Video call-based cognitive behaviour therapy for adults with common mental health conditions: A systematic review

Implementation of video call-based cognitive behavioural therapy (CBT) has increased significantly since the COVID-19 pandemic, enabling more flexible delivery, but less is known about user experience and effectiveness. This systematic review and meta-analysis investigated feasibility, acceptability, and effectiveness of individual video call-based CBT for adults with mild to moderate mental health conditions (Prospero CRD42021291055). Medline, Embase, PsycINFO and Web of Science were searched until 4 September 2023. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) assessed methodological quality of studies. Meta-analysis was conducted in R. Thirty studies (n=3275), published 2000 to 2022, mainly in the USA (n=22/30, 73%), were included. There were 15 randomised control trials, one controlled clinical trial, and 14 uncontrolled studies. Findings indicated feasibility, acceptability and effectiveness (effect size range 0.02–8.30), especially in post-traumatic stress disorder (PTSD) for military populations. Other studies investigated depression, obsessive-compulsive disorder, panic with agoraphobia, insomnia, and anxiety. Studies indicated that initial challenges with video call-based CBT subsided as therapy progressed and technical difficulties were managed with limited impact on care. EPHPP ratings were strong (n=12/30, 40%), moderate (n=12/30, 40%), and weak (n=6/30, 20%). Meta-analysis on 12 studies indicated that the difference in effectiveness of video call-based CBT and in-person CBT in reducing symptoms was not significant (SMD=0.044; CI=–0.086; 0.174). Video calls could increase access to CBT without diminishing effectiveness. Limitations include high prevalence of PTSD studies, lack of standardised definitions, and limited studies, especially those since the COVID-19 pandemic escalated use of video calls.