@article{ref1,
title="Online working alliance predicts treatment outcome for posttraumatic stress symptoms in Arab war-traumatized patients",
journal="Depression and anxiety",
year="2012",
author="Wagner, Birgit and Brand, Janine and Schulz, Wassima and Knaevelsrud, Christine",
volume="29",
number="7",
pages="646-651",
abstract="BACKGROUND: Previous studies have shown that Internet-based interventions for posttraumatic stress disorder are feasible. However, little is known about how therapeutic process factors impact online interventions in war and conflict regions. OBJECTIVE: This study aims to assess the quality of the working alliance at midtreatment and posttreatment and its relationship with therapy outcome in an Internet-based cognitive-behavioral intervention for Arabic-speaking traumatized patients. METHODS: A trial was conducted from January 2009 to August 2011 with patients recruited specifically in Iraq. Fifty-five participants with posttraumatic stress symptoms completed the Working Alliance Inventory (WAI) after at least session 4. Participants' mean age was 27.7 years (SD = 6.9); 78% of participants were females. Participants received two weekly 45-min Internet-based cognitive-behavioral interventions over a 5-week period. The main outcome measures were the Posttraumatic Diagnostic Scale (PDS) and the WAI. RESULTS: High ratings of the therapeutic alliance were obtained early in treatment, and results remained stable from sessions 4 to 10, indicating that it was possible to establish a positive and stable online therapeutic relationship. The working alliance at both assessment points predicted treatment outcome for posttraumatic stress symptoms. CONCLUSIONS: Despite the instability of the settings and patients' ongoing exposure to human right violations through war and dictatorships, it was possible to establish a stable online therapeutic relationship. Depression and Anxiety 00:1-6, 2012. © 2012 Wiley Periodicals, Inc.<p /> <p>Language: en</p>",
language="en",
issn="1091-4269",
doi="10.1002/da.21962",
url="http://dx.doi.org/10.1002/da.21962"
}