Online Therapy: Is It for You?
Psychotherapy is an effective treatment for depression and anxiety. Unfortunately, not everyone who could be helped by psychotherapy is able to take advantage of it. For some people—especially those in rural or geographically isolated areas—few therapists are available. Others may have limited time, money, or ability to travel to in person psychotherapy. Still others may avoid psychotherapy because of a perceived stigma attached to receiving treatment for mental illness, or simply because they prefer to remain anonymous. Many of these obstacles can be overcome by psychotherapy that is provided via the Internet.
How it works
Telepsychology refers to receiving psychotherapy via any type of telecommunication technology, including by teleconference, video conference, email, or text. Mental health professionals have used these methods to provide psychotherapy for years, and the American Psychological Association has even established guidelines for therapists who use telepsychology.
Recently, researchers have found that a specific type of telepsychology—Internet-based “self-help” psychotherapy—appears to work particularly well for people with depression and anxiety. This method consists of an interactive software program that teaches patients how to use the tools of a specific type of psychotherapy. These programs can be entirely self-led, led by a therapist, or a combination of both.
To begin, you typically need to register for a site with an anonymous username and password. You are usually required to answer questions designed to identify the type and extent of your illness, and the ways you typically cope with it. You then proceed through a series of online lessons, and the program provides feedback and advice based on your answers to specific questions.
Most online psychotherapy programs are based on cognitive-behavioral therapy (CBT), an effective treatment for depression and anxiety. Online CBT programs typically lead you through a series of exercises that help you identify problematic thoughts and feelings, and offer strategies you can use to change them, thus reducing your depression or anxiety.
Two of the more frequently studied online psychotherapy programs are MoodGYM and E-couch. Both were developed by the Australian National University and are available for free. Programs you can purchase include Blues Begone and Beating the Blues.
Is it effective?
Differences in individual programs—and in the skills and approaches of therapists, both online and in person—make it difficult to measure the effectiveness of online psychotherapy as a whole. However, in general, research indicates that this approach, even when it doesn’t include therapist assistance, can work at least as well as psychotherapy provided in person for some patients:
• In one randomized controlled trial published in BMJ, 525 people with symptoms of depression were randomly assigned to receive online CBT with no therapist input (MoodGYM); to consult a website that offered information about depression but no actual treatment; or to a control group involving weekly phone conversations with trained interviewers about lifestyle factors that could increase the risk of depression. After six weeks, depressive symptoms improved significantly more in people who received online CBT (and in those who read the informational website) than in those in the control group.
• In a large review published in the Medical Journal of Australia, researchers analyzed the results of 26 randomized controlled trials of online CBT for people with depression or anxiety. Two of the eight depression studies, and almost all of the anxiety studies, included some input from a therapist. Online CBT was found to be effective in 23 of these studies, including six of the eight studies that focused on depression. Overall, Internet-based CBT was as effective as traditional face-to-face psychotherapy for depression and anxiety.
• In a study published in the British Journal of Psychiatry, researchers compared four randomized controlled trials of online CBT for mild to moderate depression. One trial evaluated MoodGYM, which included no therapist contact, and another looked at Beating the Blues, which included up to 80 minutes of therapist time over eight one-hour sessions. (The other two trials analyzed a program that is no longer available.) The results suggested that both MoodGYM and Beating the Blues can effectively reduce symptoms of depression.
• In a study published in the Journal of Medical Internet Research, researchers compared online CBT to online interpersonal psychotherapy (IPT). IPT is most effective for people whose depression is the result of a stressful life event, such as the death of a loved one. Researchers randomly assigned 1,840 people with depression to receive four weeks of online CBT via MoodGYM, online CBT via E-couch, or online IPT via E-couch. Both E-couch IPT and E-couch CBT significantly reduced depressive symptoms, and both approaches were equally as effective as MoodGym.
• In a study of people with panic disorder published in BMC Psychiatry, researchers randomly assigned 113 individuals to online CBT or in-person group CBT. Those who participated in online CBT received feedback from a therapist after completing each of the 10 weekly modules. Those in the group CBT treatment met with two therapists for two hours once a week for 10 weeks. Both online and group CBT reduced the frequency and severity of panic attacks, with no significant differences between the two treatments.
Most studies of online psychotherapy have included people with mild to moderate depression or anxiety; it is not known if online treatment would work as well for someone with more severe illness. Easy access to online psychotherapy may lead some people to postpone or avoid conventional treatments that could more quickly alleviate their symptoms, such as prescribed medication.
Online therapy isn’t considered a substitute for in-person therapy, but it can provide immediate support when in-person therapy isn’t available. If you are seeing a therapist now, you shouldn’t stop your sessions in order to seek help on the Internet.
If you are interested in trying an online self-help psychotherapy website, look for a program that is backed by a university or other reputable institution, check the medical credentials of the therapists associated with the program, and ask if any research has been conducted to test its effectiveness.