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Friends of the Nonverbal Communication Blog, this week we present the paper “Evidence of Phone vs Video-Conferencing for Mental Health Treatments: A Review of the Literature”, by Chen, P. V.; Helm, A.; Caloudas, S. G.; Ecker, A.; Day, G.; Hogan, J. and Jan, L. (2022), in which authors carry out a meta-analysis in which they draw conclusions from previous literature on the positive or negative outcomes of online with video and telephone psychological therapy compared to traditional face-to-face therapy.

The ability to receive mental health care remotely, either by video and audio or by telephone only, has been available since about 1960. However, many therapists felt, even in those years, that this type of care was of lower quality than traditional care.

Precisely this traditional model was forced to change in the early 2020s. The Covid-19 pandemic imposed very drastic measures for the population, including confinement and social isolation. Thus, in-person healthcare was limited and video and telephone modalities were brought to the forefront as patients and therapists sought to continue therapy while adhering to safety and prevention measures. 

However, it is not clear whether, in fact, video and/or telephone care is better than face-to-face or not, or which of the two might be its more direct competition, because their applications have been so disparate. 

For example, from April through June 2020, of all mental health encounters conducted at Veterans facilities in the United States, 63% occurred by telephone, 21% by video, and 14% face-to-face. A survey of the use of telematics by health insurance beneficiaries found that 56% of visits were by telephone only, compared to 28% of visits by video and 16% that were a combination of telephone and video. 

The goal of the article we present this week was to provide a comparative review of the use of telephone and video to provide mental health treatment. 

Authors extracted a number of articles on “video telehealth,” including those published between 2002 and 2022, to get as current a picture as possible, and divided their findings according to different blocks of mental health conditions or problems.

When it comes to anxiety and depression, it appears that video telehealth services may be particularly valuable, as patients diagnosed with a mood disorder are more likely to attend video-conferencing appointments than patients with other diagnoses. 

In addition, both video and telephone have been shown to be effective in reducing symptoms related to mood disorders. Telephone therapy for depression is more effective than no treatment, or even more effective than treatment as usual; and treatments for anxiety conducted by telephone are at least moderately effective in reducing symptoms compared to no treatment or traditional treatment.

In patients with post-traumatic stress disorder, the effectiveness of video treatment is comparable to in-person care, and results in symptom improvement. For telephone treatments, patients also reported a decrease in symptoms.

It appears that patients, on the other hand, are less satisfied with therapists when it comes to telephone care and, in addition, treatments via video had higher dropout rates. 

For substance use treatments, there are no significant differences in effectiveness when patients receive video or telephone treatment compared to in-person care. Patients who received in-person or video group therapy had comparable positive rates on their urine screening tests, similar duration of abstinence, and similar amounts of time spent in intensive counseling.

Studies of remotely delivered smoking cessation treatments show that no differences in treatment effectiveness have been found between telephone therapy, video therapy, and face-to-face therapy in terms of abstinence rates, cigarettes per day, and quit attempts. Overall, smoking cessation therapies can be delivered very effectively by non-face-to-face means. 

For obsessive-compulsive disorder, both telephone and video are viable modalities of care for its treatment. In two controlled trials, we compared telephone and face-to-face treatment and found that, for both, symptom reduction persisted 6 months after treatment. In addition, those who received treatment for OCD by telephone reported high satisfaction with their treatment compared to in-person patients. 

Although more comparative studies are needed between video therapy and audio therapy, it can be concluded that both have a very similar percentage of effectiveness to face-to-face therapy. However, it is necessary to dedicate more efforts to study aspects such as nonverbal communication in non face-to-face therapy, for example, in order to establish solid relationships between patient and therapist.

If you want to know more about nonverbal behavior and how it affects personal relationships, visit our Master of Science in Nonverbal and Deceptive Behavior, which you can take in English or Spanish, with special grants for readers of the Nonverbal Communication Blog.

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