Effectiveness of youth psychotherapy delivered remotely

Venturo-Conerly,  Fitzpatrick, Horn, Uguerto  & Weisz (2022) published “Effectiveness of Youth Psychotherapy Delivered remotely: A meta-analysis” in American Psychologist.

Reports on remote psychotherapies for youth (e.g., technology-based treatment) suggest it is acceptable, feasible, and useful in overcoming logistical barriers to treatment. But how effective is remote care? To find out, PsychINFO and PubMed were searched from 1960 and 2020, supplemented by journal searches and reference trails, to identify randomized controlled trials of youth psychotherapy for anxiety (including obsessive-compulsive disorder and trauma), depression, attention-deficit hyperactivity disorder (ADHD), or conduct problems, in which all therapeutic contact occurred remotely. Articles (N = 37) published from 1988 to 2020, reporting 43 treatment-control group comparisons, were identified. Robust variance estimation was used to account for effect size dependencies and to synthesize overall effects and test candidate moderators. Pooled effect size was .45 (95% confidence level [CI: .26, .67], p < .001) at posttreatment, .44 (95% CI [.12, .76], p < .05) at follow-up – comparable to effects reported in meta-analyses of in-person youth psychotherapy. Effects were significantly (a) larger for remote psychotherapies supported by therapeutic provider contact (.64) than for those accessed by youths, with only logistical support (.22), (b) larger for treatments with phone contact (.65) than for those without (.25), (c) larger for treatment of anxiety (.62) and conduct problems (.78) than ADHD (-.03), and (d) smaller for therapies involving attention/working memory (-.18) than for those without (.60). Among studies with therapeutic contact, effects were significantly larger when therapists facilitated skill-building (e.g., practicing exposures or problem solving [.68]) than when therapists did not (.18). These findings support the effectiveness of remote psychotherapies for youths, and they highlight moderators of treatment benefit that warrant attention in future research.

They note in their discussion that “Remote psychotherapies with therapeutic provider contact significantly outperformed those without therapeutic provider contact. Relatedly, remote psychotherapies in which over 25% of the intervention involved provider contact significantly outperformed remote psychotherapies in which less than 25% involved provider contact.” They also discuss the lower effect sizes when interventions target ADHD as well as those utilizing attention/working memory training, while higher effect sizes occurred for behavioral therapy and caregiver-focused behavioral therapy. They suggest that lower effect sizes in studies with logistical contact may be due to “programs requiring more technical support were more confusing or frustrating, leading to lower treatment compliance and efficacy.”