The Internet has made it possible for people to work and study from home, and new research suggests that a staple of mental health care may also be headed to a computer near you.
Cognitive behavioral therapy (CBT) is a mix of two disciplines that aims to help a person improve the way he or she thinks about problems and problem-solving, while also tackling unhealthy behaviors.
For now, online versions of CBT remain rare in North America, with a few pilot programs underway in Toronto, Ohio and Kentucky, said researcher Dr. David Gratzer. He is a psychiatrist and physician-in-charge of mental health inpatient services at Scarborough Hospital in Toronto.
“The long and the short of it,” he said, “[is that] we love our iPhones here in North America, but we are failing to take advantage of technology for mental health services the way the Swedes and Australians have.”
But can depression, anxiety and/or emotional distress triggered by physical illness be treated as well online as face-to-face?
To answer that question, Gratzer and his colleague, Faiza Khalid-Khan, reviewed studies conducted between 2000 and 2012 that have examined the issue.
They found that when it is offered, online therapy typically focuses on solving a patient’s specific goals, and therefore, is usually a short-term venture. Some services are free; others have a cost. The online therapy may or may not be supplemented by in-person sessions with a therapist.
Based on their review, the study authors determined that online therapy can help with anxiety, depression and emotional distress related to illness as much, if not more, than standard face-to-face interventions. The researchers also noted that Internet treatment may be helpful for people who are shy or reluctant to speak directly to a professional.
The study authors also said that Internet-provided cognitive therapy could help some patients minimize out-of-pocket costs.
The study findings were published in the November issue of the Canadian Medical Association Journal.
However, Gratzer and Khalid-Khan cautioned that most studies they reviewed only tracked patients for relatively short periods — ranging from eight weeks to two years — after therapy.
They also noted that the absence of direct human contact can make it more difficult for a patient and therapist to develop a relationship that’s sensitive to a patient’s changing needs.
Internet-based therapy also tends to have bigger dropout rates, a problem the researchers said occasional in-person sessions might prevent.
Most important, they warned that Internet therapy may not be appropriate for patients struggling with a severe mental illness. Most of the studies reviewed didn’t include severely ill patients out of an assumption that such patients’ needs would not be met with remote counseling.
“People with mild to moderate depression and anxiety seem to do better than those with more severe illness,” said Gratzer.
Brenda Major, a professor in the department of psychological and brain sciences at the University of California, Santa Barbara, said the notion of Internet-based cognitive behavioral therapy “makes a lot of sense.”
“I think that in theory a Skype therapy session, or even an immersive virtual reality type session, could be very effective,” she said.
“But the real question,” she added, “is how good is the therapist? Because whether they’re sitting on the couch opposite you or on the other end of the computer, you want a therapist who is well trained and highly rated. Therapy provided face to face can be very ineffective with a bad provider. The same would be true online.”
Either way, she said, patients must to do their homework before choosing a therapist. “You need to find references, because I definitely think that the quality of care is more important than the medium of communication,” she said.
There’s more on cognitive therapy at the U.S. National Institute of Mental Health.