Comparing Video-Based and Face-to-Face Psychotherapy: Systematic Review and Multilevel Meta-Analysis Across Mental Disorders

BACKGROUND Randomized controlled trials (RCTs) comparing video-based psychotherapy (VBT) and face-to-face therapy (F2F) show considerable methodological heterogeneity, limiting the interpretability of findings regarding comparative efficacy. OBJECTIVE The objective of this systematic review is to compare VBT and F2F in terms of symptom reduction with strict methodological inclusion criteria, especially regarding the therapeutic setting and the duration of psychotherapy. METHODS PubMed, Embase and PsycInfo were systematically searched for RCTs comparing synchronous VBT and F2F exceeding 500 minutes in total. Primary outcome was post-treatment symptom severity. PRISMA criteria were followed. A three-level meta-analysis was conducted to analyze multiple outcomes per study. Risk of bias was assessed following Metapsy guidelines for psychological intervention trials. RESULTS Out of 9,446 records screened, 86 articles underwent full-text review; 11 RCTs (n = 858; mean age = 38.47 years; 49.3% female) met the inclusion criteria. Diagnoses included post-traumatic stress disorder, depression, obsessive-compulsive disorder, bulimia nervosa, generalized anxiety disorder, and somatoform pain. Across 36 outcomes, no significant differences in symptom reduction emerged between VBT and F2F (Hedges’ g = -0.07; 95% CI [-0.53, 0.40]; SE = 0.21; p = .76). No moderating effects were detected. Information criteria favored the three-level model over conventional approaches. CONCLUSIONS The findings indicated that there were no significant differences between VBT and F2F. These results suggest that VBT is a viable method for delivering psychotherapy for symptom reduction. Future research should focus on the effectiveness of VBT in long-term treatment and the contextual and cultural factors that may influence it. CLINICALTRIAL DOI: 10.17605/OSF.IO/ZN8Q5