Comparing Video-Based and Face-to-Face Psychotherapy: Systematic Review and Multilevel Meta-Analysis Across Mental...

Area of Science:

• Mental Health Research
• Psychotherapy Modalities
• Telehealth Innovations

Background:

• Video-based psychotherapy (VBT) is expanding mental health care access.
• Previous reviews often group VBT with other remote methods, obscuring its specific impact.
• The unique contribution of the video format to therapeutic outcomes requires clarification.

Purpose of the Study:

• To systematically compare symptom reduction between video-based psychotherapy (VBT) and face-to-face (F2F) psychotherapy.
• To apply strict inclusion criteria for maximum comparability of delivery formats.
• To analyze outcomes while considering therapy duration and treatment dose.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing synchronous VBT and F2F psychotherapy in adults.
• Inclusion criteria: minimum treatment dose (≥500 min), limited hybrid sessions (≤1/3 F2F), and health professional delivery.
• Searched MEDLINE, PsycINFO, Embase; assessed risk of bias (RoB2) and certainty of evidence (GRADE).
• Synthesized outcomes using a 3-level correlated and hierarchical effects (CHE) random-effects model.

Main Results:

• 12 RCTs (465 participants) met inclusion criteria, covering PTSD, depression, OCD, bulimia, anxiety, and somatoform pain.
• No significant differences in symptom reduction were found between VBT and F2F psychotherapy (Hedges g=-0.09).
• Substantial between-study heterogeneity was observed; no moderating effects were detected.

Conclusions:

• The evidence, though limited in scope, supports VBT as a viable option for expanding mental health care access.
• This review uniquely isolates synchronous VBT, providing a clearer estimate of its specific effects.
• Further adequately powered noninferiority trials across diverse populations and conditions are needed.