Does Online Therapy Work?

Meg Seymour, PhD: National Center for Health Research

Person on a computer

Many Americans’ mental health has been suffering during the coronavirus pandemic. People are facing stress over things like job security and having to attend to children while working from home, as well as worry over contracting the virus itself. Also, many people may feel socially isolated and lonely due to social distancing requirements, especially those who live alone.

A June 2020 report from the CDC found that mental health among Americans is worse than it was at the same time during the year before the coronavirus pandemic began.1 And in a July 2020 survey, more than half of American adults reported that worry and stress over the pandemic had negatively impacted their mental health.2 

Rates of anxiety are over 3 times higher than they were mid 2019, and rates of depression are close to 4 times higher. According to the June 2020 report, adults were twice as likely to report seriously considering suicide in the past 30 days compared to the percentage of adults who reported seriously considering suicide in a 2018 survey.1

As a result of this increase, more people may want to consider therapy. Due to social distancing requirements, most therapy now takes place over online video chat programs, rather than a traditional in-person meeting. Those considering therapy, as well as people who previously attended in-person therapy and have made the switch to online appointments, might be wondering whether online therapy, also called teletherapy, is as effective as meeting in person. This article will discuss what research can and can’t tell us about the effectiveness of online therapy. 

What does the research say?

A meta-analysis is a study that combines the results of multiple studies. In 2018, a meta-analysis compared the effectiveness of online and in-person therapy for depression and several types of anxiety, such as social anxiety. The study looked at a particular type of therapy called Cognitive Behavioral Therapy (CBT), which is a type of therapy where patients learn to change their negative emotions by changing the way that they think about problems, fears, and experiences.3 The researchers combined the results from 20 studies, which included more than 1,400 therapy patients. They found that online CBT was just as effective as in-person CBT for treating anxiety and depression.4

Another meta-analysis, from 2019, combined the results of 40 studies to look at the effectiveness of online CBT for treating depression. Most of the studies compared people receiving online therapy to people not receiving therapy, as a way to show that the online therapy itself does make a difference. However, the one study that directly compared the effectiveness of the online CBT to in-person CBT found that the two methods of therapy were equally effective at reducing depression. The people who stayed in therapy the longest had the greatest benefit in reducing their depression.5

A 2020 study looked at another type of therapy called Solution-Focused Brief Therapy, which focuses on setting goals and finding solutions to one’s problems. The researchers randomly assigned college students with mild to moderate levels of anxiety to receive either online therapy or in-person therapy. Both methods of therapy were equally effective at reducing anxiety.6

Most of the research comparing online therapy to in-person therapy has looked at treatments for anxiety and depression. However, some research has studied the effectiveness of online therapy for treating PTSD. A 2018 paper reviewed over 40 studies and found that both online and in-person therapy reduced PTSD symptoms. The paper reviewed CBT as well as therapies such as Cognitive Processing Therapy. Not only did online therapy work for reducing PTSD symptoms, but patients were equally likely to stick with either method of therapy. Also, those who had online therapy were just as satisfied with their experience as the in-person therapy patients.7 For more information about therapies for PTSD, you can read this article. 

What is still unknown?

Most of the research that compares the effectiveness of online therapy with in-person therapy has looked at CBT in particular. More research is needed on the comparable effectiveness of other forms of therapy. Also, most of the research is focused on therapy as treatment for anxiety and depression. More research is needed on the effectiveness of online therapy for schizophrenia, bipolar disorder, or other types of mental illness. Some researchers have cautioned against using online CBT to treat those more serious types of mental illness (known as Serious Mental Illness or SMI).8 However, some research that started after the coronavirus pandemic began suggests that online therapies might be helpful for SMI. SMI patients tend to have more severe symptoms and lower levels of functioning. People with SMI often delay beginning treatment or drop out of treatment, but a 2020 study found that online therapy may help these patients access mental health care. The study found that when the coronavirus pandemic began, those with SMI were just as likely as others to switch to online therapy, were just as likely as others to begin therapy for the first time using online therapy, and tended to use online therapy services more than others.9 These findings are important because they suggest that online therapy might make mental health services more accessible for patients who might otherwise delay or drop out of treatment.  

The bottom line

Research has found that online therapy can be effective at treating anxiety, depression, and trauma. There is no difference in patient satisfaction depending on whether therapy is online or in-person, and for either method of receiving therapy, the outcomes are better the more sessions someone attends.10 If you are interested in finding a therapist, you can use this website to search. If you or someone you know is feeling suicidal, please reach out to someone here for help. 

 

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

 

References 

  1.     Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morbidity and Mortality Weekly Report. 2020;69:1049–1057.
  2.     Panchal N, Kamal R, Orgera K, Cox C, Garfield R, Hamel L, Chidambaram P. The implications of COVID-19 for mental health and substance use. Kaiser Family Foundation. 21 August, 2020. 
  3.     Cherry K. What Is Cognitive Behavioral Therapy (CBT)?. Verywellmind.com. https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747. Updated June 2020. 
  4.     Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cognitive Behaviour Therapy. 2018; 47(1):1-8.
  5.     Wright JH, Owen JJ, Richards D, Eells TD, Richardson T, Brown GK, Barrett M, Rasku MA, Polser G, Thase ME. Computer-assisted cognitive-behavior therapy for depression: a systematic review and meta-analysis. The Journal of Clinical Psychiatry. 2019;80(2):18r12188. 
  6.     Novella JK, Ng KM, Samuolis J. A comparison of online and in-person counseling outcomes using solution-focused brief therapy for college students with anxiety. Journal of American College Health. 2020:1-8.
  7.     Turgoose D, Ashwick R, Murphy D. Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. Journal of Telemedicine and Telecare. 2018;24(9):575-85.
  8.     Gratzer D, Khalid-Khan F. Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness. CMAJ. 2016;188(4):263-72.
  9.     Miu AS, Vo HT, Palka JM, Glowacki CR, Robinson RJ. Teletherapy with serious mental illness populations during COVID-19: telehealth conversion and engagement. Counselling Psychology Quarterly. 2020;13:1-8.
  10.    Poletti B, Tagini S, Brugnera A, Parolin L, Pievani L, Ferrucci R, Compare A, Silani V. Telepsychotherapy: a leaflet for psychotherapists in the age of COVID-19. A review of the evidence. Counselling Psychology Quarterly. 2020:1-6.