Online psychotherapy with patient and therapist texting each other in real-time can be effective, potentially giving thousands or even millions of patients new access to much-needed treatment, researchers say.
The new study adds to a growing body of research and practice involving technology-based treatments for depression and other mental health issues. In this case, the specific type of therapy used was cognitive-behavioral therapy (CBT).
"There is a role for this, it's exciting," said one expert, Dr Kathryn J. Kotrla, chairwoman and associate professor of psychiatry and behavioural science at Texas A&M Health Science Center College of Medicine. "CBT is tremendously underutilised."
This and other computer-based treatment could benefit people in rural or remote areas who need psychotherapy, including traumatised veterans returning from Iraq and Afghanistan.
Discreet and time-related
Cognitive therapy "is proven (effective) for trauma-related issues," said Kotrla, who is also associate dean of the Texas A&M Health Science Center College of Medicine, Round Rock campus. And providing it online means that "it's discreet, it's time-related. It avoids the issue of stigma," she said.
The new findings, by a team at the University of Bristol in the United Kingdom, are published 22 August in a special Global Mental Health edition of the journal The Lancet.
According to an accompanying commentary article, prescription rates for antidepressant medications have soared over the past two decades, alongside a decline in the number of people receiving in-person psychotherapy.
Meanwhile, the commentary states, a good proportion of people for whom therapy is recommended never show up and half of those who do show up don't last through to the fourth appointment.
So, "people are looking at different ways of delivering psychotherapy other than the traditional go-to-the-therapist's-office-and-meet-for-50-minutes," said Dr Gregory E. Simon, co-author of the commentary and a psychiatrist and researcher with Group Health Cooperative in Seattle. "On the far extreme are completely computerised or completely automated programmes that don't have to have a human being involved. On the other end, people may communicate with a therapist through a website or telephone but there's a real live therapist there they're communicating with."
For this study, nearly 300 British patients with depression were randomly assigned to receive online CBT or were put on an eight-month waiting list for online CBT while they received usual care from their general practitioner.
The online therapy, which consisted of 10 weekly 55-minute sessions, essentially involved instant messages back and forth. About two-thirds of participants "showed up" for five or more sessions.
After four months of follow-up, 38% of patients in the CBT group recovered from depression compared with 24% in the control group, the study found.
At eight months, recovery rates were 42% in the intervention group and 26% in the control group, the researchers found. That's an improvement on recovery rates seen in conventional therapy.
The authors hypothesised that the heightened success rate might be due to the fact that people are writing rather than speaking their feelings and thoughts. "This approach could enhance metacognitive awareness, a term applied to changing the patient's relationship with negative thoughts and feelings, rather than changing their belief in the content of the negative thoughts," they wrote in the report.
Access and convenience
Virtual therapy sessions with a real person do not save much in costs and there may be a trade-off in terms of quality of communication. But the real benefits come in access and convenience, experts said.
"When you make the therapy much more convenient, people will be more likely to stick with it," Simon said. "I don't think anyone would argue that you don't lose something. Communicating in person is richer and communication over phone is richer than just typing text, but balance that with convenience and the person is more likely to stick with it ... You may be reaching people you wouldn't reach otherwise." (HealthDay News, August 2009)