Does online therapy actually work? What the research tells us.

Dec 17

In this strange pandemic world in which we are now living, most therapists have moved to providing online sessions. As consumers and therapists sit down in front of their screen for a therapy session, many wonder, is this actually going to work? Fortunately for us, online therapy (also known as teletherapy or telemental health) has been around for almost 20 years and thousands of studies have looked at that very question. Spoiler alert… it works!

What is online therapy ?

While online therapy is novel to many of us, it is old news to the field of psychology as a whole. For example, the Veterans Administration started providing online therapy health as early as 2002 and in 2019, the VA had conducted 2.6 million therapy sessions remotely. Psychologists have been conducting research over the last two decades examining if online therapy is effective, with whom, and why.

Here are some of the take aways…

Does online therapy work?

First, online therapy works. Studies have shown that evidence-based individual psychotherapies delivered online are effective and have similar outcomes to psychotherapy delivered face-to-face. For example, cognitive behavior therapies (CBT) for panic disorder, depression, insomnia and PTSD are similarly effective online as in person. In fact, some studies have shown that, even in pre-pandemic times, online therapy can be more effective than traditional face-to-face therapy with quicker response times for some individuals!

Is online therapy effective cross culturally?

Research has also examined if online therapy is equally effective for folks from different cultural backgrounds. Many studies shown that, indeed, online therapy is an effective modality though which to deliver culturally sensitive psychotherapy.

How acceptable is online therapy?

Another area of study is if clients find online therapy to be “acceptable.” Psychologists studying acceptability of therapy want to know if, once clients have gotten over the shock of looking at their therapist through a camera, they find the experience of therapy satisfying. Studies have found that people rate therapy conducted over video as both acceptable and satisfying. Several studies have found that clients stick with online therapy for the similar durations as in-person therapy and that dropout rate are equivalent.

How does online therapy work?

Psychologists have been particularly concerned if online therapy maintains the key therapeutic factors that predict outcome. That is, does the “special sauce” that makes therapy work translate to the computer screen? Aside from client factors (e.g., levels of motivation, effort in therapy, belief systems, types of life stressors), the largest contributor to therapy outcome is the therapeutic alliance, or the relationship between the therapist and the client. As psychologists transitioned to the screen, many worried that the special bond between themselves and their clients would be disrupted. Fortunately, the majority of the research has shown the alliance is not adversely impacted by going virtual. Some studies have even shown that clients are more willing to be more vulnerable using a online therapy format because some folks find it less intimidating.

Online therapy works!

So, if you are seeking therapy for the first time during the pandemic or are feeling the growing pains of transitioning to online sessions, you can rest assured that the research is on your side when you wonder if it will work.

Sources

- U.S. Department of Veterans Affairs. (2018). TeleMental Health in the Department of Veteran Affairs [Fact Sheet]. https://www.va.gov/anywheretoanywhere/docs/TeleMental_Health_factsheet.PDF[1] Department of Veterans Affairs. (2020). Budget in brief. https://www.va.gov/budget/docs/summary/fy2021VAbudgetInBrief.pdf

- Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., ... & Thorp, S. R. (2012). Videoconferencing psychotherapy: a systematic review. Psychological services, 9(2), 111.

- Bouchard, S., Paquin, B., Payeur, R., Allard, M., Rivard, V., Fournier, T., ... & Lapierre, J. (2004). Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference. Telemedicine Journal and E-health, 10(1), 13-25.

- García‐Lizana, F., & Muñoz‐Mayorga, I. (2010). Telemedicine for depression: a systematic review. Perspectives in psychiatric care, 46(2), 119-126.

- Bastien, C. H., Morin, C. M., Ouellet, M. C., Blais, F. C., & Bouchard, S. (2004). Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. Journal of consulting and clinical psychology, 72(4), 653.

- Germain, V., Marchand, A., Bouchard, S., Guay, S., & Drouin, M. S. (2010). Assessment of the therapeutic alliance in face-to-face or videoconference treatment for posttraumatic stress disorder. Cyberpsychology, Behavior, and Social Networking, 13(1), 29-35.

- Nelson, E.L., Duncan, A.B., & Lillis, T. (2013). Special considerations for conducting psychotherapy via videoconferencing. Telemental health: clinical, technical, and administrative foundations for evidence-based practice. San Francisco: Elsevier, 295-314

- Moreno, F. A., Chong, J., Dumbauld, J., Humke, M., & Byreddy, S. (2012). Use of standard Webcam and Internet equipment for telepsychiatry treatment of depression among underserved Hispanics. Psychiatric Services, 63(12), 1213-1217.; Shore, J. H., Brooks, E., Savin, D., Orton, H., Grigsby, J., & Manson, S. M. (2008). Acceptability of telepsychiatry in American Indians. Telemedicine and e-Health, 14(5), 461-466.; Ye, J., Shim, R., Lukaszewski, T., Yun, K., Kim, S. H., & Rust, G. (2012). Telepsychiatry services for Korean immigrants. Telemedicine and e-Health, 18(10), 797-802.

- Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., ... & Thorp, S. R. (2012). Videoconferencing psychotherapy: a systematic review. Psychological services, 9(2), 111.; Hilty, D., Yellowlees, P. M., Parrish, M. B., & Chan, S. (2015). Telepsychiatry: effective, evidence-based, and at a tipping point in health care delivery?. Psychiatric Clinics, 38(3), 559-592.; Susan Simpson, Lisa K Richardson & Nadine Pelling (2015) Introduction to the Special Issue “Telepsychology: Research and Practice”, Australian Psychologist, 50:4, 249-251

- Greene, C. J., Morland, L. A., Macdonald, A., Frueh, B. C., Grubbs, K. M., & Rosen, C. S. (2010). How does tele-mental health affect group therapy process? Secondary analysis of a noninferiority trial. Journal of Consulting and Clinical Psychology, 78(5), 746.

- Tachakra, S., & Rajani, R. (2002). Social presence in telemedicine. Journal of Telemedicine and Telecare, 8(4), 226-230.

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Chloe Koeffler