Supporting Video-Based Psychotherapy While Asking Who Benefits and Who Remains in Treatment

Meyer-Keirath and colleagues found no significant difference in posttreatment symptoms between video-based and face-to-face psychotherapy. However, the wide confidence interval indicates substantial imprecision, while the prediction interval suggests that comparative effects may vary considerably across settings; neither supports a conclusion of equivalence. For health services, symptom outcomes alone tell only part of the story. Future studies should report, by randomized group, who starts treatment, who discontinues it, and who completes the final assessment. These are distinct outcomes that may differ between delivery formats and affect the interpretation of symptom results. Video-based psychotherapy is a reasonable option, but its value should be assessed across the full treatment pathway. Adequately powered noninferiority trials should identify which patients can access, remain in, and benefit from each format.