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BJPsych Open. 2019 Jan;5(1):e15. doi: 10.1192/bjo.2018.86.

Digital mental health apps and the therapeutic alliance: initial review.

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Research Assistant,Division of Digital Psychiatry,Beth Israel Deaconess Medical Center,Harvard Medical School,USA.
Chair of Child and Adolescent Psychiatry and Director,NIHR MindTech MedTech Co-operative,NIHR Nottingham BRC Mental Health;and Technology Theme Lead,University of Nottingham and Institute of Mental Health,UK.
Stanley Cobb Professor and Vice-Chair for Public Psychiatry,Department of Psychiatry,Beth Israel Deaconess Medical Center,Harvard Medical School,USA.
Director of Digital Psychiatry,Departments of Psychiatry and Clinical Informatics,Beth Israel Deaconess Medical Center,Harvard Medical School,USA.



As mental healthcare expands to smartphone apps and other technologies that may offer therapeutic interventions without a therapist involved, it is important to assess the impact of non-traditional therapeutic relationships.AimsTo determine if there were any meaningful data regarding the digital therapeutic alliance in smartphone interventions for serious mental illnesses.


A literature search was conducted in four databases (PubMed, PsycINFO, Embase and Web of Science).


There were five studies that discuss the therapeutic alliance when a mobile application intervention is involved in therapy. However, in none of the studies was the digital therapeutic alliance the primary outcome. The studies looked at different mental health conditions, had different duration of technology use and used different methods for assessing the therapeutic alliance.


Assessing and optimising the digital therapeutic alliance holds the potential to make tools such as smartphone apps more effective and improve adherence to their use. However, the heterogeneous nature of the five studies we identified make it challenging to draw conclusions at this time. A measure is required to evaluate the digital therapeutic alliance.


Individual Psychotherapy; Smartphone; alliance

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