A recent study published in the Journal of Clinical Psychiatry has found that psychotherapy sessions done via video conference may relieve symptoms as well as sessions executed across the couch from a mental health professional.
Researchers at the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center in Charleston assigned 241 elderly patients with depression to psychotherapy session either by telemedicine (using in-home videoconferencing technology) or same-room treatment (visiting a clinician’s office).
Comparisons of intervention means were evaluated at four weeks, eight weeks, three months, and a year. None of the scores showed a significant difference between the two treatment groups by the end of the study period, and little significance was shown throughout the intermediate time points.
According to the abstract, “Over all the time points, there was no statistically significant difference in patient satisfaction or treatment credibility. This study found that telemedicine is a viable alternative modality for providing evidence-based psychotherapy for elderly patients with depression.”
A Solution for Rural Areas
This study is significant because, according to the U.S. Department of Health and Human Services’ Health Resources and Services Administration, as of June 2014, there are approximately 4,000 mental health HPSAs (health professional shortage areas). The ratio in these areas is one psychiatrist for every 30,000 or more people. It would take approximately 2,800 additional psychiatrists to eliminate the current HPSA designations.
“Based on results of this study and prior research, telemedicine is a highly relevant option to address the needs of rural patients or those living in remote locations, while providing patient satisfaction and quality of life similar to that provided by in-person treatment delivered at clinics,” said lead study author Dr. Leonard Egede, a researcher at the at the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center in Charleston.
E-Cognitive Behavioral Therapy
This is not the first study documenting the effectiveness of telemedicine. In the last decade, researchers have discovered that Internet-based “self-help” psychotherapy is successful for reducing symptoms of depression and anxiety. Interactive software programs, usually based on cognitive-behavioral therapy (CBT), teach patients how to identify problematic thoughts and feelings and offer strategies to change patterns of rumination. They can be completely self-led, led by a therapist, or a combination of both.
In an October 2014 meta-analysis published in the journal World Psychiatry, researchers conducted a systematic review of 13 studies that directly compared Internet-delivered cognitive behavior therapy (ICBT) and face-to-face delivered CBT with the conditions of social anxiety disorder, panic disorder, depression, body dissatisfaction, tinnitus, sexual dysfunction, and spider phobia. Face-to-face CBT included both group therapy and individual therapy.
The findings indicated that the overall effect for the main outcomes was close to zero, indicating that the two treatment formats are equally effective in treating the condition. The authors write:
The results of this meta-analysis are thought-provoking both from a theoretical and practical point of view. In terms of theories about change in psychotherapeutic interventions, the results suggest that the role of a face-to-face therapist may not be as crucial as suggested in the literature to generate large treatment effects.
The Value of the Real Therapist
If tuning into a free Internet program is as effective as a $150 therapy session across town, why in the world would you spend your money and time sitting across from a real person?
Because studies always have their limitations.
For starters, most of the studies done on online psychotherapy have included people with mild to moderate depression and anxiety. It’s not yet known if online treatment will be as effective for someone with a more severe condition. Second, it’s a lot easier to hide your real issues behind a computer because you don’t have a mental health professional reading your body language and doing the necessary but uncomfortable confronting that it takes to get you better.
You also don’t have anyone to diagnose you and consider whether or not medication is necessary or refer you to a psychiatrist. Online programs can’t recognize manic states or call you on your denial. There are no checks and balances.
Sagar V. Parikh, M.D., Associate Director of the University of Michigan Comprehensive Depression Center, writes in the 2016 Scientific American Depression and Anxiety White Paper writes “Online therapy isn’t considered a substitute for in-person therapy, but it can provide immediate support when in-person therapy isn’t available.”
Yeah for Technology
The Internet can provide life-changing support and information to many and allow people to create individualized treatment programs. Online therapy can provide mental health resources where there is no access to professional care.
In summary, technology is on our side.
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thank you for your wonderful postings, therese. i have followed you for a long time.
just a word to say that when i was deeply in need of hope, online therapy was absolutely not a substitute. i learned that the hard way.
i hope you will make this clear to readers
Thank you, Therese! In offering teletherapy to our patients we’ve found that, just as you discuss, it broadens the range of folks who are now able to access therapy. Thanks for pointing out the benefit to rural areas.
Teletherapy also helps busy folks access therapy. For example, some people have a strict one hour lunch break–not enough time to drive somewhere, have a therapy session and drive back. But it is enough time to log on to their computer and have a 45 or even 55 min therapy session. Also, mothers of young children benefit. With teletherapy, these often isolated women can access therapy from their home, while their babies nap, for example. What would be a complicated task that would normally involve hiring a babysitter, becomes much simpler through telehealth solutions.
Thanks also for pointing out that teletherapy isn’t a replacement for in-person therapy. It’s a supplement.