Remote vs in-person cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis of randomized controlled trials

Abstract

It has been demonstrated that remote cognitive behavior therapy (CBT) is more effective than usual care; however, the comparative effectiveness of remote versus in-person CBT is uncertain. The objective of this thesis is to conduct a systematic review and meta-analysis to address this issue. MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science were searched from inception to May 11, 2022, for randomized control trials that: (1) enrolled adults (≥18 years) presenting with any psychiatric or somatic disorder, and (2) randomized them to guided remote CBT or in-person CBT. We used a random effects model for pooling the effects on primary outcomes across trials, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess the certainty of the evidence, and the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects. We identified a total of 32 randomized control trials with 2,962 patients that were eligible for review. There were ten studies focused on the treatment of anxiety and related disorders, six on depressive symptoms, three on chronic pain, four on body image/eating disorder, four on insomnia, three on chronic tinnitus, one on alcohol use disorder, and one on insomnia comorbid with depression. High certainty evidence from 32 studies revealed no difference in the overall pooled estimate between remote CBT and in-person CBT (standardized mean difference = -0.07, 95% CI: -0.19 to 0.06).