JMIR Publications

ABSTRACT

Background:

Cognitive-behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT face-to-face limits access to the intervention. The advancements in information and communication technology, especially Internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas by utilizing the video conferencing system. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analysis.

Objective:

The present study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review.

Methods:

A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet the objective of the present study, two independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov, Cochrane Central Resister of Controlled Trials, www.ensaiosclinicos.gov.br) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan) 5.4.0. Standardized mean difference was used in major meta-analyses where a p-value of 0.05 or less was the threshold for statistical significance. A heterogeneity test using χ2 and I2 was performed to assess the presence and extent of statistical heterogeneity with significance set at p < 0.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects.

Results:

The systematic search resulted in 16 studies (total N = 1,745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedges’ g) post-treatment of −0.49 (95% CI: –0.68 to –0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes.

Conclusions:

While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Clinical Trial: The current study's protocol was registered with PROSERO (CRD42021224832).