Is online cognitive-behavioral therapy a good idea?
Cognitive-behavioral therapy (CBT), while an effective treatment for anxiety and depression, is still difficult for many people to access. However, working online means the obstacles in making cost-effective CBT available can be surmounted, to deliver training in coping strategies and other skills without one-on-one time with a qualified therapist.
Online CBT programs have been recommended by the UK’s National Institute for Health and Care Excellence
Combining self-help books and work on the Internet, generally guided by a “coach” rather than a therapist with formal psychotherapy training, online CBT programs have been recommended by the UK’s National Institute for Health and Care Excellence for mild to moderate depression and anxiety (Ali et al., 2017).
CBT is adapted to computerization easily
It is true that CBT is adapted to computerization more easily than other psychotherapies given its structured nature (Donovan et al., 2015). Its development as an online therapy has been favored for three historical reasons:
- first, the development of evidence-based psychotherapy, particularly CBT;
- secondly, the emergence of guided self-help literature;
- and thirdly, computerized testing with early programs such as Eliza (Gerhard Andersson, 2018).
Online CBT is effective and cost effective
There is increasing evidence showing that online CBT is not only as effective as other therapies, but also more cost effective, serving is not only a complement but even alternative to face-to-face psychotherapy (Gerhard Andersson, 2018). Nevertheless, despite the broad evidence base, arguments are still raised (Gerhard Andersson, 2018), and rightly so.
The disadvantages ton online CBT
The high dropout rates
The most important concern is the high dropout rates, as much as 20%, as indicated in certain major-analyses (Fernández-Álvarez et al., 2017).
Qualitative analysis of client experience reveals that the reasons are many:
- space and time limitations as well as Internet connection problem;
- insufficiently addressing client concerns; low levels of supportive miss;
- treatment ineffectiveness;
- issues as regards client expectations; lack of individualization;
- the lack of the therapeutic alliance through regular contact with the therapist;
- and other problems varying from videos running too slowly or program text being too densely written (Fernández-Álvarez et al., 2017).
53% of participants had relapsed
Sadly, another study showed that 12 months after completing an online CBT program, nearly 53% of participants had relapsed; in other words, their mental state had deteriorated to the point that they would most likely be diagnosed with depression and/or anxiety once again (Ali et al., 2017).
Does this mean that online CBT methods are actually trying to cut corners a bit too much? More research needs to happen, but it is clear that participants with residual depression at the end of the program are twice as likely to relapse (Ali et al., 2017), and should have the additional support that one-on-one work with a qualified therapist would provide.
- Ali, S., Rhodes, L., Moreea, O., McMillan, D., Gilbody, S., Leach, C., Lucock, M., Lutz, W., Delgadillo, J., 2017. How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study. Behaviour Research and Therapy 94, 1–8.
- Donovan, C.L., Poole, C., Boyes, N., Redgate, J., March, S., 2015. Australian mental health worker attitudes towards cCBT: What is the role of knowledge? Are there differences? Can we change them? Internet Interventions 2, 372–381.
- Fernández-Álvarez, J., Díaz-García, A., González-Robles, A., Baños, R., García-Palacios, A., Botella, C., 2017. Dropping out of a transdiagnostic online intervention: A qualitative analysis of client’s experiences. Internet Interventions 10, 29–38.
- Gerhard Andersson, 2018. Internet interventions: Past, present and future. Internet Interventions 12, 181–188.