Does online counselling work for depression?
It is estimated that 1 in 3 Canadians will be affected by a mental illness during their lifetime.1 With mental health conditions like depression on the rise in Canada,2 access to treatment and care are more important than ever. Therapy has long been studied and proven as a positive treatment for many mental illnesses, but online or virtual treatment is a relatively newer endeavour. While teletherapy has existed for over twenty years,13 interest in virtual treatment for mental health concerns grew significantly in 2020 when most in person services had to quickly switch to virtual due to the COVID-19 pandemic. This switch increased both the study of and interest surrounding online counselling for conditions like depression and anxiety. Research shows that both modes of delivery are effective and there may even be some lifestyle benefits to online treatment.
What makes therapy effective?
To decide whether online treatment may be the right choice for you, it helps to understand what therapy is and what makes therapy effective. In psychotherapy, professionals apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to therapy—including cognitive behavioural (CBT), interpersonal, and other kinds of talk therapy—that help individuals work through their problems.3 Psychotherapy offers people the opportunity to identify the factors that contribute to their mental conditions and to deal effectively with the causes. Skilled therapists work with individuals so they can identify negative thought patterns, pinpoint and solve certain life problems, and regain a sense of control and pleasure in life.4
Effective therapy can be determined by several factors. Broadly speaking, a person may notice a reduction in their symptoms, an increase in overall happiness, more energy, and better self-worth. 5,6
Differences and similarities between virtual and in person therapy
All of the above outcomes can be achieved whether someone chooses to seek therapy in person or online. When thinking about which option is right for you, consider how the two modes are similar and how they differ.
Keep in mind is that both are effective for treating a mental disorder. A 2014 study found that online treatment was just as effective as face-to-face treatment for depression,7 while a 2018 study found that online CBT was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.8
Reading body language
Both in person and online treatment also offer the opportunity to make a personal connection with your counsellor and have one-on-one time with them for a personal assessment and to identify any potential concerns. Therapists that operate virtually are often trained to pick up on social and body language cues even in a virtual session and can take similar, if not the same, steps to intervene in a crisis. Before selecting a virtual therapist, you can inquire about their online training and how crises are addressed to ensure that you are satisfied with their approach.
Location and time
The largest difference between the delivery of in person and online therapy is the logistics surrounding sessions, such as time and place. While virtual treatment can be done from your own home and requires no commute time, in person therapy involves travelling to and from a therapist’s office.
Because virtual treatment takes place remotely, your location does not matter. With face-to-face treatment, the therapist must be in a vicinity close to you and your choices are limited to those that practice in your area. When geographical location is eliminated from the mix, more specialized treatment can often be found online with a larger pool of services to choose from.
Cost of treatment
Cost is another thing that might differ between in person and virtual. While some therapists may charge the same for online and in person sessions, certain virtual programs may be more cost-effective, where the price breakdown per hour comes out to less than a typical session.
Anonymity and privacy
You may also want to consider the varying levels of anonymity that come with programs. With in-person, there is always the chance of running into someone you recognize in a waiting room or in front of the therapist’s office, particularly if you live in a small town. In virtual programs, there may be a group session where other participants are involved. As with many programs that deal with private subject matter, measures are taken to ensure a level of privacy. These measures are another thing to consider when inquiring about programs that may include a group component.
Privacy and confidentiality are among common concerns for those who consider online treatment programs. Despite popular belief, online therapy can be equally as confidential as in person therapy. If you are feeling unsure about your privacy, inquire about whether your service is compliant with the Health Insurance Portability and Accountability Act (HIPAA). In short, this act works to protect the confidentiality of people receiving medical treatment, including mental health services.
Lastly, consider what option is truly right for your condition and symptoms. Some individuals may not be suitable for online therapy. Individuals with severe mental health disorders such as schizophrenia, intellectual disabilities, or high suicidality may not be a good fit for some online therapy services.9 On the other hand, those with severe social anxiety might benefit from testing the waters of socialization through virtual group meetings where the perceived risks are much lower.
Proven benefits of online counselling
There are several benefits to online therapy. For many people, being able to partake in therapy from their own home saves them the time it takes to commute to and from treatment. It also allows for greater flexibility if the person cannot leave the house to attend a session. Those with younger children, for example, can attend a virtual session from their own home without having to arrange childcare.
A virtual program is also ideal for those with less accessibility to individual counsellors, such as those who live in smaller towns or remote areas. In these cases, online therapy works well as distance is no longer an issue. This also allows people to access a particular kind of service or therapeutic program that might not be offered anywhere physically near to them.
Less intimidation, more connections
Online group programs create a safe space for participants to open up to one another, which increases the number of opportunities to access peer support and make connections. Online therapy also encourages the disinhibition effect. Knowing you can close your laptop, are in a safe space, and that your support system may be close by allows people to feel more relaxed and comfortable to share their experiences. This is especially true for those who deal with social anxiety. Not having to leave the house and being able to attend treatment from a safe space makes getting help less intimidating.
While online therapy does not have the century of research behind it that in person therapy does, several studies and research in the last decade have found that online treatment has equal efficacy to in person treatment. One study directly compared the effectiveness of the online CBT to in-person CBT and found that they were equally effective at reducing depression.10 In that study, those who stayed in therapy the longest saw the greatest benefit. It is not only CBT and the treatment of depression that works well online. Solution-Focused Brief Therapy, which focuses on setting goals and finding solutions to problems, has also been tested online. In one study, researchers assigned students with mild to moderate levels of anxiety to receive either online or in-person therapy. Both methods were equally effective.11 Online therapy has also been studied regarding teletherapy’s success for PTSD and proved to be an effective method of treatment.12
To summarize, online therapy can bypass factors such as transportation, accessibility, and affordability. Remember that while a lot happens in sessions, most of the growth work is done out in the world while you are experimenting with and practicing the things you learned in treatment. Whether doing counselling in person or online, deciding to focus on your mental health and well being is always a worthwhile commitment.
How to access online counselling
If you think online treatment would suit your needs and lifestyle, consider EHN Online’s Mood (Depression) and Anxiety Intensive Outpatient Program. This online therapeutic program is for individuals struggling with mood or anxiety disorders such as (but not limited to) depression, anxiety or panic disorders and are looking to manage or alleviate their symptoms.
This online intensive outpatient program provides a supportive and structured treatment experience that allows patients to make meaningful changes to sustain long-term recoveries. You can expect to receive evidence-based therapy and support in a safe and non-judgemental space.
Still not sure which type of treatment is right for you?
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1 Canadian Community Health Survey – Mental Health (CCHS – MH), 2012. Percentage of the household population aged 12+ living in the 10 provinces that met criteria for at least one of six mental disorders (including mood disorders, generalized anxiety disorder, and substance use disorders).
2 Mental Health in Canada: Covid-19 and Beyond. (2020). CAMH Policy Advice. https://www.camh.ca/-/media/files/pdfs—public-policy-submissions/covid-and-mh-policy-paper-pdf.pdf
3 Understanding psychotherapy and how it works. (2020, July 31). Https://www.Apa.Org. https://www.apa.org/topics/psychotherapy/understanding
4 Depression and how psychotherapy and other treatments can help people recover. (n.d.). Https://Www.Apa.Org. Retrieved July 20, 2021, from https://www.apa.org/topics/depression/recover
5 What is Psychotherapy? (2019, January). American Psychiatric Association. https://www.psychiatry.org/patients-families/psychotherapy
6 Gillihan, S. (2018, February 7). How Do You Know When Your Depression Is Improving? Psychology Today Canada. https://www.psychologytoday.com/ca/blog/think-act-be/201802/how-do-you-know-when-your-depression-is-improving
7 Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders, 152–154, 113–121. https://doi.org/10.1016/j.jad.2013.06.032
8 Andrews, G., Basu, A., Cuijpers, P., Craske, M. G., McEvoy, P., English, C. L., & Newby, J. M. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. Journal of Anxiety Disorders, 55, 70–78. https://doi.org/10.1016/j.janxdis.2018.01.001
9 Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical Issues in Online Psychotherapy: A Narrative Review. Frontiers in Psychiatry, 0. https://doi.org/10.3389/fpsyt.2019.00993
10 Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cognitive Behaviour Therapy. 2018; 47(1):1-8.
11 Novella JK, Ng KM, Samuolis J. A comparison of online and in-person counseling outcomes using solution-focused brief therapy for college students with anxiety. Journal of American College Health. 2020:1-8.
12 Turgoose D, Ashwick R, Murphy D. Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. Journal of Telemedicine and Telecare. 2018;24(9):575-85.
13 Novotney, A. (2017, February). A growing wave of online therapy. Https://www.Apa.Org. https://www.apa.org/monitor/2017/02/online-therapy