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Apr 18, 2012Science and Technology
Online therapy: Taking mental health services out of the office

Web-based psychotherapy is taking treatment out of the office.Web-based psychotherapy is emerging as an alternative to conventional therapy sessions, with Skype and other  telecommunication technologies serving as platforms through which patients can communicate with their therapists from miles away. At first, video conferencing was used to provide therapy for patients in supervised facilities such as prisons, rural clinics, and veteran’s healthcare facilities. But the trend is expanding and now many patients are finding it easier to talk to a therapist from the comfort of their living rooms. Online psychotherapy sites dedicated to providing web-based therapy sessions are on the rise. Breakthrough.com is one such site and has enrolled 900 therapists over a two-year time span. There is also the Telemental Health Institute, an online training institution for telepsychiatry and online psychotherapy services.     

Web conferencing is being employed to treat an array of conditions including anxiety disorders, depression and addiction. One method of therapy commonly used in web-based sessions is cognitive behavioral therapy (CBT). In contrast to traditional methods, which delve into the inner aspects of a patient’s psyche, CBT teaches patients to use practical approaches to manage a variety of conditions, such as anxiety or depression. As a result, it is more conducive to web-based sessions, which may be less intimate. 

Despite the emergence of online therapy, until recently there was little data to substantiate the effectiveness of this mode of treatment.  But now studies are shedding light on where and when web-based therapy may be effective. Last week, a study published in Lancet provided evidence that an online Internet-based therapy program for teenagers with chronic fatigue syndrome (CFS) is effective in treating this condition. The investigators of this study used FITNET (Fatigue in teenagers on the internet), an internet-based model of CBT for CFS. CBT is an effective treatment for some patients with CFS, a condition characterized by severe fatigue that has a psychological component. The investigators of this study randomized approximately 160 teenagers to internet-based therapy or regular therapy and found that FITNET was more effective than regular therapy in alleviating the symptoms of CFS. The authors of this study speculate that internet-based therapy is a convenient and comfortable platform for teenagers who are used to receiving information on the web. 

Other studies have examined the effectiveness of internet-based therapy on a variety of mental health conditions and even medical conditions. One study published in PLOS last November found that CBT performed through the web, with and without telephone-based follow up, was effective for treating the symptoms of depression. While the telephone-based services did not have additional benefit in this study, it is possible that weekly telephone follow-ups may augment the benefits of web-based therapy. Another study published in PLOS last March examined the use of web-based CBT for the treatment of social anxiety disorder. In this study patients were randomized to receive either internet-based CBT or cognitive behavioral group therapy. These investigators found that internet-based therapy was as effective as cognitive behavioral group therapy for treating social anxiety disorder. Another recent study examined the benefits of internet-based CBT on tinnitus (ringing in the ears), and found that internet-based psychotherapy is an effective method for treating this condition.  

There are many advantages to internet-based psychotherapy. It is convenient, allows for more flexible scheduling, and reduces the problem of distance. It also makes therapy services available for patients who live in remote areas and have limited access to in-person therapy services. It may turn out to be a more cost-effective and affordable method of providing mental health services because therapists could provide services from their homes and save money on office overhead. Yet, the limitations of this approach should not be ignored. Many experts question the utility of web-based services for psychiatric emergencies and for severe psychiatric conditions, especially those requiring hospitalization.  More studies are needed to corroborate current findings and determine which conditions are effectively treatable through web-based services. 

As with other forms of telehealth, web-based psychotherapy raises legal questions such as how to apply licensure laws when services are provided for patients in another state or another country. It also raises the question of whether prescriptions for psychiatric medications could one day be given to patients who receive web-based consultations. Finally, the potential for abuse needs to be taken into consideration, as individuals lacking appropriate credentials may take advantage of web-based technology to provide services through the Internet. Answers to these questions will rely on future studies as well as dialogue between mental health professionals and policy-makers. 

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