Introduction

Have you been overrun with adverts from companies such as BetterHelp, TalkSpace, or Online-Therapy? If so, you are not the only one. Therapy services have adapted to digital trends and are now available online. In 2020, the world came to a halt, and many services, including healthcare, accelerated their migration to digital platforms in an attempt to reach users in a new way.

The use of telecommunications technology to provide healthcare services is aptly described as telehealth. Although telecommunications technologies have been used in the healthcare sector for a long time, (to, for example, book doctor’s appointments online), COVID-19 has been a catalyst for its increased use. Alongside private healthcare providers, the UK’s National Health Service (NHS) has also adapted to make services safer and more accessible during COVID-19.

Medical consultations were available telephonically, which allowed patients to receive medical advice, care, prescriptions and follow-up care without leaving the house. A prime example of the impact of the COVID-19 pandemic on technology-enabled healthcare can be found in the once-popular vaccine passport that millions of people had on their phones not too long ago.¹

The above adaptation, in part, explains the surge of adverts for online or virtual therapy. This shift to online service provision has made it easier for patients to filter between qualified professionals based on their individual needs; as well as providing clarity on practitioner expertise, price range and availability.

This article will explore what virtual therapy is, its benefits, effectiveness, recent case studies and why understanding what it is is more important for you now than ever before.

Overview of telehealth in mental health care

Virtual therapy is the provision of mental health support and services over the internet. It is also referred to as online therapy, cyber counselling, e-therapy and e-counselling. It can be delivered in real-time, similar to phone conversations and instant messaging, or in a more delayed form, such as through e-mails.

The aim of teletherapy is to increase accessibility to mental health support for individuals in remote or underserved areas, those with mobility limitations, and those who prefer the convenience and privacy of virtual sessions. Teletherapy enables the integration of innovative technologies, such as virtual reality and mobile applications, to enhance therapeutic interventions and engage clients in their treatment journey.^[2]

Teletherapy can be effective in treating a variety of conditions such as: 

• Addiction
• Anxiety disorders
• Anger issues
• Bipolar disorder (BPD)
• Depression
• Eating disorders such as anorexia nervosa, bulimia nervosa, ARFID
• PTSD
• Obsessive-compulsive disorder (OCD)
• Relationship counselling

Virtual therapy has many benefits such as making the coordination of treatment and provision of care easier through online forms, as well as aiding communication between providers and patients. Virtual Therapy can also be used to record and make notes of sessions, which optimises patient monitoring and enables access to patient data for patients and providers.¹

Mobile apps, such as Calm, Mindshift CBT, What’s Up? and Talklife allow users to record, monitor and better recall highs and lows in their mental health. This is a form of virtual journaling which can help identify personal triggers, aggravators, and helpful factors in your life. They also provide advice, a sense of community between users and activities at your fingertips.^1,2

How can it be helpful? 

The clearest benefit of virtual therapy is its convenience. Virtual therapy allows you to connect with a professional from anywhere, helping you save time and money by joining your appointments online. It is also beneficial for those with social anxiety as they do not have to share spaces with others.

Being in a familiar environment can also help the patient feel at ease and more likely to open up due to a sense of anonymity and lack of judgment. This benefit is more applicable when the environment a patient is joining from is adequate and private enough to enable discussions without hesitation or privacy concerns.³

Some online therapists also have greater availability as they can offer evening and weekend appointments, which means you can choose a time that works best for you without it impacting your personal commitments (think: work schedule and childcare priorities), or creating added strain on your personal life. This can improve engagement and motivation.⁴ Additionally, online therapists may offer cheaper rates than in-person providers, as online therapy can potentially eliminate some of their operational costs such as office rent and travel expenses.³

Online therapy allows you to filter professionals based on your budget and personalised needs, their areas of expertise, and other preferences such as cultural background without being limited by geography.⁴

All of the above-mentioned benefits are examples of things that make virtual therapy not only accessible but also effective. They can all contribute towards improved patient engagement and motivation to seek help and commit to their therapeutic journey. 

Ethical and legal considerations 

Despite the benefits of online therapy, not everyone can afford or operate the technology required to access it. People at a socioeconomic disadvantage, who may not be able to afford technology or home Wi-Fi, and individuals with lower levels of digital literacy do not benefit equally from telehealth. Additionally, poor Internet connection, software malfunctions, and other technical difficulties can affect the quality of the communication between a therapist and client.⁵

While many online platforms that provide teletherapy are equipped with high-grade encryption to ensure that patient data is protected, it is important to acknowledge that there will always be a risk of data leaks and cyber breaches which may compromise patient confidentiality.⁵

As with the provision of any other healthcare service, regulatory bodies have now also started providing training and guidelines for professionals on how to provide virtual interventions effectively, safely, and ethically.⁵

Effectiveness of teletherapy

Addiction

A comprehensive study compared and analysed research investigating the effectiveness of internet-based therapies for addiction-related problems, including substance abuse, smoking, alcohol consumption and gambling problems. The review showed that there were positive short- and long-term effects for those who completed therapy. However, the rates of completion and the extent of the benefit resulting from the therapeutic process were majorly dictated by the patient’s willingness to participate.⁶

Anxiety disorders

Another study compared the effectiveness of Cognitive Behavioural Therapy (CBT) for different anxiety disorders, including social anxiety, panic disorder, spider phobia, and fear of public speaking. The findings showed that in-person CBT and online CBT had equivalent effects overall. This suggests that whether delivered online or in-person, CBT can be equally effective and beneficial to the patient.⁷

Anger issues

Although a lot of clinicians offer online treatment for anger management, the research is a lot more limited. This could possibly be due to the fact that anger management issues may stem from difficulties dealing with other emotions and possibly other conditions or difficult situations such as PTSD or bereavement. Although more research is necessary, the research that we have at our hands shows that teletherapy is an effective way to provide evidence-based and improve mental health.^8,9

Bipolar disorder

The delivery of online CBT sessions has been shown to have a positive effect, including in the management of depressive, unipolar and bipolar symptoms, as well as improving medication adherence.¹⁰ However, there is also evidence showing that smartphone-based interventions utilising external applications (‘apps’) may not be as effective at reducing depressive symptoms of Bipolar Disorder after the intervention, and may be limited in preventing relapse and readmission.¹¹

Depression 

Studies show that in people with depression, the effect of online interventions was comparable to inpatient treatments, face-to-face outpatient psychotherapy, and interventions provided in community settings. Altogether, research shows that teletherapy for depression can be a beneficial and convenient tool.¹²

Eating disorders 

Recent research investigating the quality of digital mental health interventions in the management of eating disorders showed that the quality and design of personalised interventions have been optimised in the past years, such that they have been more effective at reducing risk factors and symptom prevention^[13]. However, it should be noted that the effectiveness of telehealth interventions in eating disorders is limited in older patients, men, and ethnic minorities.¹⁴

OCD

CBT has been commonly used to treat OCD, and the provision of internet-based CBT has been shown to alleviate symptoms. However, face-to-face CBT has been shown to be more effective in patients who have more severe symptoms of OCD prior to intervention.^15,16

Relationship counselling

Research suggests that relationship education was most effective in improving communication skills between spouses and reducing levels of psychological aggression. Post-intervention, low-income participants reported the most benefit in mental and physical well-being. The couples that benefited the least from online interventions were those who were already skilled at conflict resolution at the beginning of the study.¹⁷

Future direction 

In the future, we can expect to see mobile applications and wearable devices such as smartwatches and heart rate monitors playing an increasing role in monitoring mental health symptoms, promoting self-care, and providing real-time feedback to both therapists and clients. 

Additionally, virtual therapy is poised to address disparities in mental health access by reaching marginalised and underserved populations, including rural communities and minority groups. However, challenges such as ensuring equitable access to technology and addressing privacy and ethical concerns will require ongoing attention and collaboration among stakeholders.

Overall, the future of virtual therapy and effective psychological intervention is characterised by a blend of technological innovation, evidence-based practice, and a commitment to improving mental health outcomes for all individuals.

Summary 

As healthcare providers continue adapting their services to provide safer and more accessible care, virtual therapy stands out for its convenience and tailored treatment options. Virtual therapy utilises various technologies to provide mental health support, making it accessible to individuals in remote areas. It effectively addresses various mental health concerns, including addiction, anxiety, depression, and relationship conflicts. Virtual therapy’s effectiveness is evident across various conditions, though more research is needed.

The future of virtual therapy entails integrating innovative technologies, collaborative care models, and addressing disparities in access while navigating challenges such as privacy and technological barriers.