Cognitive behavioral therapy (CBT), while an effective treatment for anxiety and depression, is still difficult to obtain for many people. However, working online means that barriers to the availability of cost-effective CBT can be overcome to provide training in coping strategy and other skills without a one-on-one interview with a qualified therapist.
Online CBT programs recommended by the UK's National Institute for Health and Care
By combining self-help books and internet work, usually guided by a "coach" rather than a therapist with formal psychotherapy training, online CBT programs have been recommended by the National Institute of Health. UK health and care for depression and mild to moderate anxiety (Ali et al., 2017).
CBT easily adapts to the IT tool
It is true that CBT adapts more easily to computerization than other psychotherapies due to its structured nature (Donovan et al., 2015). Its development as an online therapy has been privileged for three historical reasons:
first, the development of evidence-based psychotherapy, especially CBT;
second, the emergence of a guided self-help literature;
and third, computerized testing with early programs such as Eliza (Gerhard Andersson, 2018).
Efficient and more profitable online CBT
There is growing evidence that online CBT is not only as effective as other therapies, but also more cost-effective, with the service not only being an adjunct, but even an alternative to face-to-face psychotherapy. (Gerhard Andersson, 2018). Nevertheless, despite the large evidence base, arguments still arise (Gerhard Andersson, 2018), and rightly so.
The disadvantages of CBT online
A high dropout rate
The main concern is the high drop-out rates, up to 20%, as indicated in some major reviews (Fernández-Álvarez et al., 2017).
The qualitative analysis of the customer experience reveals that the reasons are multiple:
limitation of space and time as well as the problem of connection to the Internet;
insufficiently respond to customer concerns;
low levels of lack of support;
questions relating to customer expectations;
lack of individualization;
the absence of therapeutic alliance through regular contact with the therapist;
and other issues, such as videos running too slowly or program text that is too dense (Fernández-Álvarez et al., 2017).
53% of patients relapse
Unfortunately, another study found that nearly 53% of participants relapsed twelve months after completing an online CBT program. In other words, their mental state had deteriorated to the point that they would again be diagnosed with depression and / or anxiety (Ali et al., 2017).
Does this mean that online CBT methods are really trying to cut costs a bit too much? More research is needed, but it is clear that participants who experience residual depression at the end of the program are twice as likely to relapse (Ali et al., 2017). They should have additional support such as one-on-one work with a qualified therapist.
Ali, S., Rhodes, L., Moreea, O., McMillan, D., Gilbody, S., Leach, C., Lucock, M., Lutz, W., Delgadillo, J., 2017. How sustainable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study. Behavior Research and Therapy 94, 1–8.
Donovan, CL, 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.