Comparing the effectiveness of online therapy versus in-person therapy in youth: protocol for a non-inferiority randomized controlled trial

BACKGROUND: The prevalence of mental health issues in young people is staggering, yet many face barriers in accessing professional help. These barriers, including stigma and long waiting lists, can prevent those in need from receiving the support they require. Teletherapy, which utilizes technology to connect individuals with mental health professionals, is emerging as a promising solution to overcome these obstacles. The COVID-19 pandemic has accelerated the adoption of online therapy globally, with therapists swiftly transitioning to digital platforms. The effectiveness of online therapy in youth, and factors that may potentially affect this, warrant further investigation. In a randomized controlled trial, this study therefore aims to compare the results of online Acceptance and Commitment Therapy (ACT) and Eye Movement Desensitization and Reprocessing (EMDR) therapy to traditional in-person treatment, thereby investigating the modifying role of therapeutic alliance, willingness to participate in teletherapy sessions, age, and gender.

METHODS: The study will use a randomized non-inferiority design and block randomization to assign help-seeking young people aged 12-18 that are eligible for EMDR or ACT treatment to either online or in-person therapy in specialized mental health care (SMHC ). Data analysis will include both intention-to-treat and "per protocol" analyses using mixed models. Participants and their caregiver(s) will complete questionnaires on societal functioning and symptom severity at baseline, at the end of treatment and at 6-month follow-up. Therapeutic alliance will be assessed 2 months into treatment and at the end of treatment. Peer experts were actively involved in the study design to ensure the incorporation of patient and relative perspectives.

DISCUSSION: This study seeks to assess whether teletherapy can be a viable and accessible option for young people in need of mental health support. The findings from this research have the potential to inform mental health services and policies, and to contribute to the ongoing development of digital mental health interventions for young people. Ultimately, the study's results may help improve access to mental health care and support for young people facing barriers to traditional in-person therapy.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06617663. Registered on September 27, 2024.