How does online psychotherapy work?

More and more aspects of our daily life are shifting online. Psychological consultations and psychotherapy are no different. Professor Andreas Maercker, Professor of Psychopathology and Head of the Psychological Institute at the University of Zurich, supports this trend. “I’ve become a fervent advocate of online therapies, because almost all scientific studies show that this particular type of psychotherapy works.” However, he emphasises that these online therapies aren’t designed to replace human psychologists.

“Traditional consulting room therapy will still be available in the future, but online therapies are an essential addition.” Although they can’t pick up on patients’ non-verbal signals and don’t allow a relationship to be established with a human therapist, computer-based therapies are ideal for people who struggle with the thought of going to a psychologist or whose psychological illness makes it impossible for them to attend sessions. In Maercker’s opinion, this is a key argument, because around a third to half of people with depression, anxiety, obsessive-compulsive or personality disorders in Switzerland go untreated – partly out of a false sense of shame at being helped by a psychologist or doctor.

Most effective forms of therapy 

Of course, online psychotherapy isn’t the only option. There are a wide range of web-based offerings. At one end of the scale, you have psychologists who communicate with their clients via e-mail or video call, and at the other, pure apps or computer programmes (so-called low-intensity treatments), where users click from question to question and from tip to tip. For the last five years, chatbots have also been tested on the market. These use synchronous communication and appear to address users personally.

“The content of the programmes is one aspect,” says Maercker. “Just as important is the imaginary relationship with a virtual counterpart. The programmes are designed in such a way that it seems as if a specialist is listening to you and understands your needs,” Maercker explains. Although the drop-out rate for online therapies is high, those who stick with them stand a good chance of success.

Cognitive behavioural therapy in particular lends itself to online treatments and has shown the greatest effect in studies to date, compared with pure information transfer or simple behavioural therapy. The primary focus of cognitive behavioural therapy is specific tips that help participants change their behaviour and reverse negative thoughts. Conversational therapy can also be helpful. It aims at identifying problematic patterns of thought in order to work through them.

The most promising programmes combine virtual and real assistance. In other words, online solutions supported by therapists. For example, these programmes ask users to keep a diary periodically or write letters which the therapist then reads and uses as a basis for the psychotherapy. 

Which psychological illness can be treated online?

Although research into web-based therapies is still at a relatively early stage, numerous studies published on the topic already indicate that the therapeutic effect of online treatments is comparable on average to that of conventional psychotherapy. In particular, online psychotherapy proves very effective with post-traumatic stress disorder (PTSD), social phobias and panic attacks.

However, the studies do show that for illnesses such as depression, online treatment is more effective when combined with face-to-face contact. Online therapies have also been heavily researched for the treatment of mental health conditions such as anxiety, panic, sleep and various eating disorders. 

Online therapies aren’t suitable for people experiencing acute crises, particularly those at risk of suicide or dissociation, or people suffering from acute psychosis or alcohol or drug problems.