Does online therapy work in a crisis?

Virtual therapy is nothing new. Therapists have used telephone therapy for decades; online therapy has been around since the Nineties; even psychological apps are well-established; Headspace, for example, was founded in 2010.

What is new is the speed with which things have changed. Headspace reports a recent spike in requests for stress- relieving meditation apps; Sanvello, an American company offering mood tracking, well- being apps, peer support and online therapy is suddenly receiving many more inquiries; and online therapy providers such as Talkspace report a huge demand.

The Health and Care Professions Council and the British Psychological Society in the U.K., have risen admirably to the challenge, offering webinars and clear written instructions to guide practitioners as they shift their approach to therapy. But is virtual help as effective as the face- to- face therapists have traditionally endorsed?

Both have their merits. David Mohr and his team at Northwestern assigned 325 adults with major depression to 18 sessions of either telephone- based or face- to- face cognitive behaviour therapy ( CBT). Everyone showed a decrease in depressive symptoms. But those receiving telephone therapy were more likely to continue with treatment, while those assigned face- to- face CBT were less depressed at a six-month followup.

Birgit Wagner at the University of Leipzig offered eight weeks of either faceto- face or Internet- based therapy to 62 participants suffering from depression. Individuals in both groups benefited significantly, although at a three- month followup, the online group had held on to their gains whereas face-to-face therapy patients showed a resurgence of symptoms. Wagner suggests the greater emphasis on working not only during a session, but also (via homework), between sessions is why virtual therapy was so effective.

Apps can also reduce psychological distress, although, again, the evidence isn’t straightforward. Two of the largest studies, one by John Torous and Adam Powell at Harvard and another by Eirini Karyotaki in Amsterdam, found apps help alleviate depression, particularly for those whose symptoms are less severe initially. However, when Amit Baumel at the University of Haifa looked at user engagement over time for 93 psychological apps, most people appeared to find it hard to keep up app usage — by day 15, less than four per cent still used their app regularly.

Findings suggest psychological apps help, but using an app on its own is less effective than using it in conjunction with, or as followup after, face-to-face sessions.

Ideally, teaming virtual therapy with face-to-face encounters — particularly at the outset of therapy — works best.