Comparing In-Person to Videoconference-Based Cognitive Behavioral Therapy for Mood and Anxiety Disorders: Randomized Controlled Trial

Abstract

BackgroundCognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment.ObjectiveThe present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort.MethodsA total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction.ResultsRetention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P<.001, d=1.41), anxiety (P<.001, d=1.14), stress (P<.001, d=1.81), and quality of life (P<.001, d=1.17). There were no significant differences between treatment conditions regarding symptoms of depression (P=.165, d=0.37), anxiety (P=.41, d=0.22), stress (P=.15, d=0.38), or quality of life (P=.62, d=0.13). There were no significant differences in client rating of the working alliance (P=.53, one-tailed, d=–0.26), therapist ratings of the working alliance (P=.60, one-tailed, d=0.23), or client ratings of satisfaction (P=.77, one-tailed, d=–0.12). Fisher’s Exact P was not significant regarding differences in reliable change from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.41, P=.26), anxiety (P=.60, P=.99), or quality of life (P=.65, P=.99) but was significant for symptoms of stress in favor of the videoconferencing condition (P=.03, P=.035). Difference between conditions regarding clinically significant change was also not observed from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.67, P=.30), anxiety (P=.99, P=.99), stress (P=.19, P=.13), or quality of life (P=.99, P=.62).ConclusionsThe findings of this controlled trial indicate that CBT was effective in significantly reducing symptoms of depression, anxiety, and stress and increasing quality of life in both in-person and videoconferencing conditions, with no significant differences being observed between the two.Trial RegistrationAustralian New Zealand Clinical Trials Registry ID: ACTRN12609000819224; http://www.anzctr.org.au/ACTRN12609000819224.aspx (Archived by WebCite at http://...

Aliança Terapêutica nas Terapias Cognitivo-comportamentais por Videoconferência: uma Revisão da Literatura

“…A maioria (n = 5) dos estudos realizou psicoterapia individual (Bouchard et al, 2004;Ertelt et al, 2011;Germain, Marchand, Bouchard, Guay, & Drouin, 2010;Stubbings, Rees, Roberts, & Kane, 2013;Vogel et al, 2012), mas dois artigos realizaram intervenção em grupo (Greene et al, 2010;Morland et al, 2014) e dois conduziram terapia de família (Carey, Wade, & Wolfe, 2008;Freeman, Duke, & Harris, 2013).…”

“…Seis estudos aplicaram o Working Alliance Inventory (WAI) (Bouchard et al, 2004;Ertelt et al, 2011;Freeman et al, 2013;Germain et al, 2010;Stubbings et al, 2013;Vogel et al, 2012), sendo que dois deles utilizaram a versão reduzida do instrumento (Stubbings et al, 2013;Vogel et al, 2012). Dois artigos utilizaram a versão abreviada da Group Therapy Alliance Scale (GTAS) (Greene et al, 2010;Morland et al, 2014) e um estudo utilizou a Agnew Relationship Measure (ARM) (Carey et al, 2008).…”

“…Os demais manuscritos não encontraram tais diferenças, indicando que a aliança terapêutica na TCC por videoconferência foi semelhante com o tratamento presencial (Carey et al, 2008;Freeman et al, 2013;Germain et al, 2010;Morland et al, 2014;Stubbings et al, 2013). Ertelt et al (2011) investigaram as diferenças de fatores terapêuticos entre a TCC realizada por videoconferência ou na forma presencial para o tratamento da bulimia nervosa.…”

“…Além disso, não houve diferença entre os grupos com relação à aliança terapêutica, tanto no escore total da GTAS, quanto nas suas subescalas. Stubbings et al (2013) investigaram a aliança terapêutica na TCC realizada por videoconferência para tratamento de Transtorno de Humor e de Ansiedade e compararam com a terapia presencial. Os resultados mostraram que não houve diferenças significativas em aliança terapêutica entre as condições, tanto nas respostas dos clientes (p = 0,53) quanto dos terapeutas (p = 0,6), avaliadas no pós-teste.…”

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach (Preprint)

“…However, the inclusion of a video call at the beginning of the intervention may overcome these concerns. Indeed, the delivery of CBT via video conference is as effective as face-to-face CBT [24], allowing similar communication to that in face-to-face therapy [25]. The inclusion of some form of face-toface contact with an e-therapist may help develop a therapeutic alliance [26].…”