Background: Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs. Objective: This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in (e)MBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions. Methods: This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of (e)MBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form. Results: The strength of early therapeutic alliance did not predict treatment dropout in (e)MBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P<.001 this increase did not differ between embct and mbct p=".74)." therapeutic alliance at week predicted a decrease in psychological distress t114="−2.656;" an mental well-being t113="2.651;" posttreatment. the relationship with reduction of differed treatments: weaker early higher posttreatment but conclusions: can develop both mbct. findings revealed that strength predict treatment dropout. furthermore level reduced increased conditions. interestingly appeared to be more related outcome group-based than embct. clinical trial: study was registered on clinicaltrials.gov>
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