Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: A Qualitative Exploratory Study (Preprint)

Abstract

Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates are high. Exploring modifiable protective factors for participant engagement in self-guided digital interventions, including therapeutic alliance and social presence, is fundamental to preventing attrition.

This open-label qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention (MBI).

Adolescents ages 12-17.99 were recruited from a pediatric emergency department within 48 hours of sustaining a concussion (acute cohort) or through a tertiary care clinic over 1 month following a concussion (persisting symptoms cohort). Participants (N = 10) completed a 4-week MBI delivered via smartphone application. At 4-weeks, participants completed questionnaires and a semi-structured interview exploring their experience of therapeutic alliance and social presence with their asynchronous mindfulness guides in the intervention.

Quantitative and qualitative results revealed that participants developed therapeutic alliance and social presence with their guides, and that important factors to their development were guides’ personal backgrounds and the tone of their voices. Participants endorsed that therapeutic alliance and social presence were important for their engagement with the intervention.

These data suggest that therapeutic alliance and social presence can develop in interventions with limited synchronous human contact and may be important elements to participant engagement. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible and engaging treatment.