CNN’s Elizabeth Landau reported yesterday on new research suggesting that online psychotherapy is an effective way to treat depression. The original study, published August 22 in the Lancet by Dr. David Kessler and colleagues in the UK, examined the effectiveness of cognitive-behavioral therapy (CBT) delivered by a therapist online in real time. When compared to usual care only, a combination of online CBT and usual care led to higher rates of recovery at follow-up eight months later.
Despite logistical and policy issues – health insurance coverage of online therapy, legal questions about offering treatment to people in other states, and privacy of transcripts, for example – online therapy has already been used in many forms. According to the CNN article, some existing programs are more automated, rather than being directly controlled by a therapist as in the Lancet study. Other approaches are more like email, with delayed rather than real-time interaction. Videoconferencing is also used, although poor video quality can cause therapists to miss subtle visual clues such as fleeting facial expressions.
To those of us used to the traditional image of psychotherapy, with sofas, clipboards, and carefully decorated offices, the idea of long-distance and primarily verbal therapy may be surprising. But given recent changes in the way people are communicating, it really isn’t much of a stretch. In fact, Landau quotes, patients may be more willing to discuss embarrassing or stigmatizing issues without face-to-face interaction, an observation many of us have made in our own lives and on websites like the hugely popular Post Secret. The few moments of self-reflection when composing an instant message may also be therapeutic, says Kessler. Finally, having the transcript of an online conversation readily available would allow both patients and therapists to refer back to everything that was said.
In addition to these potential benefits for the individual, online therapy can also improve public health. The new medium can improve accessibility for people who cannot access in-person therapy, and encourage those who wouldn’t otherwise seek treatment to do so. All in all, the emergence of online therapy parallels the way the internet and information technology has entered other aspects of our lives and health care – WebMD and electronic health records are just two examples. More research into its effectiveness, particularly among population subgroups, should be encouraged.