Evidence for Bidirectional, Cross-Lagged Associations Between Alliance and Psychological Distress in an Unguided Mobile-Health Intervention

Bidirectional associations between changes in symptoms and alliance are established for in-person psychotherapy. Alliance may play an important role in promoting engagement and effectiveness within unguided mobile-health (mHealth) interventions. Using models disaggregating alliance and psychological distress into within- and between-persons components (random intercept cross-lagged panel model), we report bidirectional associations between alliance and distress over the course of a 4-week smartphone-based meditation intervention ( n = 302, 80.0% elevated depression/anxiety). Associations were stable across time, and effect sizes were similar to those observed for psychotherapy (distress to alliance: βs = −0.13 to −0.14; alliance to distress: βs = −0.09 to −0.10). Alliance may be worth measuring to improve the acceptability and effectiveness of mHealth tools. Further empirical and theoretical work characterizing the role and meaning of alliance in unguided mHealth is warranted.