Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta‐analysis

Norwood, Carl; Moghaddam, Nima; Malins, Sam; Sabin‐Farrell, Rachel

doi:10.1002/cpp.2315

Cited by 246 publications

(259 citation statements)

References 64 publications

(234 reference statements)

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“…However, other studies have found better results with face-to-face therapy (Mallen et al, 2005). In a recent study, meta-analytic results indicated that the alliance formed through videoconferencing was inferior to that of face-toface therapy; despite this, the outcomes were non-inferior (Norwood et al, 2017).…”

Section: Experience and Therapeutic Alliancementioning

confidence: 95%

Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study

et al. 2020

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Videoconferencing is an emerging medium through which psychological therapy, including relationship interventions for couples, can be delivered. Understanding clients' expectations and experiences of receiving therapy through this medium is important for optimizing future delivery. This study used a qualitative methodology to explore the expectations and experiences of couples throughout the process of the Couple CARE program, which was delivered through videoconferencing. Fifteen couples participated in semi-structured interviews during the first and last sessions of the intervention. The interviews were conducted using the iChat program, with the therapist conducting the first interview and an external interviewer conducting the second. Thematic analysis was used to identify themes from the interview transcripts. Five themes were identified from the pre-therapy interviews, reflecting couples' initial impressions and expectations: new experience, comparison, practical aspects, connection and dynamics, and distance and space. Couples' experiences were explored in the eight themes from the post-therapy interviews: technicalities, the idea of "distance," satisfaction and comfort, confidentiality, comparisons, new experience, expectations change, and working alliance. Overall, the present study found that couples experienced a positive shift in expectations. Despite some initial concerns regarding the therapist's ability to empathize over a screen and the potential for the technology to break down, many clients noted that videoconferencing allowed them to become fully immersed in the therapeutic process. In fact, many couples felt that videoconferencing created an element of 'distance' from the therapist that allowed them to feel a greater sense of control and comfort. Couples consistently described being able to effectively connect with the therapist, and that the video actually enhanced the therapeutic alliance, due to a greater perceived focus on therapy processes. Overall, despite some initial concerns, the majority of couples found the videoconferencing experience to be beneficial and positive.

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Section: Experience and Therapeutic Alliancementioning

confidence: 95%

Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study

et al. 2020

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“…The most common weaknesses included a lack of explicit statements that a protocol was developed prior to commencement of the review (Explicit statements were reported in two reviews (18,19)), lack of duplicate study selection (duplicate selection was reported in five reviews (19)(20)(21)(22)(23)), no report of excluded studies and reasons for exclusion (exclusions were reported in two reviews, (19,21)), and no report of sources of funding (sources of funding were reported in three reviews, (21,24,25)). Meta-analysis was not performed in the majority of reviews, usually due to heterogeneous data or aims centring around more narrative conclusions such as satisfaction (K=12), but in those that included meta-analysis (19,21,(25)(26)(27)(28), all except two (21,27) assessed publication bias. The potential impact of risk of bias was only assessed in two reviews performing meta-analysis (21,27), but all reviews performing meta-analysis used appropriate statistical methods for combining results.…”

Section: Quality Of Included Reviewsmentioning

confidence: 99%

“…Meta-analysis was not performed in the majority of reviews, usually due to heterogeneous data or aims centring around more narrative conclusions such as satisfaction (K=12), but in those that included meta-analysis (19,21,(25)(26)(27)(28), all except two (21,27) assessed publication bias. The potential impact of risk of bias was only assessed in two reviews performing meta-analysis (21,27), but all reviews performing meta-analysis used appropriate statistical methods for combining results. The reviews eliciting higher confidence (moderate) were the two Cochrane reviews (21,28).…”

Section: Quality Of Included Reviewsmentioning

confidence: 99%

Remote working in mental health services: a rapid umbrella review of pre-COVID-19 literature

Barnett

Goulding

Casetta

et al. 2020

Preprint

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Background: Tele-mental health care has been rapidly adopted to maintain services during the pandemic, and there is now substantial interest in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw not only on COVID-19 experiences, but also on the substantial research evidence accumulated prior to this. Aims: to conduct an umbrella review of systematic reviews of research literature and evidence-based guidance on remote working in mental health, including both qualitative and quantitative literature. Method: Three databases were searched between January 2010 and August 2020 for systematic reviews meeting pre-defined criteria. Reviews retrieved were independently screened and those meeting inclusion criteria were synthesised and assessed for risk of bias. Narrative synthesis was used to report findings Results: Nineteen systematic reviews met inclusion criteria. Fifteen examined clinical effectiveness, eight reported on aspects of tele-mental health implementation, ten reported on acceptability to service users and clinicians, two on cost-effectiveness and one on guidance. Most reviews were assessed as low quality. Findings suggested that video-based communication could be as effective and acceptable as face-face formats, at least in the short-term. Evidence was lacking on extent of digital exclusion and how it can be overcome, or on significant context such as children and young people and inpatient settings. Conclusions: This umbrella review suggests that tele-mental health has potential to be an effective and acceptable form of service delivery. However, we found limited evidence on impacts of large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for future tele-mental health implementation.

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“…In a systematic review on VCP, Backhaus et al (2012) found that only 16 out of 47 studies examined the patient-provider relationship in therapy, and 14 out of 16 concluded that patients and providers perceived a strong working alliance. However, a more recent review using different criteria (Norwood et al, 2018) highlighted the need for more studies, including for PDA, and considered that the working alliance was slightly lower in VCP than in FF therapy. Psychotherapists may be apprehensive toward using videoconferencing for fear of disrupting the working alliance (Rees and Stone, 2005;Richardson et al, 2009;Connolly et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial

et al. 2020

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Background: In the context of the COVID-19 pandemic, legislations are being modified around the world to allow patients to receive mental health services through telehealth. Unfortunately, there are no large clinical trial available to reliably document the efficacy of delivering videoconferencing psychotherapy (VCP) for people with panic disorder and agoraphobia (PDA) and whether basic psychotherapeutic processes are altered. Methods: This 2-arm intent-to-treat non-inferiority study reports on a clinical trial on VCP and documents how therapeutic working alliance and motivation toward psychotherapy are associated to treatment outcome. We hypothesized that VCP would not be inferior to standard face-to-face (FF) cognitive behavior therapy for PDA. No specific hypothesis was stated to address working alliance and treatment mechanisms. VCP was compared to a gold-standard psychotherapy treatment for PDA, which was delivered either in person or in videoconference, with a strict tolerance criterion of about 2 points on the primary outcome measure. Seventy one adult patients were recruited. Measures of working alliance were collected after the first, fifth, and last session. Motivation toward therapy at pre-treatment and working alliance after the fifth therapy session were used as predictors of treatment outcome and compared with change in dysfunctional beliefs toward bodily sensations. Results: Panic disorder, agoraphobia, fear of sensations and depressed mood all showed significant improvements and large effect-sizes from pre to post-treatment. Gains were maintained at follow-up. No significant differences were found between VCP and FF, and effect sizes were trivial for three of the four outcome measures. Noninferiority tests confirmed that VCP was no less effective than FF therapy on the primary outcome measure and two of the three secondary outcome measures. Working alliance was very strong in VCP and did not statistically differ from FF. Working alliance and motivation did not predict treatment outcome, which was significantly predicted by the

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Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta‐analysis

Cited by 246 publications

References 64 publications

Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study

Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study

Remote working in mental health services: a rapid umbrella review of pre-COVID-19 literature

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial

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