June 5, 2024 — Significant improvements in depression and insomnia symptoms over time can be achieved using internet-based cognitive behavioral therapy (ICBT), according to a new study by Hebrew University of Jerusalem researchers.  

The new study in Psychotherapy Research led by Dr. Dina Zalaznik from the Hebrew University Department of Psychology highlights the critical role of interpersonal factors in ICBT. These findings advance the understanding of depression treatment through internet interventions and therapy’s broader benefits. 

The study focused on two crucial aspects: the therapeutic alliance and attachment styles. Study participants, consisting of thirty-nine mostly female participants (59%) with an average age of 38 years, were recruited through ads for a free trial and underwent screening, including online surveys and a phone interview. 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 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 therapist alliance was significantly related to symptom improvement.  

The results also showed that avoidant attachment style scores improved significantly during ICBT, whereas anxious attachment did not show significant improvement. This finding suggests that although the focus of ICBT is not on interpersonal relationships and the therapist’s involvement is limited, the emotional and cognitive components of attachment can still be positively impacted. 

The researchers note that clinicians should consider using a weekly questionnaire to track these relationships and make necessary improvements and that future studies should explore factors influencing these relationships further. 

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 here. 

Researchers: 

Dina Zalaznik1, Elad Zlotnick1, Snir Barzilay1, Tal Ganor1, Hila Sorka1, David Daniel Ebert2, Gerhard Andersson3,4, & Jonathan D. Huppert1   

Institutions: 

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