title: How does tele-mental health affect group therapy process? Secondary analysis of a noninferiority trial.
abstract: OBJECTIVE
  Video teleconferencing (VTC) is used for mental health treatment delivery to geographically remote, underserved populations. However, few studies have examined how VTC affects individual or group psychotherapy processes. This study compares process variables such as therapeutic alliance and attrition among participants receiving anger management group therapy either through traditional face-to-face delivery or by VTC.
  
  
  METHODS
  The current study represents secondary analyses of a randomized noninferiority trial (Morland et al., in press) in which clinical effectiveness of VTC delivery proved noninferior to in-person delivery. Participants were male veterans (N = 112) with posttraumatic stress disorder (PTSD) and moderate to severe anger problems. The present study examined potential differences in process variables, including therapeutic alliance, satisfaction, treatment credibility, attendance, homework completion, and attrition.
  
  
  RESULTS
  No significant differences were found between the two modalities on most process variables. However, individuals in the VTC condition exhibited lower alliance with the group leader than those in the in-person condition. Mean self-leader alliance scores were 4.2 (SD = 0.8) and 4.5 (SD = 0.4), respectively, where 5 represents strongly agree and 4 represents agree with positive statements about the relationship, suggesting that participants in both conditions felt reasonably strong alliance in absolute terms. Individuals who had stronger alliance tended to have better anger outcomes, yet the effect was not strong enough to result in the VTC condition producing inferior aggregate outcomes.
  
  
  CONCLUSIONS
  Our findings suggest that even if group psychotherapy via VTC differs in subtle ways from in-person delivery, VTC is a viable and effective means of delivering psychotherapy.
authors.affiliation: National Center for Posttraumatic Stress Disorder-Dissemination and Training Division, Department of Veterans Affairs Palo Alto Healthcare System, 795 Willow Road (PTSD–334), Menlo Park, CA 94025, USA. carolyn.greene3@va.gov
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Greene
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Morland
authors.forename: Alexandra
authors.initials: A
authors.lastname: Macdonald
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Grubbs
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000368:Aged; D000786:Anger; D003130:Combat Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011615:Psychotherapy, Group / Q000379:methods*; D019114:Remote Consultation / Q000379:methods*; D012931:Social Environment; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D014728:Veterans / Q000523:psychology*; D049269:Videoconferencing; D047829:Vietnam Conflict