Elder-Vass, Jasmine; (2023) Does the way symptoms change during psychological therapy for anxiety disorders differ when it is conducted face-to-face or via video-delivery? Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: Video-delivered psychotherapy has become increasingly more common in recent years, particularly since the COVID-19 pandemic and associated lockdown restrictions. This systematic review and meta-analyses aimed to assess whether live video psychotherapy interventions are efficacious in reducing symptoms for adults with depression or an anxiety disorder. / Methods: Studies evaluating any type of psychotherapy delivered by live video sessions to adults, and with a randomised controlled design were included. Included studies examined participants with depression or an anxiety disorder, including OCD and PTSD. Electronic databases PsycINFO, Medline, Embase, Emcare, CINAHL, CENTRAL and ASSIA were searched from inception to October 2022, along with reference lists of eligible studies and review articles. Risk of bias was assessed with the Cochrane tool for assessing risk of bias in randomised trials. Data were synthesised using three-level random effects meta-analysis models and subgroup analyses were conducted to evaluate differences between diagnoses. / Results: 3879 records were identified through search strategies, with a total of 20 studies, containing 26 effect size estimates, meeting inclusion criteria. Eleven studies included an equivalent face-to-face comparator, while nine studies had a non-active comparison condition. There was no evidence of a difference between the efficacy of video-delivered therapy compared to an active control (SMD = 0.06 (95% CI: -0.06; 0.18), p = .329). Video-delivered therapy was found to be superior to non-active control groups for anxiety (SMD = -0.92, 95% CI: -1.51; -0.33, p = .002), depression (SMD = -0.84, 95% CI: -1.43; -0.25, p = .005) and trichotillomania (SMD = -1.84, 95% CI: -3.45; -0.23, p = .030). Ten out of 20 studies were classified as ‘high risk’ for at least one domain on the risk of bias tool. There was some evidence of potential publication bias with a lack of smaller studies where the face-to-face condition performed better than video-delivered therapy. / Discussion: Overall, the findings suggest that psychotherapy delivered by video is an efficacious treatment for depression and anxiety conditions, and is comparable in efficacy to face-to-face delivery. Future research could investigate variables driving the success of video-delivered therapy and potential moderators, or replicating the above studies with a focus on risk of bias reduction.

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