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You may have seen advertisements for online therapy on Facebook or in your web browser. These ads promise the convenience of accessing your therapist when you need them and of not needing an office visit. But how effective is online therapy in helping people with mental health issues? Let’s discuss.

Online therapy gets positive results in clinical research

A few studies have been done comparing the effectiveness of online therapy vs. similar treatment administered in person. A study published in the Journal of Affective Disorders administered the same cognitive behavioral therapy (CBT) program to an online group and an in-person group. Results showed that the online CBT plan was as effective at improving depression symptoms as a traditional CBT curriculum.

Another study at the University of Pittsburgh was even more bullish on the ability of online counseling to abate mental health symptoms. This analysis compared an internet-based CBT program plus support group to the typical behavioral health care administered by a primary physician. The results showed a significant improvement in depression and anxiety symptoms for the respondents in the online CBT + support group cohort and showed more marked improvement than patients in the in-person counseling group. Though these differences in impact can be attributed to the overall effectiveness of CBT vs. regular counseling, this study does point to the overall usefulness of electronic therapy tools.

What do online therapy sites offer?

There are a number of therapy websites that offer a range of services. Talkspace is probably the largest online therapy site with about 500,000 users and thousands of therapists. In order to be matched with a therapist, a licensed therapist performs an intake via chat, which is used to match you to one of their therapists. They do offer therapists trained in CBT, so there is a chance to take part in the highly effective treatment modality. Talkspace has a monthly flat fee which varies depending on whether you want all text interaction or text plus video chat services.

Betterhelp is another site that offers text-based counseling with a licensed therapist. Before signing up, you fill out an intake questionnaire to match with a therapist. The questions used are similar to those an in-office therapist would use for a new patient, meant to assess your emotional state, risk of suicide and therapy goals. Betterhelp offers the same flat-fee payment as Talkspace, but they offer a free trial where you can learn more about your therapist and the process.

Another online therapy service, Breakthrough, operates a bit more like traditional in-office therapy. You can browse through their therapists and pick someone who specializes in your concerns and is licensed in your area. These therapists accept insurance and self-pay, so their fees are variable and comparable to those offered in person; in this model, you pay for the sessions you use. Breakthrough differs from other online therapy services in that you can schedule an appointment in advance and then have a video call with your therapist that lasts from 15 minutes to an hour.

Online CBT, the program that proved effective in the studies noted above, is available at Online Therapy. This site offers a structured cognitive behavioral health program as well as daily therapist contact for a flat weekly fee. You can indicate your concerns, be they mental illnesses or general mental health issues and this information is used to match you with a therapist. At first glance, this service offers more structured support than some of the other online therapy programs.

Is online therapy for me?

Based on research and anecdotal information, online therapy is most useful for people who have a temporary emotional issue or concern that they need to discuss. Because therapists on the text-only sites likely have a full in-person practice, they may have less time to respond to online patients. Similarly, because of the format of texting, a therapist might only be able to provide surface responses rather than going into detail about the patients’ problems. The possible exceptions to this would be the CBT program and the appointment-based service that Breakthrough offers.

For people with diagnosed mental illness, online therapy might not be as useful. Part of the therapeutic process for someone with mental illness is monitoring their language — including body language — and appearance for signs of deterioration in condition. These processes can’t be conducted properly via texting, though there is potential for monitoring via video chat.

If your option is online therapy or nothing, online counseling may be very useful. It is convenient and accessible anywhere you are. It might work for people who can’t get to an appointment because of mobility or transportation issues. And for people without insurance, the flat fees are often less expensive than the out-of-pocket payment for an office visit. As with any health service, it would be wise to consult a trusted medical professional before committing to an online therapy program.

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