A new study at Hebrew University examined the effects of guided internet-based cognitive behavioral therapy for depression, focusing on the therapeutic alliance and attachment styles. 

The study, published in Psychotherapy Research, found significant improvements in depression and insomnia symptoms over time. It focused on two crucial aspects: the therapeutic alliance and attachment styles.

Participant Recruitment and Treatment Program

Participants for the study were recruited through ads for a free trial and underwent screening, including online surveys and a phone interview. Thirty-nine participants, 59% female, with an average age of 37.9 years, were included. The internet-based cognitive behavioral therapy program consisted of six modules covering psychoeducation, cognitive work, behavioral activation, challenging thoughts, optional cognitive behavioral therapy for insomnia, and relapse prevention. 

Treatment was delivered by supervised doctoral students, with weekly guidance and homework assignments. Dropout rates and treatment adherence were also examined.

Therapeutic Alliance and Attachment Styles

One of the key findings of the study was the importance of the alliance between the therapist and the patient, as well as the alliance with the program, in predicting adherence and dropout rates. While both alliances played a role in treatment outcomes, only the alliance with the therapist was significantly related to symptom improvement. This highlights the unique contributions of each aspect of the alliance in the effectiveness of internet-based cognitive behavioral therapy.

The study also addressed the role of attachment styles in internet-based cognitive behavioral therapy, with results indicating that avoidant attachment style scores improved significantly during internet-based cognitive behavioral therapy, whereas anxious attachment did not show significant improvement. This finding suggests that even though the focus of internet-based cognitive behavioral therapy is not on interpersonal relationships and the therapist’s involvement is limited, the emotional and cognitive components of attachment can still be positively impacted.

Effectiveness and Future Implications

Results from the study demonstrate the effectiveness of a culturally adapted Hebrew version of guided internet-based cognitive behavioral therapy for depression and insomnia. Depression symptoms and insomnia improved significantly over time, with noticeable and meaningful changes observed for all variables.

This study suggests that in internet-based therapy, the relationship between the therapist and the program is crucial for maintaining motivation and commitment to the treatment. Clinicians should consider using a weekly questionnaire to track these relationships and make necessary improvements. Future studies should explore factors influencing these relationships further.

The study reveals the critical role of interpersonal factors in internet-based cognitive behavioral therapy, highlighting the distinct impacts of the therapist and program alliances. According to the researchers, these findings advance our understanding of depression treatment through internet interventions, emphasizing the therapeutic alliance’s importance and the therapy’s broader benefits.

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