Randomised controlled trials (RCTs) of a treatment that incorporated a psychological intervention (defined as any treatment with an explicit psychological orientation) mediated by remote communication in any group seeking treatment for a mood disorder or functional mental health problem were eligible for inclusion. Mood disorders and functional mental health problems were as defined by criteria from ICD-10 (International Classification of Diseases and Related Health Problems, 10th edition) or DSM (Diagnostic and Statistical Manual of Mental Disorders).
Any treatment in which all or most treatment was delivered by a therapist to a patient on a scheduled one-to-one basis through a remote technology (not face-to-face) was accepted as being mediated by remote communication.
There was a number of exclusion criteria. Therapy involving more than one client simultaneously. Trials examining telephone helplines. Trilas of the efficacy of medication management programs in the absence of psychotherapy. Interventions in which the majority of therapy was delivered outside of client-therapist interaction or via technology with little or no therapist contact. Studies in which changes in mental health symptoms were measured as a by-product of counselling for physical illness. Studies involving therapy for substance misuse or addictions. And trials that examined remote therapy for healthy populations at risk of mental health difficulties.
Most included studies assessed psychotherapy mediated by telephone. Other methods included internet and video conference. Where reported, psychotherapy included problem-solving therapy, cognitive behavioural therapy or exposure therapy. Comparators included face-to-face psychotherapy or an alternative remote psychotherapy (stress management, supportive emotion focused therapy and relaxation therapy). Duration and frequency of interventions varied between studies. Follow-up duration ranged from six weeks to 12 months. Study populations included primary and secondary care patients with depression (including one study of children) and individuals with obsessive compulsive disorder (OCD), agoraphobia with panic disorder and post traumatic stress disorder (PTSD). Outcome measures varied between studies and included a number of different rating scales and symptom checklists.
Two reviewers independently selected papers for inclusion in the review. Disagreements were resolved through discussion with other team members.