ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
What if you could get what a psychologist offers without actually having to see one? Many people enjoy the warm, caring relationship provided by a mental health clinician, but others simply want to get better. Many people would rather not open up to another person about their problems — at least, not in person. Plus, seeing a mental health clinician can be inconvenient and expensive — and there might not even be any nearby.
One of the new frontiers in psychotherapy is using the Internet to deliver cognitive behavioral therapy (CBT) for depression, anxiety, and other behavioral health problems in a way that reduces — or sometimes eliminates — the amount of time spent with clinicians in person. This novel delivery method allows treatments that have traditionally been provided one-on-one to be scaled up so they can reach far more people. After all, it doesn’t matter if a good treatment exists if people don’t have access to it.
What are these online therapies?
The field is new, so the data about these online programs are sparse — but a team of British researchers recently conducted a review of the available literature. For the review, they scoured medical journals looking for “John Henry” studies — that is, comparisons of live cognitive behavioral therapy against websites or computer programs that deliver treatments for anxiety or depression.
What did the researchers find? They used a high bar of scientific rigor and found only five online mental health interventions that had been directly compared with live clinicians providing the same treatment, for working-age adults. Two of the interventions were Australian and three were Swedish, and all of them were for social anxiety or panic disorder.
Most online interventions studied by the researchers were divided into sessions, mirroring the way in-person CBT is delivered on a weekly basis. All of the online therapies delivered treatment via written content, also known as “bibliotherapy.” This was combined with communication with a mental health clinician, usually a psychologist, over email or private messaging systems. In one study, psychologists were limited to spending only 10 minutes per week on each participant. Some programs added text messaging and discussion forums, and most included homework — things that participants did between sessions — just as in-person CBT involves between-session practice.
All treatment groups, for both in-person and online CBT, significantly improved in symptoms. One study found better outcomes for the online treatment, and the others found equal results between the two types. The online treatments required much less clinician time, making them more cost-effective.
The downside? All of the online treatment participants needed to do a lot of reading, which can be a limiting factor for some people. Also, written interaction with a psychologist or other clinician was part of every online intervention in this review. This means that to some extent, the effectiveness of the intervention still depends on the clinician who’s on the other end. Plus, requiring clinicians to be involved at all creates a hurdle to scaling up treatments to reach massive numbers of people.
The newest innovations in a very new field
New online programs and mobile apps are emerging that minimize the amount of reading, use video and audio to deliver treatments, and require no clinician involvement at all. These simulate live CBT but can be delivered to huge numbers of people. Head-to-head comparisons of these newer programs against traditional therapy (the kind of comparison that would meet the criteria of the British team) have not yet been published. So stay tuned for developments in this next generation of treatment delivery.