Postpandemic Use of Video-Based Psychotherapy Among German Outpatient Psychotherapists: Repeated Cross-Sectional and Partially Longitudinal Survey Study.

Abstract

Video-based psychotherapy (VBT) became an essential modality during the COVID-19 pandemic, enabling outpatient care despite social distancing measures. Yet little is known about how usage continued and acceptance evolved after the pandemic. Most existing research is cross-sectional, pandemic-focused, and rarely integrates technology acceptance with clinical process quality and therapist heterogeneity to explain sustained postpandemic VBT use. This study examined the postpandemic sustainability of VBT among German outpatient psychotherapists. Guided by UTAUT-T (unified theory of acceptance and use of technology for therapists), we investigated VBT use, acceptance-related predictors, perceived clinical process quality, and therapist acceptance profiles using cross-sectional and longitudinal perspectives. We conducted a repeated cross-sectional, partially longitudinal postal survey among licensed German outpatient psychotherapists during the COVID-19 pandemic (T1: July 2020-January 2021) and postpandemically (T2: March-May 2024). The final T2 sample included 296 psychotherapists; 117 participated in both waves. VBT sustainability was assessed through usage status and intensity. Technology acceptance was measured using the UTAUT-T, and clinical process evaluations were assessed using items based on Grawe's general change mechanisms. Analyses included regression models, longitudinal within-person tests, group comparisons, and person-centered cluster analysis. Postpandemic VBT use was reported by 68.2% (202/296) of psychotherapists. In retrospective comparisons, use remained above prepandemic levels but below the pandemic peak (4.4% [13/296] prepandemic; 81.1% [240/296] during the pandemic; χ22=357.2, P<.001, Kendall W=.64). In the longitudinal subsample, weekly VBT sessions declined from 5.81 during the first pandemic wave to 1.51 postpandemically (χ22=47.9, P<.001, Kendall W=.41). UTAUT-T constructs explained 66.6% of the variance in behavioral intention (R²=.666), with therapy quality expectation as the strongest predictor (β=.513, P<.001). Behavioral intention predicted postpandemic VBT use (odds ratio 6.56, 95% CI 4.31-9.99; P<.001) and usage intensity (β=.414, P<.001). Prior pandemic VBT use and regulatory awareness predicted postpandemic use beyond behavioral intention. Therapists rated VBT as less effective than face-to-face therapy (z=13.14, P<.001, r=0.77), and only 35.8% (106/294) perceived core therapeutic change mechanisms as equally supported. Cluster analysis based on UTAUT-T identified 3 clusters, associated with postpandemic VBT use (χ22=131.1, P<.001, V=.67) and significantly differing in pandemic VBT use, age, therapeutic approach, regulatory awareness and restrictions, and perceived equivalence of Grawe's therapeutic change mechanisms. This study extends previous pandemic-era and cross-sectional VBT research by examining sustained postpandemic use under more voluntary routine-care conditions and by integrating technology acceptance, clinical process quality, and therapist heterogeneity. The findings show that VBT has become a sustained but selectively used component of German outpatient psychotherapy rather than a universal replacement for face-to-face treatment. Postpandemic use is shaped by perceived clinical meaningfulness, prior experience, regulatory awareness, and therapist acceptance profiles. Implementation efforts should move beyond technical access and support clinically differentiated, profile-sensitive VBT use through targeted training, clear regulatory guidance, and shared decision-making with patients.