JMIR Publications

ABSTRACT

Background:

Video-based psychotherapy (VBT) became an essential modality during the COVID-19 pandemic, enabling continuity of outpatient care despite social distancing measures. While adoption surged during the pandemic, little is known about how usage and attitudes evolved after restrictions were lifted. Understanding patterns of sustained use and the factors influencing acceptance can guide targeted implementation strategies.

Objective:

This study examines changes in VBT usage, attitudes, and determinants among German outpatient psychotherapists before, during, and one year after the pandemic restrictions. Specifically, it assessed (1) frequency and purposes of use, (2) changes in perceived effectiveness and therapeutic factors, (3) determinants of acceptance and continued use, and (4) attitudinal profiles of psychotherapists based on a person-centered clustering approach.

Methods:

A longitudinal partially repeated cross-sectional survey was conducted among German outpatient psychotherapists (N=296) during the pandemic (T1:2020/ 2021) and one year after restrictions were lifted (T3:2023). Measures included VBT usage frequency, perceived effectiveness, therapeutic change mechanisms based on Grawe’s model, and determinants from the Unified Theory of Acceptance and Use of Technology for therapists (UTAUT-T). Analyses combined longitudinal comparisons, theory-based regression modeling, and person-centered clustering to examine changes in VBT usage, attitudes, and acceptance.

Results:

Out of the 296 outpatient psychotherapists surveyed, 202/296 (68.2%) reported using VBT post-pandemic. Usage rose from 13/296 (4.4%) pre-pandemic to 240/296 (81.1%) during the pandemic and declined post-pandemically but remained above pre-pandemic levels, Q(2)=357.2, P<.001. Longitudinal data (117 therapists) showed balanced inflow and outflow of users (15, 12.8% new users; 14, 12.0% discontinuers; χ²(1)=0.0, P=1.000). VBT was rated less effective than face-to-face therapy (Wilcoxon, P<.001), with non-users assigning significantly lower ratings than users (U=5638.00, P<.001). Predictors of intention to use included Therapy Quality Expectation (β=.513, P<.001) and Ease of Use (β=.213, P<.001). Logistic regression showed that prior use (OR=.25, P<.001), perceived effectiveness (OR=.36, P=.001), professional internet use (OR=.48, P=.029), and regulatory awareness (OR=.30, P<.001) significantly predicted post-pandemic usage. A three-cluster solution based on UTAUT-T dimensions identified three therapist profiles significantly differing in VBT usage intensity, digital affinity, therapeutic orientation, pandemic usage, awareness of and perceived restrictions by regulations, and perceptions of Grawe’s therapeutic factors.

Conclusions:

Post-pandemic VBT use among German outpatient psychotherapists remains heterogeneous, shaped by distinct attitudinal profiles that reflect deeper professional value orientations. Implementation strategies should be tailored to profile-specific needs, consider professional identity, and ensure regulatory clarity. These findings point to the central role of person-technology fit in sustaining digital innovations in psychotherapy. However, sustained implementation has boundaries; not all therapists will adopt VBT, even under favorable conditions, and some may view face-to-face therapy as more compatible with their values.