Therapeutic alliance, motivation for change, and mental distress as psychological correlates of outcome in webcam-based treatment for internet use disorders

Introduction The therapist-guided, webcam-based OMPRIS treatment for internet use disorder (IUD) has demonstrated efficacy in prior studies. Research has also shown that comorbidity, motivation for change, and therapeutic alliance influence treatment outcomes in general. In a secondary analysis of the registered randomised controlled trial (RCT) of OMPRIS, we tested whether these psychological factors relate to IUD symptom severity (IUDSS) and inter-individual differences. Methods Participants of the OMPRIS study ( N = 180, 136 men [75.6%], 41 women [22.8%], 3 others [1.7%]) M age 31.78 years, SD = 12.19, range = [16; 84]) were tested at six measurement times (pretreatment—2 years after). Primary outcome: IUDSS. Independent variables: therapeutic alliance, depression, anxiety, and motivation for change. We used multiple imputation for missing data, mixed-effects models adjusted for sociodemographics and IUD subtype, and cluster analyses for hypothesis testing. Results Linear mixed-effects models showed that therapist-rated alliance (negative), depression (positive), anxiety (positive), recognition (positive), and taking steps (negative) were associated with IUDSS, whereas ambivalence, patient-rated alliance, sociodemographics, and IUD subtype were not. Exploratory clustering of individual IUDSS slopes identified three treatment-response groups (Good, Low, and High). These clusters differed in baseline severity, comorbidity, and motivation. High Responders showed the highest recognition level (strongest psychological correlate), reflecting reduced denial and greater readiness for change. Discussion This study identified psychological factors associated with IUDSS trajectory. Findings underscore that comorbidities can delay strong treatment success. In general, inter-individual differences in treatment response should be considered by therapists. Clinical Trial Registration https://drks.de/search/en/trial/DRKS00019925/details , identifier DRKS00019925.