Online therapy: the mental health treatment of the future?

Though online therapy existed before 2020, the COVID-19 pandemic swung open the door for more providers to offer web-based therapy sessions. Using a device like a computer or tablet for video conferencing or a telephone for texts or calls, you connect virtually to speak with a licensed therapist. Research shows that it can be just as effective as in-person sessions for various mental health conditions.  According to the American Psychiatric Association (APA), tens of thousands of mobile applications and digital health resources are available on demand to monitor and support mental health. These sources range from consumer-facing wellness apps to prescription digital therapeutics.

Another important role in this direction is played by chatbots, which are an emerging technology that shows potential for mental health care applications to enable effective and practical evidence-based treatments. According to the National Institute of Health, (2023), Mental Health (MH) chatbots can target a range of MH concerns, including anxiety, depression and stress. These can provide coping strategies, mindfulness exercises, and information about MH conditions and treatments and, in some cases, connect users to MH professionals. Furthermore, early intervention through artificial intelligence (AI) tools can help develop healthy emotional coping mechanisms and prevent the escalation of mental health problems.

Some popular examples include ChatGPT, (2015) which has become a popular gateway to mental health AI, with many people using it for work or school and then progressing to asking for feedback on their emotional struggles, according to interviews with users, the Woebot, (2017) a designed chatbot to offer cognitive-behavioral therapy techniques, mood tracking, and emotional support and Wysa, (2016) an AI-powered MH chatbot that provides emotional support, coping mechanisms, and mood tracking through conversations. Of course there are many of them, which can be very helpful for treating MH issues.

Regarding the above, online therapy and the relevant tools have some significant advantages. They provide more flexibility overall and this is one of the biggest perks, as many individuals prefer to save time by not traveling to an office location and staying at home. They offer access to MH treatment to people who live in remote areas. This is also beneficial for people with physical limitations, disabilities or restrictions. Online therapy is usually fairly affordable and convenient. It gives people the opportunity to attend therapy sessions online in the comfort of their own home and they can often schedule their therapy sessions for times that are the most convenient for them (Gratzer, D., & Goldbloom, D., 2020).

According to the World Health Organization (WHO), these chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or not possible to achieve. The internet makes MH treatment more approachable. People may feel comfortable talking to friends and family about physical health care issues but may not feel the same discussing MH concerns that are just as important. Online access makes it easier to overcome the stigma that has historically been attached to MH issues. 

While online therapy and these tools can potentially be very helpful for people in certain situations, they do not come without some risks and disadvantages over traditional therapy options. There are several restrictions and limitations that these tools must establish according to the level of service they offer. Some of the potential risks associated with AI-driven MH treatments include the dehumanization of healthcare, largely because the human element of a therapist-patient relationship is much greater than in other healthcare scenarios. Such dehumanization could lead to a loss of empathy and trust. Moreover, too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Technology problems can also make it difficult to access treatment when you really need it.

Confidentiality issues are also very important. Since information is being transmitted online, the situation makes privacy leaks and hacks more of a concern. Moreover, the therapist’s response to crisis situations like suicidal thoughts is more challenging without in person contact. Another disadvantage is that online therapy, and online MH tools generally, overlook body language and therapists cannot see facial expressions, vocal or body signals, which are also important means of communication.  People need a private, quiet space for their session, which can be especially challenging for those who live with family or roommates, and not finding a truly private space may impact their session. Online treatment is not always appropriate for serious psychiatric illnesses, especially for those who suffer from severe or complex symptoms of a MH condition (Banbury et al., 2018; Washington et al., 2020; Weinberg, 2020).

To sum up, the research regarding therapy and its tools (in-person versus online) indicates that both formats are an effective means of facilitating growth and change. Relationships with therapists can be formed both in person and online through certain treatment modalities, including interpersonal psychotherapy, narrative therapy, CBT or more treatment-specific interventions (Kambeitz-Ilankovic et al., 2022). Individual preference is an important factor and some people might have a strong desire or preference for one format over the other. Therapy is not a one-size-fits-all approach and needs to be adapted to the specific person. There is a need for more research and recommendations for the adaptation and balanced use of effective chatbots for MH support as well as online treatment platforms and relevant tools. 

REFERENCES

Banbury A., Nancarrow S., Dart J., Gray L., Parkinson L. (2018). Telehealth interventions delivering home-based support group videoconferencing: Systematic review. Journal of Medical Internet Research, 20(2), e25. https://doi.org/10.2196/jmir.8090

Fitch D. (2017). Technology-mediated groups. In Garvin C. D., Gutiérrez L. M., Galinsky M. J. (Eds.), Handbook of Social Work with Groups (2nd ed., pp. 587–599). Guilford Press.

Gratzer, D., & Goldbloom, D. (2020). Therapy and e-therapy—preparing future psychiatrists in the era of apps and chatbots. Academic Psychiatry, 44, 231-234.

Kambeitz-Ilankovic L., Rzayeva U., Völkel L., Wenzel J., Weiske J., Jessen F., Reininghaus U., Uhlhaas P. J., Alvarez-Jimenez M., Kambeitz J. (2022). A systematic review of digital and face-to-face cognitive behavioral therapy for depression. NPJ Digital Medicine, 5(1), 144. https://doi.org/10.1038/s41746-022-00677-8

Lecomte T., Abdel-Baki A., Francoeur A., Cloutier B., Leboeuf A., Abadie P., … Guay S. (2020). Group therapy via videoconferencing for individuals with early psychosis: A pilot study. Early Intervention in Psychiatry, 15(6), 1595–1601. https://doi.org/10.1111/eip.13099

Stoll J., Müller J. A., Trachsel M. (2020). Ethical issues in online psychotherapy: A narrative review. Frontiers in Psychiatry, 10, 993. https://doi.org/10.3389/fpsyt.2019.00993

Washington T., Parker Oliver D., Benson J., Rolbiecki A., Jorgensen L., Cruz-Oliver D., Demiris G. (2020). Factors influencing engagement in an online support group for family caregivers of individuals with advanced cancer. Journal of Psychosocial Oncology, 38(3), 235–250. https://doi.org/10.1080/07347332.2019.1680592

Weinberg H. (2020). Online group psychotherapy: Challenges and possibilities during COVID-19: A practice review. Group Dynamics: Theory, Research and Practice, 24(3), 201–211. https://doi.org/10.1037/gdn0000140

INDICATIVE LINKS

https://www.apa.org/practice/digital-therapeutics-mobile-health

https://pmc.ncbi.nlm.nih.gov/articles/PMC10242473/

https://www.researchgate.net/publication/375042279_AI_Chatbots_in_Digital_Mental_Health