Table 2.
Between group differences in working alliance, primary outcomes, dropout, and satisfaction in large randomized controlled trials involving direct comparisons with in‐person therapy
| Study | Population | N | Therapy | Therapeutic alliance | Primary outcome | Dropout/satisfaction |
|---|---|---|---|---|---|---|
| Acierno et al. (2016) | PTSD and depression, veterans | 232 | BA‐TE | ‐ |
PCL‐M, BDI: VC non‐inferior to IP at post‐therapy, and 3 and 12 months |
Rate of completion of both therapy and post‐treatment assessment: no difference (VC 82%, IP 77%) |
| Acierno et al. (2017), Gros, Allan, et al. (2018) | PTSD and depression, veterans | 150 | PE | ‐ |
PCL‐M: VC non‐inferior to IP at post‐therapy, 3 months and 6 months; BDI: VC non‐inferior to IP at 6 months, inconclusive at post and 3 months |
No difference in number of sessions attended (VC 7.6, IP 8.6) or completion of a minimum dose of 6 sessions, but discontinuation occurred earlier in VC over sessions 1‐8 |
| Liu et al. (2019) | PTSD, veterans | 207 | CPT | ‐ | CAPS: VC non‐inferior to IP at 6 months, but not at post‐therapy; PCL: VC non‐inferior to IP at post and 6 months. PHQ‐9: VC non‐inferior to IP at post and 6 months | No difference in study dropout (VC 23%, IP 28%) |
| Maieritsch et al. (2016) | PTSD, veterans | 90 | CPT | WAI client ratings show equivalence | CAPS, PCL: inconclusive but trend for equivalence between groups (p < .10) | High rates of treatment dropout (43% overall) but no difference by group |
| Morland et al. (2015) | PTSD, female, civilians and veterans | 149 | CPT | WAI client ratings: VC inferior to IP at session 2, but difference small (d = −0.07), and no difference at session 6 or 12; therapist ratings: no difference at any time point. Homework completion: no difference (VC 77%, IP 80%) | CAPS: VC non‐inferior to IP at post‐treatment, 3 and 6 months. |
Therapy completion rate: no difference (≥ 10 sessions: VC 76%, IP 79%). Treatment expectations: no difference. Satisfaction ratings: both groups rated service highly on global ratings, with no difference, but VC inferior to IP on CPOSS ratings of broader service delivery (d = −0.24) |
| Yuen et al. (2015) | PTSD, combat‐related | 52 | PE | No difference on ratings of how comfortable feel talking with therapist or quality of communication | CAPS: VC non‐inferior to IP; PCL: neither group superior but non‐inferiority analysis inconclusive | SDPQ: 100% satisfied with treatment in both VC and IP |
| Choi, Hegel, et al. (2014), Choi, Marti, et al. (2014) | Depression, housebound adults over 50 | 158 | PST | ‐ | HAMD: neither group superior at 12 or 24 weeks; VC superior to IP at 36 weeks; WHODAS: neither superior at any time point | Treatment Evaluation Inventory: VC superior to IP |
| Egede et al. (2015) | Depression, veterans | 241 | BA | ‐ | BDI, GDS, SCID: VC non‐inferior at 4 weeks (mid), 8 weeks (post) and 3 months. | No difference in full therapy completion rate (VC 81%, IP 79%) |
| Luxton et al. (2016) | Depression, military personnel | 121 | BA | ‐ | BDI: VC non‐inferior to IP at mid‐therapy and 12 weeks, but not at post‐therapy; BHS: VC non‐inferiority not established at any time point, and found to be inferior to IP at post‐therapy. |
CSQ: high satisfaction, no difference between groups. Attitudes to seeking mental health treatment: no difference between groups. No difference in full therapy completion rate (VC 64%, IP 71%) |
| Watts et al. (2020) | Generalized anxiety disorder | 115 | CBT | WAI: Across 8 time points, VC superior to IP in client ratings; neither group superior on therapists’ ratings. | ‐ | ‐ |
| Mitchell et al. (2008), Ertelt et al. (2011), Marrone et al. (2009) | Bulimia nervosa or EDNOS | 128 | CBT |
WAI: no difference in client ratings, VC inferior to IP in therapist ratings. |
EDE: neither group superior for abstinence from bingeing and/or purging. VC inferior to IP for reduction in binge eating frequency across time points. | Client ratings of treatment suitability, client expectation of success, and number of sessions completed: no difference. |
| Morgan et al. (2008) | People in prison or secure forensic psychiatric hospital | 186 | Individualized therapy | WAI: no difference in client ratings. | ‐ | No differences on CSQ, or ratings of session depth, smoothness, positivity or distress. |
Only includes randomized controlled trials sufficiently powered to detect large between group effects (N ≥ 52 at 80% power). If no primary outcome specified, symptoms of target disorder listed. Superiority/inferiority refers to group differences observed versus a null hypothesis of no difference; non‐inferiority (one tailed test) and equivalence (two‐tailed test) refer to whether or not the confidence interval for the difference includes a null hypothesis of the groups differing by the minimum clinically significant difference. PTSD = post‐traumatic stress disorder; EDNOS = Eating disorder not otherwise specified. Therapies: BA = behavioural activation; BA‐TE = behavioural activation and therapeutic exposure; CBT = cognitive behavioural therapy; CPT = cognitive processing therapy; PST = problem‐solving therapy. Groups: IP = in‐person; VC = videoconferencing. Measures: BDI = Beck Depression Inventory; CAPS = Clinician Administered PTSD Scale; CGI = Clinical Global Impression; CPOSS = Charleston Psychiatric Outpatient Satisfaction Scale; CSQ = Client Satisfaction Questionnaire; EDE = Eating Disorders Examination; GDS = Geriatric Depression Scale; HAMD = Hamilton Rating Scale for Depression; SCID = Structured Clinical Interview for DSM diagnosis; SCL‐90R = Hopkins Symptom Checklist; SDPQ = Service Delivery Perceptions Questionnaire; SEQ = Session Evaluation Questionnaire; WAI = Working Alliance Inventory.