Research Portfolio Submitted in Part Fulfilment of the requirements for the Degree of Doctorate in Clinical Psychology

: Alternative Format Thesis 1) Persuasive systems design features of smartphone applications for psychosis: a systematic review; 2) Psychological wellbeing for patients and families following an Intensive Care Unit (ICU) Admission at the Royal United Hospitals, Bath; 3) How do users of a mental health app conceptualise digital therapeutic alliance? A qualitative study using the Framework Approach.

Abstract

Background: Fully automated mental health apps have the potential to increase access to evidence-based psychological interventions and reduce burden on staff resources in overburdened mental health services. Within human-to-human therapy the working relationship (therapeutic alliance) between the client and therapist is well studied and has been consistently linked to effective and engaging therapy. However, less is known about whether a digital therapeutic alliance exists, what its components may be and how it can be fostered to improve engagement and adherence to digital interventions. This study explored the experiences of users of a mental health app to better understand digital therapeutic alliance and how persuasive systems design may be able to help us understand which features of app design influence this.

Methods: We conducted a qualitative study using semi-structured interviews with 13 participants who had recent experience of using a mental health app. Data were analysed using framework analysis with therapeutic alliance and persuasive systems design as deductive theoretical frameworks.

Results: We constructed five dimensions of digital therapeutic alliance: 1) Humanness of the app 2) Personal meaningfulness 3) Progression towards goals 4) How I use the app and 5) Flexibility enhances relationship. Themes 1-4 are digital analogues of the existing dimensions of therapeutic alliance and theme 5 (Flexibility enhances relationship) provides the context within which a digital therapeutic alliance forms. Persuasive systems design features were found to reinforce and enhance aspects of digital therapeutic alliance.

Conclusions: This study provides valuable insight into the existence of digital therapeutic relationships (alliance) and its dimensions. From our findings, there are indicators that digital therapeutic alliance is a digital analogue of therapeutic alliance and is enhanced by persuasive features of the app. Findings from this study could be used to inform the design of digital interventions to enhance their capacity to foster digital therapeutic alliance with users.

Date of Award	20 Sept 2024
Original language	English
Awarding Institution	University of Bath
Supervisor	Pamela Jacobsen (Supervisor), Simon D'Alfonso (Supervisor), Maria João Tralhão Dolan (Supervisor) & Jenny Yiend (Supervisor)