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

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.