PDF(Pubmed)
Abstract：
Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence-the extent to which digital encounters feel like they are occurring in person-may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored.
This 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. Additionally, this study aimed to determine factors important to adolescents\' development of therapeutic alliance and social presence with the intervention.
Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention.
Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by \"developing a genuine connection\" with their mindfulness guides and \"sensing real people.\" Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides\' \"personal backgrounds and voices,\" such that participants felt more connected to the guides by knowing information about them and through the guides\' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants\' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would.
Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents\' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment.
This 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. Additionally, this study aimed to determine factors important to adolescents\' development of therapeutic alliance and social presence with the intervention.
Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention.
Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by \"developing a genuine connection\" with their mindfulness guides and \"sensing real people.\" Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides\' \"personal backgrounds and voices,\" such that participants felt more connected to the guides by knowing information about them and through the guides\' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants\' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would.
Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents\' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment.
摘要：
背景：尽管自我指导的数字干预对青少年脑震荡恢复有希望的好处，此类干预措施的流失率很高。证据表明，成年人可以通过自我指导的数字干预来发展治疗联盟，这反过来又与干预参与有关。然而,尚无研究调查青少年是否与自我指导的数字干预措施发展治疗联盟,以及哪些因素对其发展很重要.此外,社会存在——数字接触在多大程度上感觉它们是在人身上发生的——可能是理解青少年和自我引导数字干预之间联系性质的另一个相关因素，尽管这还有待于探索。
目的：这项定性研究探讨了从脑震荡中恢复的青少年在使用基于自我指导的数字正念干预期间发展治疗联盟和社会存在的程度。此外,本研究旨在确定对青少年发展治疗联盟和社会存在的重要因素。
方法：从2个地点招募年龄在12至17.99岁之间的持续脑震荡的青少年：脑震荡后48小时的儿科急诊科和脑震荡后1个月以上的三级护理诊所，以捕获脑震荡后有急性和持续症状的青少年。参与者（N=10）通过智能手机应用程序完成了为期4周的基于正念的干预。在app中,参与者听取了正念指南（配音演员）的录音，讲述了心理教育和正念实践。4周时,参与者完成了问卷调查和半结构化访谈，探讨了他们在干预中使用正念指南进行治疗联盟和社交活动的经验。
结果：在定性结果中确定的主题表明，参与者通过“与正念指南建立真正的联系”和“感知真实的人”来发展治疗联盟和社会存在。“对治疗联盟和社会存在的发展特别重要的是正念指南”个人背景和声音，“通过了解有关他们的信息并通过指南，参与者感到与指南的联系更加紧密。定量结果支持定性结果；参与者治疗联盟的平均得分远高于量表中点，虽然社会存在测量的混合结果与定性发现一致，参与者认为正念指南似乎是真实的，但并不像面对面的联系那样真实。
结论：我们的数据表明，青少年可以在没有直接接触的情况下使用数字干预措施时发展治疗联盟和社会存在。青少年通过自我指导的数字干预来发展治疗联盟和社会存在，可以通过提高类似人类的素质来支持(例如，真实的声音)在干预中。最大化治疗联盟和社会存在可能是一种有希望的方法，可以减少自我指导的数字干预中的减员，同时提供可访问的治疗。
目的：这项定性研究探讨了从脑震荡中恢复的青少年在使用基于自我指导的数字正念干预期间发展治疗联盟和社会存在的程度。此外,本研究旨在确定对青少年发展治疗联盟和社会存在的重要因素。
方法：从2个地点招募年龄在12至17.99岁之间的持续脑震荡的青少年：脑震荡后48小时的儿科急诊科和脑震荡后1个月以上的三级护理诊所，以捕获脑震荡后有急性和持续症状的青少年。参与者（N=10）通过智能手机应用程序完成了为期4周的基于正念的干预。在app中,参与者听取了正念指南（配音演员）的录音，讲述了心理教育和正念实践。4周时,参与者完成了问卷调查和半结构化访谈，探讨了他们在干预中使用正念指南进行治疗联盟和社交活动的经验。
结果：在定性结果中确定的主题表明，参与者通过“与正念指南建立真正的联系”和“感知真实的人”来发展治疗联盟和社会存在。“对治疗联盟和社会存在的发展特别重要的是正念指南”个人背景和声音，“通过了解有关他们的信息并通过指南，参与者感到与指南的联系更加紧密。定量结果支持定性结果；参与者治疗联盟的平均得分远高于量表中点，虽然社会存在测量的混合结果与定性发现一致，参与者认为正念指南似乎是真实的，但并不像面对面的联系那样真实。
结论：我们的数据表明，青少年可以在没有直接接触的情况下使用数字干预措施时发展治疗联盟和社会存在。青少年通过自我指导的数字干预来发展治疗联盟和社会存在，可以通过提高类似人类的素质来支持(例如，真实的声音)在干预中。最大化治疗联盟和社会存在可能是一种有希望的方法，可以减少自我指导的数字干预中的减员，同时提供可访问的治疗。
