Remote therapy on par with in-person treatment, study finds
Mac research could lift barriers to accessing psychotherapy
Talk therapy works just as well remotely as it does in person found a McMaster University study that could help break down barriers to mental health care.
“We know that right now there’s a lot of individuals in Canada that are not getting access to this type of therapy,” said senior researcher Jason Busse. “Having access to psychotherapy, although it’s been established as effective for a wide range of conditions, has really been a problem.”
The pandemic opened up a new pathway to treatment as practitioners were forced to move to virtual options.
“There was a lot of uncertainty, whether or not that might compromise patient care,” said Busse, who is a professor in the department of anesthesia and a faculty member in the department of health research methods, evidence and impact.
The Hamilton researchers sought to provide clarity by analyzing the effectiveness of virtual and in-person cognitive behavioural therapy (CBT) provided for anxiety, depression, insomnia, chronic pain, chronic fatigue syndrome, tinnitus and alcohol use disorder by reviewing 54 randomized controlled trials involving 5,463 patients.
Their findings that CBT was as effective when delivered remotely and patient compliance was the same were published March 18 in the Canadian Medical Association Journal.
“This has important implications,” said Busse. “In a country as large as ours and as sparsely populated, with a lot of people living in rural or remote areas, this would seem to provide a very good approach for allowing access to these services.”
This is the second McMaster study to conclude recently that there is a place for virtual care in Ontario’s health-care system. Different research published Nov. 27 in HealthCare Quarterly found virtual care is safe and appropriately used by physicians and patients.
The results mirror the Ontario Psychological Association’s own findings going back to 2015, says the past president.
“Therapy provided virtually is as effective,” said neuropsychologist Sylvain Roy, who was not involved in the Hamilton studies. “Those findings are consistent with our own observations and data.”
Roy is lead clinician of the association’s askforhelptoday.ca, which connects those seeking care with psychologists. The service found nearly one-third of patients preferred virtual care in 2023 and another one-third had no preference between remote and in-person.
For some patients, virtual care “melts away” barriers such as having to take a day off work, finding child care, paying for parking or travelling hours from remote communities.
“If the psychologists in Hamilton in a given time are all pretty busy and have long wait times, we are now able to match somebody from Hamilton to a psychologist in Brampton or in Thunder Bay that might have faster wait times,” said Roy.
Another bonus of virtual care can be making it easier for patients to get therapy in a particular language or with a psychologist from a specific culture or gender.
“The ability to leverage the entire workforce virtually allows you to connect these patients with the services they need, being mindful of their preferences as well,” said Roy.
The findings from the two McMaster studies comes as public policy decisions have attempted to moderate the use of remote care.
Fees paid for virtual-only appointments were reduced as part of a new physician services agreement between the Ontario Medical Association (OMA) and the province in 2022.
“I would hope that policymakers and funders would take advantage of these results to consider funding this kind of therapy,” said Busse. “We were quite conscious that there was a real barrier-to-access issue and not a lot of provincial funding dedicated to providing psychotherapy in remote forms.”
The unfunded study looked at real-time remote therapy that would be done through phone or virtual appointments. It also examined asynchronous CBT, where the patient completes online modules and sends in homework that is reviewed by a therapist who provides feedback.
The latter could be a more affordable option for those without coverage for talk therapy.
“Unfortunately, psychotherapy is not funded in many cases,” said Buse. “Unless you have private insurance or you’re getting access to these services through a hospital, you have to pay out of pocket. If you could do this remotely that actually has cost saving implications, especially when therapists aren’t delivering in real time.’
While the study found both types of remote care to be effective, it did not compare whether one was better than the other.
The results could also be different if CBT was being used to treat conditions not included in the study.
Overall, the research aims to make both clinicians and patients feel comfortable using remote care when it’s appropriate.
“I hope that this encourages practitioners to feel comfortable offering both in-person and remote delivery of cognitive behavioural therapy now that we have good evidence that the effectiveness looks very similar,” said Busse. “I would also hope that, patients might be willing to consider which format would work better for them.”