The effectiveness of telehealth versus face-to face interventions for anxiety disorders: A systematic review and meta-analysis

Abstract

Introduction Worldwide, it is estimated that 264 million people meet the diagnostic criteria for anxiety conditions. Effective treatment regimens consist of cognitive and behavioural therapies. During the COVID-19 pandemic, treatment delivery relied heavily on telemedicine technologies which enabled remote consultation with patients via phone or video platforms. We aim to identify, appraise and synthesise randomised controlled trials comparing telehealth to face-to-face delivery of care to individuals of any age or gender, diagnosed with anxiety disorders, and disorders with anxiety features. Methods To conduct this systematic review and meta-analysis, we searched three electronic databases, clinical trial registries and citing-cited references of included studies. Results A total of five small randomised controlled trials were includable; telehealth was conducted by video in three studies, and by telephone in two. The risk of bias for the 5 studies was low to moderate for most domains. Outcomes related to anxiety, depression symptom severity, obsessive-compulsive disorder, function, working alliance, and satisfaction were comparable between the two modes of delivery at each follow-up time point (immediately post-intervention, 3 months, 6 months and 12 months), with no significant differences reported ( p > 0.05). None of the trials reported on the costs of telehealth compared to face-to-face care. Discussion For effectively treating anxiety and related conditions, interventions delivered by telehealth appear to be as effective as the same therapy delivered in-person. However, further high-quality trials are warranted to determine the effectiveness, acceptability, feasibility, and cost-effectiveness of telehealth interventions for the management of a wider range of anxiety disorders and treatments.

Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials

“…For common mental health conditions, there is evidence that telehealth is an effective modality in the provision of psychological therapy as face-to-face therapy. There is some evidence of equivalence between videoconferencing and face-to-face care for depression [ 20 ], anxiety [ 21 , 22 ], PTSD [ 23 ], and psychotherapy broadly [ 5 ]. Furthermore, there is evidence of telephone-delivered therapy being effective for depression and anxiety [ 45 ].…”

“…We included studies with people of any age or gender, who were receiving psychotherapy for less common mental health conditions, such as bulimia nervosa and substance use disorder, or any conditions where psychotherapy was used, such as cognitive behavioral therapy (CBT) for patients with cancer with high psychological needs. Although anxiety [ 22 ], depression (Scott AM et al, PhD, unpublished data, February 2022), and PTSD [ 23 ] were within the scope of this review, there was enough literature to conduct separate systematic reviews by condition, and hence, these were excluded. Studies involving hospital patients (eg, explicitly identified as taking place in hospital wards, or with patients shortly after discharge) or those consulting a secondary or tertiary specialist (ie, a psychiatrist) were excluded.…”

“…Evidence supports the use of telehealth for application in some psychotherapies [ 5 , 20 , 21 ] and the management of common mental health conditions, including reviews in this series for depression (Scott AM et al, PhD, unpublished data, February 2022), anxiety [ 22 ], and posttraumatic stress disorder (PTSD) [ 23 ]. It is important to rigorously assess whether its effectiveness is generalizable beyond these groups.…”

Real world effectiveness of digital mental health services during the COVID-19 pandemic

“…Digitally delivered mental health services that leverage videoconferencing technology have emerged as a scalable option to meet this demand [ 7 ]. Technology-enabled mental health care that delivers virtual one-on-one support appears to produce similar outcomes as in-person treatment [ 8 , 9 ] and offers several promising solutions to enhance care. Digital platforms that collect information before treatment can use patient characteristics and preferences to identify and deliver the most effective yet least burdensome and least costly intervention from a range of care modalities, including psychotherapy with paraprofessionals or licensed therapists [ 10 ].…”

Understanding Components of Therapeutic Alliance and Well-Being from Use of a Global Digital Mental Health Benefit During the COVID-19 Pandemic: Longitudinal Observational Study

“…The types of mental health services offered through digital means are comprehensive, with most one-on-one care shifting to videoconferencing meetings or phone calls. Although telehealth services produce similar outcomes to in-person treatment (Krzyzaniak et al, 2021 ; Thomas et al, 2021 ), questions remain about whether a virtual setting is conducive to the development and maintenance of a strong therapeutic alliance between patients and providers (Simpson & Reid, 2014 ).…”