Cited by 132Telemedicine and Telehealth ImplementationDigital Mental Health InterventionsPsychotherapy Techniques and Applications

Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems.

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Thomas, Neil, McDonald, Caity, de Boer, Kathleen, Brand, Rachel M., Nedeljkovic, Maja, Seabrook, Liz·2021·Psychology and Psychotherapy: Theory, Research and Practice

Abstract

PURPOSE: The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD: Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS: Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS: Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS: Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.

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Crossref · 10.1111/papt.12332

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  • Virtual delivery of CBTs has proven to be as effective as in-person therapy in the sporting domain.

    “The virtual delivery of CBTs has proven to be as effective as in-person therapy (Thomas et al., 2021) in the sporting domain (Price et al., 2022).”

    From Integrating Acceptance and Commitment Therapy (ACT) with Psychological Skills Training (PST): a case study (2025) · cites this paper as Thomas et al., 2021

    The Abstract (Results) and Discussion report non-inferiority to in-person delivery for specific therapies, including prolonged exposure, cognitive processing therapy, and behavioural activation. Table 3 (Results) shows that comparable evidence has not been established across all CBT applications, so the unqualified claim about virtual CBTs is broader than this review supports. The citing sentence attaches the sporting-domain claim to Price et al., not Thomas et al. (LLM, conf=0.86)

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  • Most studies using videoconferencing have been conducted on anxiety-related disorders and major depression.

    “Indeed, most studies using videoconferencing have been conducted on anxiety-related disorders and major depression [26,29,30,32,33,88].”

    From A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference (2022) · cites this paper as [33]

    The Results (page not available in our copy) identify PTSD (14 studies) and depression (10) as the most frequently studied diagnostic groups, followed by anxiety disorders (6). This supports substantial study of depression and anxiety-related conditions, but the review distinguishes PTSD from anxiety disorders and does not establish that most studies concerned anxiety-related disorders and major depression specifically. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Reports on development of therapist-client rapport during videoconference sessions are mixed, with some indicating providers struggle to build therapeutic alliances and others indicating videoconferencing does not hinder rapport.

    “Reports on development of therapist-client rapport during videoconference sessions are mixed, with some indicating that providers struggle to build therapeutic alliances [26,73], whereas others indicate that videoconferencing does not hinder the therapist-client rapport or therapeutic alliance [73,74].”
  • A recent review reported that psychotherapies delivered through videoconferencing were effective and easy to access for patients, with strong evidence supporting CBT delivered through videoconferencing for PTSD and depression.

    “A recent review reported that psychotherapies delivered through videoconferencing were effective and easy to access for patients; in particular, there was strong evidence supporting the use of cognitive behavioral therapy (CBT) delivered through videoconferencing for posttraumatic stress disorder (PTSD) and depression treatment [9].”
  • Results of research to date indicate that psychological treatments administered by videoconference obtain similar results to treatments applied in person.

    “Los resultados de las investigaciones realizadas hasta la fecha indican que los tratamientos psicológicos administrados por videoconferencia obtienen unos resultados similares a los tratamientos aplicados en persona (Batastini et al., 2020; Fernández-Álvarez y Fernández-Álvarez, 2021; Thomas et al., 2021).”

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Authors
Thomas, N., McDonald, C., de Boer, K., Brand, R. M., Nedeljkovic, M., & Seabrook, L.
Affiliations
  • The Alfred Hospital (AU)
  • Swinburne University of Technology (AU)
  • Centre for Mental Health Swinburne University of Technology Melbourne Victoria Australia
  • University of the Sunshine Coast (AU)
  • National eTherapy Centre Swinburne University of Technology Melbourne Victoria Australia
Corresponding author
Thomas, Neil
Venue
Psychology and Psychotherapy: Theory, Research and Practice
Publisher
Wiley
Published
2021-02-23
Volume
94
Issue
3
Pages
854-883
ISSN
  • 1476-0835 (ISSN-L)
  • 2044-8341
OpenAlex
W3129452557
Cited by
132
References
92
Citations by year
2026: 15 · 2025: 25 · 2024: 26 · 2023: 31 · 2022: 25 · 2021: 10
FWCI
4.10
Type
journal article
Language
en
Open access
Locations
  • Psychology and Psychotherapy Theory Research and Practice (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
videoconferencing, external beam radiotherapy, individual psychotherapy, cognitive behavioral therapy, post-traumatic stress disorder, depression, prolonged exposure, cognitive processing therapy, behavioral activation, health anxiety, bulimia nervosa, eating disorders, obsessive-compulsive spectrum disorders, therapeutic relationship, nonverbal communication, COVID-19 pandemic, remote therapy delivery
MeSH terms
Therapeutic Alliance, COVID-19, Behavior Therapy, Mental Disorders, Humans, Patient Satisfaction, Process Assessment, Health Care, Telemedicine, Videoconferencing

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