Psychotherapy via Internet found as good as or better than face-to-face

http://www.mediadesk.uzh.ch/articles/2013/psychotherapie-via-internet-wirkt-gleich-gut-oder-besser-wie-im-sprechzimmer_en.html

by ca98am79 • 13 years ago

118 56 13 years ago

mediadesk.uzh.ch

girvo4• 13 years ago

I did CBT online on the advice of my doctor to learn coping strategies for my severe depression.

That was a year ago, and while I've had an episode since, I got help within days and was better within weeks. Sure beats the 6 months it usually takes!

Only an anecdote, but it worked well for me, and my ex girlfriend (severe anxiety). I think it's great for those who don't want to play Psychologist Roulette.

polymatter• 13 years ago

Can you recommend a particular site?

gxs• 13 years ago

Seconding your request!

nazgulnarsil• 13 years ago

Moodgym.

ajkdfg76• 13 years ago

It's a book, not a website, but I highly recommend "The Feeling Good Handbook." http://www.amazon.com/dp/0452281326

It's also been shown in experiments to be beneficial: see e.g. http://psycnet.apa.org/journals/ccp/63/4/644/ http://psycnet.apa.org/journals/ccp/65/2/324/

I know there's also another study that compared it to a placebo book instead of just a waiting list control group, and it was better than the placebo book too.

girvo4• 13 years ago

https://moodgym.anu.edu.au/welcome

That's what I and my ex girlfriend used. She introduced me to it. :)

pessimizer2• 13 years ago

I thought that it was pretty well known that all talk therapy is equally good, regardless of content or delivery system. Here's a couple other references:

Phone Based Cognitive Behavioral Therapy Works as Well as In-Person Therapy:

http://www.choosehelp.com/news/emotional-health/study-phone-...

Talking treatments work equally well for depression:

http://www.webmd.boots.com/depression/news/20130529/talking-...

edit: I guess it's not. It's true, though. Even religious counseling works just as well as reality-based. The content doesn't really matter.

thelamest2• 13 years ago

If anyone wants to read up on this, the controversy is called Dodo bird verdict (https://en.wikipedia.org/wiki/Dodo_bird_verdict).

pessimizer2• 13 years ago

Thanks for this! Didn't know it had a name.

jessriedel• 13 years ago

My understanding before reading your article is that CBT had consistently outperformed other types of talk therapy for at least some problems. And indeed, wikipedia ( https://en.wikipedia.org/wiki/Dodo_bird_verdict ) confirms there is evidence for this (although as usual everyone disputes everything). I think you are selling yourself short if you give in to the comforting simplicity of "oh, the only thing that matters is having someone to talk to". It's probably correct to first order, though.

aridiculous• 13 years ago

"Patients treated online had to perform one predetermined written task per therapy unit – such as querying their own negative self-image."

Smells like bad experimental design. Shouldn't the face-to-face subjects also be completing written tasks in session as a control? There are entire schools of psychotherapy that require in-session activities.

If not, then they should compare standard talk face-to-face therapy with online CBT "chat."

As an addendum: I think social sciences are categorically separate from harder sciences (good social scientists understand this) and attempts at laboratory/population experiments are typically laughable. They're usually just done because that's what the people and organizations that fund the departments want.

thelamest2• 13 years ago

I get the sentiment, but attempts at experiments are what makes science a science. Psychology actually drove a lot of progress in statistics, because of the fuzzy character of data.

vacri• 13 years ago

They're usually just done because that's what the people and organizations that fund the departments want

Is that not exactly the same for the 'hard sciences'?

DenisM• 13 years ago

In related news, reading the "Feeling Good" book on CBT was shown to be as effective as professional theraphy. Get the book, you have nothing to lose.

hga• 13 years ago

Here it is http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/03808... at Amazon.

I can only directly recommend the '80s version, before the "Behavioral" bit was added, but I found it to be very very powerful. In 20/20 hindsight, so good that talk therapy afterwords hasn't been useful (there's no doubt a bit of Psychologist Roulette as grivo puts it involved, maybe there's a better therapist out there that I haven't found, but...).

aw3c2• 13 years ago

Reference for that research?

artjumble• 13 years ago

Not sure if there is any outside research. I believe that newer additions has this info in the preface. But I can say I felt good while reading it. I need to do that again.

themodelplumber3• 13 years ago

A friend who is a very experienced therapist told me that "10 Days to Self Esteem" was, despite the awful title, the book she recommended most. It contains a testing/evaluation method you can use to evaluate yourself without setting foot in a therapist's office, and functions more like a workbook. Seems pretty cool except I don't want to give the idea here that people should avoid the therapist.

jrubinovitz• 13 years ago

This is the actual paper documenting the study the article refers to: http://www.sciencedirect.com/science/article/pii/S0165032713...

"Method A total of 62 participants suffering from depression were randomly assigned to the therapist-supported internet-based intervention group (n=32) and to the face-to-face intervention (n=30)."

"Limitations Due to the small sample size, it will be important to evaluate these outcomes in adequately-powered trials."

"Conclusions This study shows that an internet-based intervention for depression is equally beneficial to regular face-to-face therapy. However, more long term efficacy, indicated by continued symptom reduction three months after treatment, could be only be found for the online group. "

They go in depth into the limitations of the study in section 4.1, but in a nutshell the sample size was too small and heterogeneous. I look forward to seeing more research in this area, but one cannot make the claim "Psychotherapy via Internet found as good as or better than face-to-face" just yet.

duaneb2• 13 years ago

one cannot make the claim "Psychotherapy via Internet found as good as or better than face-to-face" just yet.

Actually, they did find it as good or better, just not conclusively.... not that one ever could.

(I agree with the analysis—a larger sample size is definitely needed—but I get annoyed by people who discard studies entirely. This is far, far better than no study.)

ForrestN• 13 years ago

I would say "found as" is a little misleading when the size is so small. Maybe "initial evidence suggests" or something would be more accurate.

jawerty• 13 years ago

I highly doubt the problems people have who attend online Psychotherapy are the same as the face-to-face interactions. Not to discredit any patients (at all) but it takes a different type of person to get analyzed in person than it does via the Internet.

PavlovsCat2• 13 years ago

it takes a different type of person to get analyzed in person than it does via the Internet

Can you elaborate on that?

llamataboot• 13 years ago

This sounds like online counseling, not actual psychotherapy. But subjects were randomly assigned so shouldn't be any self-selection bias going on.

AndrewDucker• 13 years ago

In this case the people were randomly assigned to either face-to-face or internet counselling, in order to prevent that bias having an effect.

willaaye• 13 years ago

This is one of the reasons we started https://www.liveninja.com/ - therapy is just as effective and more affordable via the web which allows more people access to the treatments they need.

dergachev• 13 years ago

Is there any control for the exact therapists participating? I'd imagine that therapists who are willing to work online are very different than people who work face to face. If online therapy involves written correspondence, that seems it's more demanding of a therapist than just conversing with a patient.

casca• 13 years ago

The details of the design of studies is critical in assessing most research and the field of psychology is no different. While it is incredibly frustrating that it's not possible to see the full paper to make a reasonable assessment, this small result with no long-term data is likely to become headline fodder.

It would be great if it were true, but there's not enough information available to draw any conclusions at this point.

drKarl• 13 years ago

dr Sbaitso!

kristopolous• 13 years ago

I really want to crack an eliza joke here, but I'm just not clever enough.

Gormo• 13 years ago

Not directly referencing ELIZA, but with it in mind, I was thinking of something along the lines of "I bet a few of those psychotherapists might even be able to pass the Turing test".

PavlovsCat2• 13 years ago

Beware of addictions.

ca98am79• 13 years ago

weird, I submitted the article with this link: http://www.kurzweilai.net/psychotherapy-via-internet-found-a...

But at some point it was changed to this (not by me): http://www.mediadesk.uzh.ch/articles/2013/psychotherapie-via...

Why did this happen?

adammil• 13 years ago

With NSA spying, would anyone seriously suggest exposing that level of personal communication to the Internet?

JulianMorrison• 13 years ago

Do you think your mood doesn't leak all over Facebook, email, and HN comments?

Kiro• 13 years ago

Yes.

dhm116• 13 years ago

I'm pretty sure this has been proven already - http://www.imdb.com/title/tt1343865/

Falling3• 13 years ago

I just started therapy a weeks ago after several years of debating it. It is, at times, extremely difficult for me to say things out loud. There are even things I have trouble admitting to myself. Every time I go in for a session, I wish there were some option other than a face-to-face.

I think this is great.

crazygringo• 13 years ago

I'm not surprised at all. A lot of therapy is being able to admit undesirable/guilty thoughts, or not worry about if the therapist is judging you, etc.

It makes a lot of sense that you might be more inhibited in a room with the actual therapist, and more disinhibited if it's just over the phone, or looking at your laptop screen.

And therapy is just talk -- it's not like a doctor who has to judge your blood pressure.

salleh• 13 years ago

Hi all,

I'm a PhD candidate in clinical psychology who just started building a new website to address this issue. If anyone here is interested in telepsychotherapy (therapy using any form of digital communication), I'm currently looking for a talented dev/designer to join me as cofounder. It's an exciting time for my field, and I think with the right mix of innovation and professional standards, the mental health world will soon see a revolution in the types of services we offer and the populations we treat.

The Birgit et al. article is just one of a growing number of studies that supports the efficacy of telepsychotherapy. It's true that --as some commentators have mentioned-- the study has limitations. That can be said about a vast majority of RCTs and other clinical-science studies. But we can expect to see more and more of this research in the coming years. A number of professional mental health organizations have recently formed task forces and developed guidelines for ehealth practitioners, and those in the legal realm are working on reducing regulatory/statutory barriers to telemedicine.

There are, of course, certain limits to telepsychotherapy. For example, it's not a replacement for in-person treatment of individuals with severe mental illness (e.g., suicidal tendencies). However, it carries a world of potential, both for developing new multimodal services and for reaching persons who would not otherwise receive services. Medicare already reimburses teletherapy for persons in rural areas.

I can be reached at cerark@gmail.com - would be happy to hear from anyone who is interested in discussing further.

themodelplumber3• 13 years ago

I discussed the suicidal tendencies a friend had in another comment in-thread, but do you know why it is considered worse than in-person treatment for severe illness? Certainly the friction of online contact is lower for people who generally avoid personal/social contact, which I thought would be a good thing / possibly help otherwise incapacitated people get started.

Daishiman• 13 years ago

You can be the best academic social scientist in the world, but being a good psychotherapist is, fundamentally, about being good with people, and non-verbal cues are fundamental for that.

It's one thing being open about normal depression, it's another to talk about highly problematic mental disorders.

themodelplumber3• 13 years ago

I have a friend who attempted to sign up for online therapy via email but was turned down during the intake process because he admitted to having suicidal thoughts. This was a few years ago, so I'm not sure if the landscape has changed much, but he was pretty excited about trying it out and pretty disappointed he would have to get out and push himself to visit a typical brick-and-mortar (? :-) therapist.

GalacticDomin8r• 13 years ago

I use online psycotherapy to treat my Internet addiction. I can tell you it works great. I always feel better during a session. Coming back down is a little rough so I found another online psycotherapist for that.

lsiebert• 13 years ago

Also see http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna...

which discusses social anxiety, and compares cognitive behavior therapy without direct interaction over the internet, vs group cognitive behavior therapy.

That said, it's difficult to deal with confounding factors if you only see your patient during assessments. And the possibility that staring at a monitor is itself a form of phototherapy comes to mind.

jheriko• 13 years ago

no control group? i'm 'sure' (by which I mean hope) psychotherapy is effective in the general case... but i'd rather have data.

my 'gut' reaction to this is 'does psychotherapy work at all?' rather than 'i wonder why this is true.'

Psychotherapy via Internet found as good as or better than face-to-face

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