ArticleDigital health
A qualitative study exploring the digital therapeutic alliance with fully automated smartphone apps.
Article in Digital health. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Does the Digital Therapeutic Alliance Exist? Integrative Review.JMIR mental health · 2025Pooled it
- "It Felt Good to Be Able to Say That Out Loud"-Therapeutic Alliance and Processes in AVATAR Therapy for People Who Hear Distressing Voices: Peer-Led Qualitative Study.JMIR mental health · 2026Trial
- "It's like having a friend in your pocket." the service user experience of the Actissist digital health intervention for early psychosis: a qualitative study.BMC psychiatry · 2025Trial
- Evaluating a Dual Digital Cognitive Behavioral Therapy and Health and Wellness Coaching Intervention for Anxiety and Depression: Single-Arm Pilot Study.JMIR human factors · 2026Article
- User experience and perceived impact of the Eating Disorder Support App: a mixed-methods evaluation.Journal of eating disorders · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
Background: Digital mental health interventions are increasingly used to scale up access to mental health support, yet very few mental health apps are empirically supported, with high attrition rates. The therapeutic alliance between therapists and clients is a key factor in predicting psychological therapy retention and outcomes. Understanding how this concept translates to the digital context, the so-called digital therapeutic alliance (DTA), may help enhance retention and outcomes in digital mental health. Objectives: To explore and conceptualise the DTA with mental health interventions delivered by standalone apps. Specifically: (1) whether people with mental health difficulties form an alliance with mental health apps; (2) what constitutes the DTA; and (3) the similarities and differences across the traditional therapeutic alliance and DTA. Methods: Qualitative semi-structured interviews were conducted with 17 individuals utilising mental health apps. Interview topic examples included rationale for app support, goals around app use and perceived connection. Interviews were analysed using thematic analysis. Results: Five core themes were identified: (1) connection with 'an other'; (2) accessibility; (3) choice and empowerment; (4) goals and expectations: having lower expectations than in-person support; and (5) safe place: non-judgemental, loyalty, trust. Conclusions: The study strengthens support for the concept of the DTA but adds to existing knowledge by suggesting that the DTA needs to be conceived differently to the traditional therapeutic alliance. App developers can enhance alliance by paying particular attention to the use of human voice features, validating statements, personalised interfaces, and multiple options for activities and strategies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.