JMIR Publications

ABSTRACT

Background:

As digital modes of delivering mental health interventions are becoming increasingly prominent, there is a need to establish a solid evidence-base regarding their efficacy, particularly in relation to comparable face-to-face delivery modalities. In contrast to data on common types of interventions such as CBT or mindfulness-based interventions, available evidence on systematic psychotherapy awaits systematic integration.

Objective:

We aimed to synthesize evidence from randomized controlled trials on the comparative efficacy of systemic psychotherapy interventions provided via digital versus face-to-face delivery modalities.

Methods:

We followed the PRISMA guidelines in searching Medline, Embase, Cochrane CENTRAL, CINAHL, PsycInfo, and PSYNDEX for eligible publications and conducting a systematic review and meta-analysis that included randomized controlled trials comparing self-guided and therapist-guided digital versus face-to-face delivery modalities of systemic psychotherapy interventions on mental, behavioral, and somatic outcomes.

Results:

We screened 3633 references and included 12 publications reporting on 4 trials (total N=754). Recipients of interventions were youth with poor diabetic control, traumatic brain injuries, increased risk behavior likelihood, and parents of youth with Anorexia Nervosa. A total of 56 youth, parent, family functioning, and tertiary outcomes were identified. Two trials provided digital intervention delivery via videoconferencing, 1 trial utilized an interactive graphic interface, and 1 trial utilized an online programme. Across all publications and risk of bias domains, 14/60 (23.4%) judgements were “high risk”, 25/60 (41.6%) judgements were “some concerns”, and 21/60 (35%) judgements were “low risk” with substantial heterogeneity between publications. We meta-analytically compared digital versus face-to-face delivery modalities for attrition (Risk Ratio 1.03; 95% CI 0.52-2.03) and number of sessions attended (Standardized Mean Difference -0.11; 95% CI -1.13 to 0.91; P=.83), indicating that no conclusions regarding equivalence or superiority of either delivery modality in terms of attrition or attendance can be made at this stage. In line with these findings, non-aggregated analyses of mean differences and confidence intervals between delivery modalities yielded mixed results, with superiority of the digital delivery modality for 11 outcomes (19.6%), of the face-to-face delivery modality for 5 outcomes (8.9%), equivalence between delivery modalities for 1 outcome measure (1.8%), and neither superiority of one modality nor equivalence between modalities for 39 outcome measures (69.6%).

Conclusions:

Available evidence on differences in digital and face-to-face modalities for systemic psychotherapy interventions is largely heterogeneous, which prohibits us from drawing conclusions regarding the differential efficacy of digital and face-to-face delivery modalities. Equally, our analyses did not reveal any strong evidence for the superiority of face-to-face compared to digital delivery conditions, and might tentatively indicate favourable effects of digital delivery modalities for certain outcomes and certain contexts. More high-quality research is needed to conclude if the efficacy of systemic psychotherapy interventions delivered via digitial and face-to-face delivery modalities is generally equivalent or if one modality is superior to another. Additionally, further research is required to determine the effect of treatment modality for specific participant populations, contexts, and outcomes, which may inform differential treatment decisions and pave the way for more personalized digital, face-to-face, and blended systemic psychotherapy. Clinical Trial: This systematic review was pre-registered (PROSPERO ID: CRD42022335013).