Comparing Telemedicine and In-Person Psychological Interventions for Anxiety: A Systematic Review.

Abstract

Barriers such as stigma and limited access to care continue to impede treatment for anxiety disorders. Telemedicine has emerged as a promising alternative to in-person psychological interventions, particularly after the COVID-19 pandemic. This systematic review compares the efficacy of telemedicine and in-person therapies for anxiety disorders, evaluating outcomes, patient engagement, and methodological rigor. Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and ClinicalTrials.gov, with the final search conducted in July 2025. Ten studies comparing telemedicine with in-person interventions were included. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for non-randomized studies. A narrative synthesis was conducted due to heterogeneity. Telemedicine demonstrated non-inferior efficacy to in-person therapy across diverse modalities and outperformed self-help programs. Patient satisfaction and adherence were high, with telehealth groups showing longer retention. Small effect size differences favored in-person therapy for generalized anxiety disorder, but most studies reported comparable outcomes. Risk of bias was low for nine out of ten studies. Telemedicine is a viable alternative to in-person therapy for anxiety disorders, with advantages in accessibility and therapist-guided formats. Future research should address long-term outcomes and equity in delivery.