From in-person to virtual: The impact of crisis-enforced delivery change on treatment for low positive affect, depression, and anxiety.

Publication date: Jul 11, 2025

The global COVID-19 pandemic necessitated a shift in therapy services to virtual platforms. Whereas telemedicine has long been considered a key to reducing barriers to care, the extent to which patients tolerate and benefit therapeutically from just-in-time adapted delivery formats remains unclear. Here, we report findings from a crisis-related shift in treatment delivery format during an intervention trial. Eighty-five treatment-seeking adults with severely low positive affect, moderate-to-severe depression or anxiety, and functional impairment were randomized to either 15-session Positive Affect Treatment (PAT) or Negative Affect Treatment (NAT), with approximately 1/3 receiving in-person treatment (before March 2020), 1/3 switched to virtual sessions, and 1/3 treated exclusively virtual. We compared delivery modes and their interactions with treatment type as predictors or moderators of change in positive affect, depression/anxiety/stress, and clinician-assessed anhedonia. Treatment fidelity, credibility, therapeutic alliance, and attendance were equally high among treatment conditions and delivery formats. Individuals treated entirely virtually versus entirely in-person demonstrated superior clinical status. Sensitivity analyses suggest that, within participants, improvement in clinical status was greater when treatment was delivered virtually than in-person, despite controlling for therapist status. Cohort-independent and effectiveness studies are needed to confirm the equivalence of need-based switches to virtual or in-person treatment on treatment tolerability and efficacy. As the rise in public health and environmental disasters calls for greater adaptability in the delivery of evidence-based psychotherapy, our findings suggest that crisis-driven switching to virtual format delivery appears acceptable and comparably effective despite the clinical severity of the treated population. NCT03439748.

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