The Working Alliance in a Randomized Controlled Trial Comparing Internet-Based Self-Help and Face-to-Face Cognitive-Behavior Therapy for Chronic Tinnitus

Kristine Jasper, Johannes Gutenberg-University Mainz
Cornelia Weise, Philipps-University Marburg
Isabell Conrad, Johannes Gutenberg-University Mainz
Gerhard Andersson, Linköping University
Wolfgang Hiller, Johannes Gutenberg-University Mainz
Maria Kleinstäuber, Philipps-University Marburg


Objective: This study (ID: NCT01205906) compared the impact of the working alliance between the therapist and the client on treatment outcome in a group and an Internet-based cognitive behavior therapy (GCBT vs. ICBT) for chronic tinnitus. Methods: The Working Alliance Inventory — Short Revised (WAI-SR, scale range: 1–5) was administered to 26 GCBT and 38 ICBT participants after treatment weeks 2, 5, and 9, and the Tinnitus Handicap Inventory (THI) before and after the treatment. Results: High alliance ratings were found in both ICBT (WAI-SR total scores at week 9: M = 3.59, SD = 0.72) and GCBT (WAI-SR total scores at week 9: M = 4.20, SD = 0.49), but significantly higher ratings occurred in GCBT on most WAI-SR scales (ps < .01). Significant time × group interactions for most WAI-SR scales indicated differences in alliance growth patterns between the treatments (ps < .001). Residual gain scores for the therapy outcome measure ‘tinnitus distress’ were significantly correlated with the agreement on treatment tasks between therapist and client in ICBT (r = .40, p = .014) and with the affective therapeutic bond in GCBT (r = .40, p = .043) at mid-treatment (week 5). Conclusion: More time was needed to build a strong alliance in ICBT although GCBT yielded generally higher alliance ratings. Moreover, different aspects of the therapeutic alliance might be important for treatment success in ICBT versus GCBT.