Telehealth versus face-to-face psychotherapy for less common mental health conditions: systematic review and meta-analysis of randomized controlled trials
Open accessPublished version of a preprint
Abstract
BACKGROUND: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. OBJECTIVE: This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. METHODS: In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. RESULTS: A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI -0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI -0.40 to 0.39), function (SMD 0.13, 95% CI -0.16 to 0.42), working alliance client (SMD 0.11, 95% CI -0.34 to 0.57), working alliance therapist (SMD -0.16, 95% CI -0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI -0.30 to 0.53), or at any other time point (3, 6, and 12 months). CONCLUSIONS: With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Digital therapy is just as effective as in-person therapy in improving clinical outcomes.
“Evidence suggests that digital therapy is just as effective as in-person therapy in improving clinical outcomes”
From Predictors and Correlates of Depression and Anxiety Symptom Trajectories in a Large Digital Mental Health Provider: Retrospective Analysis of Data From Rula Health (2025) · cites this paper as [14]
The Results report no significant differences in symptom severity or overall improvement between telehealth and face-to-face psychotherapy. But the Conclusions explicitly say the authors cannot conclude the approaches are equivalent, and the review concerns telephone- or video-delivered psychotherapy for less common mental health conditions and physical conditions requiring psychological support—not digital therapy generally. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe psychological treatment delivery format via video calls has proven to be as effective as traditional in-person treatments.
“This psychological treatment delivery format has proven to be as effective as traditional in-person treatments (Berryhill et al., 2019; Greenwood et al., 2022).”
From Evaluation of effectiveness and acceptability of a psychological treatment for smoking cessation combined with a smartphone App: A pilot study (2024) · cites this paper as Greenwood et al., 2022
The Discussion (Principal Findings) reports no significant outcome differences between telehealth and face-to-face psychotherapy in 12 trials, but the interventions included telephone as well as video delivery. It describes the evidence as insufficient to establish a difference, with confidence intervals often too wide to rule out a meaningful difference. The claim therefore overstates both the certainty of equivalence and the video-specific evidence. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
Wang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,759 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions
(2019) · doi:10.1002/9781119536604 · Cited by 14,828 · see citing works
COVID-19 pandemic and mental health consequences: Systematic review of the current evidence
Vindegaard, N., & Benros, M. E. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.05.048 · Cited by 3,221 · see citing works
The outbreak of COVID-19 coronavirus and its impact on global mental health
Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020) · International Journal of Social Psychiatry · doi:10.1177/0020764020915212 · Cited by 3,013 · see citing works
The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence
Monaghesh, E., & Hajizadeh, A. (2020) · BMC Public Health · doi:10.1186/s12889-020-09301-4 · Cited by 1,941 · see citing works
Telehealth transformation: COVID-19 and the rise of virtual care
Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., Curtis, S., Roman, M., Poon, E. G., Ferranti, J., et al. (2020) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaa067 · Cited by 1,581 · see citing works
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014) · World Psychiatry · doi:10.1002/wps.20151 · Cited by 1,077 · see citing works
Clark, J. M., Sanders, S., Carter, M., Honeyman, D., Cleo, G., Auld, Y., Booth, D., Condron, P., Dalais, C., Bateup, S., et al. (2020) · Journal of the Medical Library Association JMLA · doi:10.5195/jmla.2020.834 · Cited by 610 · see citing works
Self-citationVideoconferencing psychotherapy: a systematic review
Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorp, N. M., Lohr, J., & Thorp, S. R. (2012) · Psychological Services · doi:10.1037/a0027924 · Cited by 586 · see citing works
Smith, K. B., Humphreys, J. S., & Wilson, M. G. A. (2008) · Australian Journal of Rural Health · doi:10.1111/j.1440-1584.2008.00953.x · Cited by 584 · see citing works
National Survey of Mental Health and Wellbeing: Summary of Results
(2008) · PsycEXTRA Dataset · doi:10.1037/e681292012-001 · Cited by 525 · see citing works
Determining if Telehealth Can Reduce Health System Costs: Scoping Review
Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L., & Caffery, L. J. (2020) · Journal of Medical Internet Research · doi:10.2196/17298 · Cited by 469 · see citing works
Evolution of Heterogeneity (I2) Estimates and Their 95% Confidence Intervals in Large Meta-Analyses
Thorlund, K., Imberger, G. L., Johnston, B. C., Walsh, M. W., Awad, T., Thabane, L., Gluud, C. N., Devereaux, P. J., & Wetterslev, J. (2012) · PLoS ONE · doi:10.1371/journal.pone.0039471 · Cited by 432 · see citing works
Chang, J. E., Lai, A. Y., Gupta, A., Nguyen, A. M., Berry, C. A., & Shelley, D. (2021) · Milbank Quarterly · doi:10.1111/1468-0009.12509 · Cited by 390 · see citing works
Josephine, K., Josefine, L., Philipp, D., David, E., & Harald, B. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.07.021 · Cited by 341 · see citing works
Butzner, M., & Cuffee, Y. (2021) · Journal of Medical Internet Research · doi:10.2196/29575 · Cited by 332 · see citing works
Videoconferencing psychotherapy and depression: a systematic review
Berryhill, M. B., Culmer, N., Williams, N., Halli-Tierney, A., Betancourt, A., Roberts, H., & King, M. (2019) · Telemedicine and e-Health · doi:10.1089/tmj.2018.0058 · Cited by 275 · see citing works
Hoermann, S., McCabe, K. L., Milne, D. N., & Calvo, R. A. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7023 · Cited by 263 · see citing works
Comer, J. S., Furr, J. M., Miguel, E. M., Cooper‐Vince, C. E., Carpenter, A. L., Elkins, R. M., Kerns, C. E., Cornacchio, D., Chou, T., Coxe, S. J., et al. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000230 · Cited by 240 · see citing works
Psychotherapy using distance technology: A comparison of face-to-face, video, and audio treatment.
Day, S. X., & Schneider, P. L. (2002) · Journal of Counseling Psychology · doi:10.1037/0022-0167.49.4.499 · Cited by 214 · see citing works
Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., Crow, S., Lancaster, K., Simonich, H., Swan-Kremeier, L., Lysne, C., & Cook Myers, T. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.02.004 · Cited by 210 · see citing works
Himle, M. B., Freitag, M., Walther, M. R., Franklin, S. A., Ely, L. J., & Woods, D. W. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.05.009 · Cited by 202 · see citing works
A systematic review of internet-based therapy for the treatment of addictions
Gainsbury, S., & Blaszczynski, A. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.11.007 · Cited by 192 · see citing works
Dowling, M. J., & Rickwood, D. (2013) · Journal of Technology in Human Services · doi:10.1080/15228835.2012.728508 · Cited by 190 · see citing works
Jenkins-Guarnieri, M. A., Pruitt, L. D., Luxton, D. D., & Johnson, K. (2015) · Telemedicine and e-Health · doi:10.1089/tmj.2014.0165 · Cited by 189 · see citing works
Therapeutic Alliance in Face-to-Face Versus Videoconferenced Psychotherapy.
Rees, C. S., & Stone, S. (2005) · Professional Psychology Research and Practice · doi:10.1037/0735-7028.36.6.649 · Cited by 189 · see citing works
Richter, D., Wall, A., Bruen, A. J., & Whittington, R. (2019) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13083 · Cited by 187 · see citing works
E-therapy in the treatment and prevention of eating disorders: A systematic review and meta-analysis
Loucas, C. E., Fairburn, C. G., Whittington, C., Pennant, M. E., Stockton, S., & Kendall, T. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.09.011 · Cited by 169 · see citing works
Provider Barriers to Telemental Health: Obstacles Overcome, Obstacles Remaining
Brooks, E. A., Turvey, C., & Augusterfer, E. F. (2013) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2013.0068 · Cited by 165 · see citing works
Rural–urban disparities in health: How does Canada fare and how does Canada compare with Australia?
Pong, R., DesMeules, M., & Lagacé, C. (2009) · Australian Journal of Rural Health · doi:10.1111/j.1440-1584.2008.01039.x · Cited by 162 · see citing works
Recent Advances in Delivering Mental Health Treatment via Video to Home
Fletcher, T. L., Hogan, J., Keegan, F. S., Davis, M. L., Wassef, M., Day, S. C., & Lindsay, J. A. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0922-y · Cited by 145 · see citing works
Videoconferencing psychological therapy and anxiety: a systematic review
Berryhill, M. B., Halli-Tierney, A., Culmer, N., Williams, N., Betancourt, A., King, M., & Ruggles, H. (2019) · Family Practice · doi:10.1093/fampra/cmy072 · Cited by 143 · see citing works
King, V. L., Stoller, K. B., Kidorf, M., Kindbom, K., Hursh, S., Brady, T., & Brooner, R. K. (2009) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2008.06.011 · Cited by 135 · see citing works
Technology-Based Mental Health Treatment and the Impact on the Therapeutic Alliance
Lopez, A., Schwenk, S., Schneck, C. D., Griffin, R. J., & Mishkind, M. C. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1055-7 · Cited by 128 · see citing works
Krzyżaniak, N., Greenwood, H., Scott, A. M., Peiris, R., Cardona, M., Clark, J. M., & Glasziou, P. (2021) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x211053738 · Cited by 121 · see citing works
Self-citationTelepsychotherapy for generalized anxiety disorder: Impact on the working alliance.
Watts, S., Marchand, A., Bouchard, S., Gosselin, P., Langlois, F., Belleville, G., & Dugas, M. J. (2020) · Journal of Psychotherapy Integration · doi:10.1037/int0000223 · Cited by 117 · see citing works
Xie, Y., Dixon, J. F., Ong, M. Y., Zhang, J., Chen, Y. A., DeAngelo, S., Yellowlees, P., Hendren, R. L., & Schweitzer, J. B. (2013) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2012.0108 · Cited by 114 · see citing works
Humer, E. C., Stippl, P., Pieh, C., Pryss, R. C., & Probst, T. (2020) · Journal of Medical Internet Research · doi:10.2196/20246 · Cited by 108 · see citing works
A randomized trial of Web-based videoconferencing for substance abuse counseling
King, V. L., Brooner, R. K., Peirce, J. M., Kolodner, K., & KIDORF, M. S. (2013) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2013.08.009 · Cited by 107 · see citing works
Benefits and challenges of conducting psychotherapy by telephone
Brenes, G. A., Ingram, C. W., & Danhauer, S. C. (2011) · Professional Psychology: Research and Practice · doi:10.1037/a0026135 · Cited by 103 · see citing works
Ertelt, T. W., Crosby, R. D., Marino, J. M., Mitchell, J. E., Lancaster, K., & Crow, S. J. (2010) · International Journal of Eating Disorders · doi:10.1002/eat.20874 · Cited by 99 · see citing works
Crow, S. J., Mitchell, J. E., Crosby, R. D., Swanson, S. A., Wonderlich, S. A., & Lancanster, K. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.02.006 · Cited by 82 · see citing works
Coughtrey, A. E., & Pistrang, N. (2016) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x16686547 · Cited by 78 · see citing works
Freeman, K. A., Duke, D. C., & Harris, M. A. (2013) · Journal of Diabetes Science and Technology · doi:10.1177/193229681300700318 · Cited by 76 · see citing works
Evidence of a Rapid Shift in Outpatient Practice During the COVID-19 Pandemic Using Telemedicine
Punia, V., Nasr, G., Zagorski, V., Lawrence, G., Fesler, J. R., Nair, D. R., & Najm, I. (2020) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2020.0150 · Cited by 71 · see citing works
Health systems around the world – a comparison of existing health system rankings
Schütte, S., Acevedo, P. N. M., & Flahault, A. (2018) · Journal of Global Health · doi:10.7189/jogh.08.010407 · Cited by 66 · see citing works
Assessing equivalence and noninferiority
Treadwell, J. R., Uhl, S., Tipton, K. N., Shamliyan, T., Viswanathan, M., Berkman, N. D., Sun, X., Coleman, C. I., Elshaug, A. G., Singh, S., et al. (2012) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.05.001 · Cited by 58 · see citing works
Does E-Therapy for Problem Drinking Reach Hidden Populations?
Postel, M. G., de Jong, C. A. J., & de Haan, H. A. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.12.2393 · Cited by 53 · see citing works
Hoffmann, M., Wensing, M., Peters-Klimm, F., Szécsényi, J., Hartmann, M., Friederich, H., & Haun, M. W. (2020) · Journal of Medical Internet Research · doi:10.2196/17569 · Cited by 50 · see citing works
Burgess, M., Andiappan, M., & Chalder, T. (2011) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465811000543 · Cited by 48 · see citing works
Watson, M., White, C., Lynch, A., & Mohammed, K. (2017) · Psycho-Oncology · doi:10.1002/pon.4338 · Cited by 40 · cited 2× · see citing works
“3 | e31780 | p. 6https://mental.jmir.org/2022/3/e31780 (page number not for citation purposes) XSL•FO RenderX Comparator: modality dose Telehealth: modality doseIntervention Age (years), mean (SD)Participants Study participants, total N (n THb, n F2Fc) Followup (months) RCTa designCountry Reference F2F, 8 sessions, 12…”
BackgroundInfluentialReal-Time Telehealth Versus Face-to-Face Management for Patients With PTSD in Primary Care
Scott, A. M., Bakhit, M., Greenwood, H., Cardona, M., Clark, J. M., Krzyżaniak, N., Peiris, R., & Glasziou, P. (2022) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.21r14143 · Cited by 38 · see citing works
Self-citationVideoconferencing for Teens With Diabetes
Duke, D. C., Wagner, D. V., Ulrich, J., Freeman, K. A., & Harris, M. A. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816642577 · Cited by 27 · see citing works
Malas, N., Klein, E. J., Tengelitsch, E., Kramer, A., Marcus, S. M., & Quigley, J. M. (2018) · Psychosomatics · doi:10.1016/j.psym.2018.06.005 · Cited by 27 · see citing works
Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2022) · Psychological Services · doi:10.1037/ser0000435 · Cited by 23 · see citing works
McAndrew, L. M., Greenberg, L. M., Ciccone, D. S., Helmer, D. A., & Chandler, H. K. (2017) · Military Behavioral Health · doi:10.1080/21635781.2017.1337594 · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [26]Scopus Elsevier B.V 2021 2021-12-01 https://www.scopus.com/search/form.uri?display=basic#basic
- [28]Review Manager (RevMan) [Computer program]. Version 5.4 The Cochrane Collaboration 2020 2022-02-11 https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman/revman-non-cochrane-reviews
Cited by
Sorted by citations
Kearney, B. E., Corrigan, F. M., Frewen, P. A., Nevill, S., Harricharan, S., Andrews, K., Jetly, R., McKinnon, M. C., & Lanius, R. A. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2240691 · Cited by 23 · see citing works
A systematic review of the literature on telepsychiatry for bipolar disorder
Farrell, A., George, N., Amado, S., & Wozniak, J. (2022) · Brain and Behavior · doi:10.1002/brb3.2743 · Cited by 19 · see citing works
Barroso-Hurtado, M., López-Durán, A., Martínez-Vispo, C., Suárez-Castro, D., & Becoña, E. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100737 · Cited by 6 · see citing works
McAlister, K. L., Baez, L., Newton, D., Seiniger, S., Pearlman, A., Woodhouse, A., & Huberty, J. (2025) · Journal of Medical Internet Research · doi:10.2196/75750 · Cited by 2 · see citing works
- Authors
- Greenwood, H., Krzyzaniak, N., Peiris, R., Clark, J., Scott, A. M., Cardona, M., Griffith, R., & Glasziou, P.
- Affiliations
- Bond University (AU)
- Corresponding author
- Greenwood, Hannah
- ORCID
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2022-03-11
- Volume
- 9
- Issue
- 3
- Pages
- e31780
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC8956990
- OpenAlex
- W4221029000
- Cited by
- 141
- References
- 58
- Citations by year
- 2026: 32 · 2025: 51 · 2024: 26 · 2023: 25 · 2022: 7
- FWCI
- 5.42
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bond University Research Portal (Bond University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- 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
- telemedicine, face-to-face psychotherapy, videoconferencing, telephone-delivered therapy, cognitive behavioral therapy, family therapy, addiction, eating disorders, child psychopathology, chronic disease, therapeutic relationship, client satisfaction, cost-effectiveness, access to mental health care, general practitioners, primary care nurses, allied health professionals, symptom severity, functional outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
