Video Therapy Beat Phone and In-Person Care in a Study of 813,699 Veterans

Since the pandemic, a lot of therapy has moved onto screens and phones.

In the US veterans’ health system, about half of all mental health visits now happen remotely. Many people love the convenience.

But does it matter how you get your care? Is a video call as good as sitting in a therapist’s office, or a plain phone call?

A new study of more than 800,000 US veterans tried to find out. Video came out slightly ahead of both phone and in-person care.

Phone care came out slightly behind. But there’s an important catch in who chose video.

The study: 813,699 veterans

Who was included

Researchers at the US Department of Veterans Affairs (VA), Harvard Medical School and partner centres ran the study.

They included every veteran with at least three outpatient mental health appointments between July 2021 and October 2022.

That came to 813,699 people. Most were men, and many were over 60.

That timing matters. By mid-2021, remote care had settled into routine use rather than being an emergency stopgap, so the study reflects a fairly stable system.

Access wasn’t a big barrier either: about 94% of the veterans had high-speed internet access.

How they were grouped

Each person was put into a group based on how they had most of their appointments:

The researchers then followed everyone for a year. They tracked mental health hospital stays, mental health emergency visits, suicidal behaviour, and how many appointments people actually attended.

Making the groups comparable

People who choose video may be different from people who choose phone or in-person care. So the team used statistical weighting to balance the groups on many factors.

These included age, diagnoses, past hospital use, how rural people lived and how far they were from a clinic.

The results: small edges for video

What happened over the year

Here are the raw rates in each group.

After adjusting for differences

The gaps shrank a lot once the researchers adjusted for differences between groups. But video still came out slightly ahead.

The chance of a mental health hospital stay was about half a percentage point lower with video than with phone or in-person care. Emergency visits and suicidal behaviour showed the same direction.

Video users also completed about 4 percentage points more of their appointments than phone users, and about 3.6 points more than in-person users.

Who used each format

The groups looked quite different before any therapy started.

Video users were younger, more often women, more urban and better off. They also had lower rates of past psychiatric hospital stays, schizophrenia and bipolar disorder.

The statistical weighting balanced these known differences well. But it can only balance what’s measured.

The catch: who chooses video?

Here’s the part I find most important. The authors say themselves that their results may be explained by factors they couldn’t measure.

They ran a clever check. Video users also had fewer hospital stays for physical, non-mental-health reasons.

There’s no obvious way that therapy format should affect, say, a hip operation.

That suggests video users were simply healthier and better resourced overall.

People with good internet, a private room and a stable life may find video easier. They may also be less likely to reach a crisis.

There’s another twist: hospital stays and emergency visits happen in person.

Someone who already goes to the clinic in person may find it easier to be taken to the emergency department when things get bad.

Why might video beat phone?

The comparison between video and phone is more believable, and it matches earlier research.

On a phone call, therapists lose facial expressions and body language. That can make it harder to judge how someone is really doing.

Both patients and therapists have also reported that the relationship feels weaker by phone. That relationship is one of the strongest predictors of how well therapy works.

What earlier research found

Video versus face-to-face: similar results

A 2026 meta-analysis in the Journal of Medical Internet Research pooled 12 randomised trials comparing video therapy with face-to-face therapy.

The trials covered conditions including PTSD, depression, OCD, bulimia and generalised anxiety. There was no significant difference in how much symptoms improved.

The authors noted the evidence was limited, mostly from Western countries and mostly about PTSD and CBT.

Telehealth for less common conditions

A 2022 meta-analysis pooled 12 trials with 931 patients comparing telehealth with face-to-face therapy for less common problems. These included addiction, eating disorders and childhood mental health problems.

Again, there were no significant differences in symptoms, function, the therapy relationship or satisfaction.

How it fits together

Randomised trials suggest video therapy works about as well as in-person therapy. The new study adds real-world data from a huge health system.

Its most useful message is probably about phone care: it seems to do a little worse than video. The apparent edge of video over in-person care is less convincing, because of who chooses video.

How much should you trust this?

Early. It’s enormous and realistic, but it can’t separate the format from the kind of person who picks it.

What makes it convincing

• It covers essentially every veteran in outpatient mental health care over more than a year.
• It uses hard outcomes: hospital stays, emergency visits and suicidal behaviour.
• The researchers used a robust statistical method and openly tested whether hidden differences remained.
• No conflicts of interest were reported.

What makes me cautious

• It’s observational. People chose their format; they weren’t randomly assigned.
• The authors’ own check suggests video users were healthier in ways the analysis missed.
• The differences are small, often less than one percentage point.
• Veterans are mostly older men, so results may differ for other groups.
• It didn’t measure symptoms directly, such as depression scores.

What this means for you

If you’re choosing how to have therapy, this is reassuring. Video appears to be a solid option, and trials suggest it works about as well as meeting in person.

• Pick the format you’ll actually stick with. Showing up regularly matters, and video made that a bit easier here.
• Prefer video over phone if you can. Seeing each other helps your therapist read how you’re doing.
• In-person care is still a good choice. Especially if you don’t have privacy at home or a reliable connection.
• Mix and match. Many people combine formats as their needs change.

Getting the most from video sessions

A few practical things can make video therapy work better:

• Find a private space. Being overheard makes it hard to speak openly. A parked car or a quiet room can work.
• Keep your camera on. Your therapist learns a lot from your face and body language.
• Test your connection first. Frozen screens and dropped calls break the flow of a session.
• Treat it like a real appointment. Turn off notifications and give yourself a few minutes afterwards before jumping back into your day.

And if video stops working for you, say so. Switching formats is normal, not a failure.

The US National Institute of Mental Health explains different types of psychotherapy. In England, you can refer yourself to NHS Talking Therapies.

If you’re in crisis, please contact a person, not a chatbot.

In the US, call or text 988. In the UK and Ireland, you can call Samaritans on 116 123, any time.

Elsewhere, Find a Helpline lists free services. If someone is in immediate danger, call emergency services.

In this video, a psychologist looks at what the research says about online therapy:

What we still don’t know

1. Is video really better than in-person? Only a randomised trial in routine care could settle it.
2. Who benefits most from each format? People with severe illness may need different care.
3. Does phone care work for some people? It may still be vital for those without internet access.
4. What about symptoms? This study tracked crises, not how people felt day to day.
5. Do the results apply outside the VA? Civilian health systems work differently.
6. What happens over many years? One year of follow-up is fairly short.

My take: video is a solid choice; phone deserves a second look

What I like about this study is its honesty. The authors found a result that flatters video, then tested it and warned readers not to overread it.

I’m not convinced video beats sitting in a therapist’s office. But I am fairly convinced it’s at least as good for most people.

The more useful signal may be about phone care. If you can see your therapist, it seems worth doing.

The authors suggest therapists could prioritise video over phone when video is practical and the patient prefers it. They also suggest sharing findings like these with patients, so they can make an informed choice.

That seems sensible. Access matters most, and for some people a phone call is still far better than no care at all.