Does Online Therapy Work for Mental Health?

Does Online Therapy Work for Mental Health?

Yes, online therapy, specifically connecting to a therapist via videoconferencing or even phone, can be appropriate and effective in many cases.

“Therapy is all about the relationship you have with your psychologist,” says Lynn Bufka, PhD, a licensed clinical psychologist and an associate chief of practice transformation at the American Psychological Association (APA), where she works on healthcare policy issues and improving mental health care delivery.

Many clinicians consider this one-on-one relationship to be essential for good therapy, and something that develops over time as a client continues to work with a provider, she says. “Typically that’s going to happen in real time, whether in an office [in person] or via telehealth.”

A meta-analysis of 57 studies including more than 4,300 clients comparing in-person therapy for mental health with videoconferencing sessions found that the two modes were equally helpful to patients.

The lead author, Ashley Batastini, PhD, an assistant professor of counseling, educational psychology, and research at the University of Memphis in Tennessee, notes that her group analyzed research dating back to the late 1990s. The studies included patients being treated for a wide range of mental health conditions, such as depression, psychotic disorders, trauma, and eating disorders, among other issues. Studies included patients treated (virtually and in-person) in a variety of settings, such as private care, university clinics, outpatient centers, prisons, and hospitals.

There’s less evidence that therapy delivered via asynchronous communication (such as text messages or email) is as effective as talk therapy delivered in real-time between a patient and provider, one-on-one, Dr. Maheu says. Studies have not yet compared the effectiveness of therapy apps with one-on-one counseling in a way that proves they work just as well.

But the further away you get from traditional talk therapy delivered in a one-on-one setting in real-time with a therapist (either in an office or virtually), the more you should tread carefully, says Maheu.

Apps with chat- and text-based therapy, for example, should not replace traditional one-on-one talk therapy, she says. Mental health providers pick up on your facial expressions, tone of voice, hesitations, and pauses in conversation when they’re talking with you one-on-one (more so in person when you don’t have to worry about videoconferencing delays and other restrictions). They can’t do that via chat or email.

“In-person is the gold standard. Second best is on camera. Third best is hearing your voice. Those are the mainstays,” Maheu says.

Bufka says there is room for apps in bettering your mental health, but they shouldn’t be used as a stand-alone.

“These tools can be a great supplement to integrate into your care and move therapy along faster,” she says.

Appropriate uses of therapy apps and other online mental health tools that don’t offer one-on-one real-time therapy options include day-to-day symptom tracking, worksheets assigned by your therapist, or reminders of tips to improve their mental health , from sleep hygiene to yoga, meditation, or breath-work exercises, according to the National Alliance on Mental Illness (NAMI).

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