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 found significant improvements in depression and insomnia symptoms over time. These findings deepen our understanding of how depression can be treated through internet-based interventions, underscoring the crucial role of the therapeutic alliance and the wider benefits of this form of therapy.

A new study led by Dr. Dina Zalaznik, from Prof. Jonathan Huppert's Laboratory for the Treatment and Study of Mental Health and Well Being at the Hebrew University of Jerusalem, has revealed significant advancements in the treatment of depression. The study focused on two crucial aspects: the therapeutic alliance and attachment styles.

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, mostly female (59%), 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.

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.

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 with 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.

Dr. Zalaznik's study reveals the critical role of interpersonal factors in internet-based cognitive behavioral therapy, highlighting the distinct impacts of the therapist and program alliances. These findings advance our understanding of depression treatment through internet interventions, emphasizing the therapeutic alliance's importance and the therapy's broader benefits.

The research paper titled “Interpersonal factors in internet-based cognitive behavioral therapy for depression: Attachment style and alliance with the program and with the therapist” is now available in Psychotherapy Research and can be accessed at https://doi.org/10.1080/10503307.2024.2325510.

Researchers:

Dina Zalaznik¹, Elad Zlotnick¹, Snir Barzilay¹, Tal Ganor¹, Hila Sorka¹, David Daniel Ebert², Gerhard Andersson^3,4, & Jonathan D. Huppert¹  

Institutions:

1. Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
2. Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
3. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
4. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Disclaimer: In these challenging times of war and crisis, Hebrew University of Jerusalem is resolute in its dedication to advancing research and education. We stand in full support of the brave individuals on the frontlines, safeguarding our nation and the well-being of all Israelis, and extend our deepest gratitude and unwavering solidarity to our community and fellow citizens. Together, we shall prevail against the challenges that confront us, and our shared commitment to the well-being of all Israelis and the pursuit of knowledge remains resolute.

The Hebrew University of Jerusalem is Israel's premier academic and research institution. Serving over 23,000 students from 80 countries, the University produces nearly 40% of Israel’s civilian scientific research and has received over 11,000 patents. Faculty and alumni of the Hebrew University have won eight Nobel Prizes and a Fields Medal. For more information about the Hebrew University, please visit http://new.huji.ac.il/en.