Preference, Dropout, and Clinical Outcomes in Face-to-Face Versus Video-Based Cognitive Behavioral Therapy for Children and Adolescents

Abstract: Partially randomized preference trials (PRPTs) have been proposed as an alternative to randomized controlled trials (RCTs) in psychotherapy research to address challenges of representativeness and treatment preferences. Evidence on their feasibility and validity in younger populations, however, remains limited. This study examined the feasibility of PRPT designs in pediatric psychotherapy by evaluating randomization and participation rates, treatment dropout, and clinical outcomes for children and adolescents ( n = 52). Participants who agreed to randomization ( n = 23) were randomly assigned to six sessions of either videoconference delivered CBT or in-person-delivered CBT. Participants who declined randomization ( n = 29) self-selected the modality of treatment delivery (video vs. in-person). More than half of participants (56 %) declined randomization, primarily due to strong treatment preferences, while no significant baseline differences emerged between groups. Dropout, treatment changes, and clinical outcomes were comparable across the preference and randomized group. However, the preference group showed superior reductions in individual problems, suggesting positive preference effects. Findings support the internal and external validity of PRPT designs in psychotherapy research and extend evidence to children and adolescents. PRPTs appear to enhance representativeness and reduce selection bias and are particularly suitable for psychotherapy trials. The trial was pre-registered at the German Clinical Trials Register (DRKS0‌0029172).