Working Alliance and Subjective Engagement With a Digital Avatar CBT Platform (RITch^®CBT): Comparing Young Adults With and Without Co-Occurring Substance Use and Depression

Authors

• Victoria Pezzino, University of Rochester MedicineFollow
• Cassandra Berbary, University of Rochester MedicineFollow
• Courtney McKinney, Rochester Institute of TechnologyFollow
• Celeste Sangiorgio, Rochester Institute of TechnologyFollow
• Emi Moriuchi, Rochester Institute of TechnologyFollow
• Korena S. Klimczak, Utah State UniversityFollow
• Robert Kay Cooper Jr., State University of New York at BuffaloFollow
• Wonkyung Kniffen, University of Rochester MedicineFollow
• Maya Hareli, Rochester Institute of TechnologyFollow
• Cory Crane, University of Rochester MedicineFollow
• Caroline J. Easton, University of Rochester MedicineFollow

Document Type

Article

Journal/Book Title/Conference

Behavioral Sciences

Author ORCID Identifier

Victoria Pezzino https://orcid.org/0009-0004-8356-2398

Celeste Sangiorgio https://orcid.org/0000-0002-2111-3624

Emi Moriuchi https://orcid.org/0000-0003-1330-3505

Korena S. Klimczak https://orcid.org/0000-0003-2173-6431

Robert Kay Cooper, Jr. https://orcid.org/0000-0003-4787-5501

Maya Hareli https://orcid.org/0000-0002-4421-0646

Volume

16

Issue

5

Publisher

MDPI AG

Publication Date

5-7-2026

Journal Article Version

Version of Record

First Page

1

Last Page

21

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Abstract

Digital mental health interventions (DMHIs) can help bridge treatment gaps experienced by young adults with co-occurring substance misuse and depression. However, it remains unclear whether engagement with these interventions differs for young adults with co-occurring conditions compared to those experiencing substance misuse or depression alone. To investigate this issue, we assessed working alliance and subjective engagement with a digital avatar-assisted cognitive-behavioral therapy (CBT) treatment platform (RITch^®CBT), comparing young adults with substance use, depression, and the co-occurrence of the two. A secondary data analysis was conducted on a sample of 99 young adults aged 18–28 years who presented at an urban university clinic. Participants rated their alliance and engagement following two brief sessions of the RITch^®CBT platform. Participants were then categorized into behavioral health groups. Repeated exposure to the program had a greater impact on subjective engagement and usability across diagnostic conditions, but there was no difference in working alliance reported across sessions or behavioral health groups. Further, participants’ depressive symptoms were significantly correlated with the number of sessions they expressed they were willing to engage in and attend. Our findings suggest that digital tools may support early engagement in treatment for young adults, regardless of presenting problem.

Recommended Citation

Pezzino, V.; Berbary, C.; McKinney, C.; Sangiorgio, C.; Moriuchi, E.; Klimczak, K.S.; Cooper, R.K., Jr.; Kniffen, W.; Hareli, M.; Crane, C.; et al. Working Alliance and Subjective Engagement with a Digital Avatar CBT Platform (RITch^®CBT): Comparing Young Adults with and Without Co-Occurring Substance Use and Depression. Behav. Sci. 2026, 16, 719. https://doi.org/10.3390/bs16050719