PCN

Psychiatry and
Clinical Neurosciences

REGULAR ARTICLE

Live two-way video versus face-to-face treatment for
depression, anxiety, and obsessive-compulsive disorder:
A 24-week randomized controlled trial
Taishiro Kishimoto, MD ,1†,* Shotaro Kinoshita, MD,1,2† Momoko Kitazawa, PhD,3 Akitoyo Hishimoto, MD ,4
Takeshi Asami, MD,5 Akira Suda, MD,5,6 Shogyoku Bun, MD,3,7 Toshiaki Kikuchi, MD,3 Mitsuhiro Sado, MD ,3
Akihiro Takamiya, MD,1,3,8 Masaru Mimura, MD ,3 Yasunori Sato, PhD,9 Ryo Takemura, PhD,9
Kengo Nagashima, PhD ,9 Takashi Nakamae, MD ,10 Yoshinari Abe, MD ,10 Tetsufumi Kanazawa, MD,11
Yasuo Kawabata, PhD,11 Hiroaki Tomita, MD ,12,13 Koichi Abe, MD,12 Seiji Hongo, MD,14 Hiroshi Kimura, MD,15,16
Aiko Sato, MD,16 Hisashi Kida, MD,3,17 Kei Sakuma, MD,17 Michitaka Funayama, MD ,18 Naoya Sugiyama, MD,19
Kousuke Hino, MD,19 Toru Amagai, MD,20 Maki Takamiya, MD,21 Hideyuki Kodama, MD,21 Kenichi Goto, MD,22
Shuichiro Fujiwara, MD,23 Hisanobu Kaiya, MD,8 Kiichiro Nagao, MD24 on behalf of the J-PROTECT collaborators‡
Aim: Live two-way video, easily accessible from home via
smartphones and other devices, is becoming a new way of
providing psychiatric treatment. However, lack of evidence
for real-world clinical setting effectiveness hampers its
approval by medical insurance in some countries. Here, we
conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video
using smartphones and other devices, which are currently
the primary means of telecommunication.
Methods: This randomized controlled trial compared twoway video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder
in the subacute/maintenance phase during a 24-week
period. Adult patients with the above-mentioned disorders
were allocated to either a two-way video group (≥50% video
sessions) or a face-to-face group (100% in-person sessions)
and received standard treatment covered by public medical
insurance. The primary outcome was the 36-Item ShortForm Health Survey Mental Component Summary (SF-36

MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the
severity rating scales for each disorder.
Results: A total of 199 patients participated in this study.
After 24 weeks of treatment, two-way video treatment was
found to be noninferior to face-to-face treatment regarding
SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001).
There were no significant differences between the groups
regarding most secondary end points, including all-cause
discontinuation, treatment efficacy, and satisfaction.
Conclusion: Two-way video treatment using smartphones
and other devices, was noninferior to face-to-face treatment
in real-world clinical settings. Modern telemedicine, easily
accessible from home, can be used as a form of health care.
Keywords: anxiety

disorder,

depression,

long-term

treatment,

obsessive-compulsive disorder, two-way video.
http://onlinelibrary.wiley.com/doi/10.1111/pcn.13618/full

1

Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
4
Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
5
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
6
Psychiatric Center, Yokohama City University Medical Center, Yokohama, Japan
7
Sato Hospital, Yamagata, Japan
8
Akasaka Clinic, Tokyo, Japan
9
Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
10
Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
11
Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
12
Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
13
Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
14
Himorogi Psychiatric Institute, Tokyo, Japan
15
Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan
16
Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan
17
Asaka Hospital, Fukushima, Japan
18
Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Tochigi, Japan
2
3

© 2023 The Authors.
Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in
any medium, provided the original work is properly cited and is not used for commercial purposes.
Psychiatry and Clinical Neurosciences

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