The internet is affecting psychological research and treatment in some interesting ways. Huge amounts of psychological research and information are now available online and many forms of treatment are becoming online-based. Online therapy poses some significant advantages over face-to-face treatment, the most obvious being that the therapist and patient do not have to be in the same place, making remote treatment possible for those with difficulty accessing traditional treatment.
Online treatments allow both real-time interaction, either by text or video calling software such as Skype, and delayed responding via email and other messages. This asynchronous conversation can be helpful in many situations as it enables both client and therapist to properly think about their reply without being pressured into replying by the other person expecting an immediate reply. Internet communication also allows both client and therapist instant access to records of past conversations, which can be useful for monitoring progress and keeping track of past thoughts.
However there are some disadvantages to this form of communication. Without face to face contact it is harder to perceive a client’s reaction to what you are saying and it is harder to repair misunderstandings and miscommunications.
Online-based therapy also allows some aspects of treatment to be carried out by automated computer programs. This can include anything from reminders to delivering attention training and other interventions.
The internet is also useful for administering assessments for a range of disorders. Research has shown that diagnostic assessments for anxiety, depression and health psychology all translate well from pen and paper or face to face styles to online questionnaires. This often allows for the development of assessment tools which are easier to follow and responsive to the answers given, for example questionnaires which offer further questions only if a client indicates a particular problem. Online assessments can also test for cognitive function and biases in information processing, and Smartphone based apps and tests can provide useful in-the-moment data along a range of variables such as mood, heart rate and level of activity.
Despite its uses, online assessments cannot replace a spoken, face to face interview in the diagnosis and assessment of many conditions. For this reason Skype therapy is becoming increasingly useful as it enables a more in-depth assessment to take place than simply answering pre-determined questions in writing.
Forms of Online Therapy
Many different forms of therapy can be translated into an online context. Delivering Cognitive Behavioural Therapy online has proven popular and online variations of psychodynamic, interpersonal and mindfulness based treatments are all available. Treatment often takes the form of downloadable text documents, streamable videos and audio files, along with interactive features such as quizzes. Group based online therapy can also make use of forums to facilitate group discussion.
Regarding the content of online therapy, most forms will use similar content to conventional therapy, usually based around CBT principles in a self-help format. Online cognitive behavioural therapy usually lasts as long as conventional therapy and covers similar topics, beginning with educating the client on the principles involved and finishing with modules on preventing relapse and ensuring long-term change.
Text used in such therapy needs to be easy to understand as the therapist will not be immediately available to clarify any details. It also needs to show empathy and convey a personal tone rather than simply relaying facts. As much as is possible, information needs to fit all different clients and all different experiences, but this is not always possible due to the variation in symptoms that are shown between different clients. Treatment programs are most effective when tailored to suit an individual and their needs. Having a clear timescale for treatment and the availability of a therapist for support were also important to reduce dropout rates.
One distinct advantage of online therapy and its greater use of text is that clients are better able to remember and re-read information from past modules, whereas clients in face to face therapy often struggle to recall all the details about their sessions. Another advantage is that online treatment is often less daunting for people to undertake than seeing someone face to face or in a group. These lower levels of fear can help clients engage with the material more effectively, especially for those who suffer from anxiety disorders such as social anxiety.
The structured, pre written nature of online therapy has both good and bad implications. The focussed nature means that patients will always get the same experience and results won’t be affected by the therapist forgetting to mention something or accidentally drifting off into other topics. On the other hand online treatment can sometimes lack responsiveness and flexibility if it becomes clear that the client’s needs change partway through the treatment.
Therapist Involvement in Online Therapy
How much does the therapist need to be involved in treatment? This depends to a large extent on the condition being treated- conditions such as insomnia and phobias can be successfully treated with minimal guidance from a therapist as all the required information is relatively easy to understand and make use of. Online depression therapy requires a larger involvement from the therapist. Therapy is often more effective if a therapist is on hand to answer questions, guide clients through the material and provide support and encouragement. Scheduled phone calls and real-time chats can also supplement the reading and exercises done by clients in these forms of therapy.
Is Online Therapy Effective?
Research has examined the effectiveness of online therapy against conventional face to face therapy for various different conditions. Results are summarised below:
Online Therapy for Anxiety:
Online therapy has been shown to have a large effect in reducing symptoms of anxiety disorders such as panic disorder, PTSD, GAD and phobias. Online therapy appears particularly well suited to treating social anxiety, with high rates of success, low client dropout rates and long-lasting improvements having been demonstrated.
Online Therapy for Depression:
Studies from around the world have shown the effectiveness of online cognitive behavioural therapy for treating symptoms of depression. Long-term outcomes and dropout rates were comparable to those from face to face therapy. No studies have yet tested the effect of online therapy on severe depression or other mood disorders such as bipolar.
Internet therapy has shown to produce a moderate improvement in symptoms for somatic conditions such as chronic pain and tinnitus. Such improvements were on a similar level to face to face therapy.
Online therapy has also been used to treat non-diagnosed issues and traits which can contribute to various disorders, such as stress, procrastination and perfectionism. All of these studies show promising findings. Research also suggests that online cognitive behavioural therapy is cost effective when compared to conventional CBT in terms of the time and resources required to carry it out effectively.
Online therapy is a promising new area in clinical psychology, with research suggesting it as an effective treatment for anxiety, depression and a range of other disorders. Further research will need to identify if there are any moderating variables which affect how effective online therapy is for certain people in order to offer it as a suitable treatment for the right people.
Future work into online therapy should aim to increase its use and its integration with conventional therapy in order to reduce treatment cost and improve accessibility, while also developing ways to effectively use online therapy to treat more severe disorders. Future research should also look at implementing online therapy outside of the western world and the feasibility of using it in different cultures.
For more information or to book your own online therapy sessions please get in touch.