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Online Therapy May Be More Effective Than Face-to-Face

Bald female student text messaging through phone
A new study suggests technology can improve access to therapy.

Klaus Vedfelt / DigitalVision / Getty Images 

Key Takeaways

  • A new study highlights how technology can improve access to cognitive behavioral therapy for depression.
  • Given the barriers to conventional mental health care for some people, online therapy may be an even better option than in-person sessions.
  • Therapists are hopeful that as online therapy gains more momentum, some of the stigma of mental health can be reduced.

Substantial research has shown that cognitive behavioral therapy (CBT) can be effective for treating a range of mental health challenges, including mood disorders, anxiety, and depression. Best of all, you may not need to find a nearby therapist to get the benefits.

According to a recent meta-analysis in EClinicalMedicine that looked at 17 studies, electronically delivered CBT was more effective than face-to-face therapy at reducing depression symptom severity, and one study also reported it was less costly to patients as well.

Sometimes called "talk therapy," CBT involves meeting with a mental health counselor like a psychotherapist in a structured way, with the goal of helping you become more aware of negative thought patterns. With this information, you can work toward responding to stressors and unwelcome thoughts in a better way. CBT is a useful tool in addressing emotional challenges, and may help you:

  • Treat an emotional difficulty when medications aren't a good option
  • Learn techniques for coping with stressful life situations
  • Identify ways to manage emotions
  • Resolve relationship conflicts
  • Learn better ways to communicate
  • Cope with grief or loss
  • Overcome emotional trauma related to abuse or violence
  • Cope with a medical illness

This isn't the first study to highlight the benefits of online treatment versus in-patient CBT. Research published in the Canadian Medical Association Journal found that online CBT, combined with clinical care, was effective in treating anxiety, depression, and emotional distress related to chronic illness.

Help at Home

In addition to stigma over seeking mental health services, other barriers to care can include lack of access (an issue that's particularly acute in rural areas, where therapy may involve a long drive to the nearest office), limited insurance coverage, and lengthy wait times for appointments.

Electronically delivered therapy can eliminate all of these, especially with many health insurers covering telehealth over the last few months, and employers encouraging mental health as self-care.

Jennifer Gentile, PsyD

There is definitely a higher level of comfort that comes with being able to stay in a familiar environment like your home. You also take away barriers that might seem minor but are actually very important, like scheduling flexibility and transportation issues.

— Jennifer Gentile, PsyD

All of that can add up to less stigma about seeking care, which is potentially the biggest hurdle of all. With more assurance that patients can communicate how they want—through email, text messaging, video conferencing, online chat, or messaging—it helps them feel more in control, and less hesitant about giving it a try, Gentile says.

Recognizing Depression

Many people associate depression with a prevailing sense of sadness or despondency, but those actually aren’t always present, according to Scott Dehorty, LCSW-C, a Maryland-based psychotherapist. In fact, he notes, signs like those are seen much less than others, like anxiety and fatigue.

“Depression is a poor term for this illness, because people do correlate that with feeling sad,” he says. “But feeling really down isn’t all that common for someone with depression.”

Instead, he says, consider looking for signs such as:

  • Absence of joy or pleasure, general feeling of indifference
  • Exhaustion or fatigue that isn't lightened with rest or sleep
  • Sudden mood changes unrelated or out of proportion to a situation
  • Chronic pain, especially headaches or general ache
  • Lower level of self-care like not showering, poor eating habits, being sedentary
  • Feeling hopeless, distracted, helpless, or irritable

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. 

For more mental health resources, see our National Helpline Database.

The current pandemic is certainly raising anxiety and depression levels, and the U.S. Census Bureau recently reported that 24% of Americans show signs of major depressive disorder and 30% have symptoms of generalized anxiety disorder.

What This Means For You

As people are urged to stay at home as much as they can, online therapy can be a way to increase access and provide services in a way that therapists simply can't do safely right now otherwise. This can be a scary, serious illness, nut but we know a great deal about how to address it and treat it. No one should feel hopeless, because there is help available.

If you find yourself struggling with emotional and mental health challenges and experiencing signs of anxiety and/or depression talk with your primary care physician or other healthcare provider for appropriate referrals. You may be able to do telehealth sessions with a therapist or counselor, even as a new patient.

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Article Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. C. Luo et al., A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis, EClinicalMedicine (2020), doi:10.1016/j.eclinm.2020.100442

  2. Gratzer D, Khalid-khan F. Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illnessCMAJ. 2016;188(4):263-272. doi:10.1503/cmaj.150007

  3. CDC. Mental health. Updated July 15, 2020.