Research Supports the Efficacy of Internet Therapy


Internet therapy can be as effective, if not more effective than face-to-face therapy with the added bonus that it costs less.

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The COVID-19 crisis and subsequent stay-at-home orders have caused numerous life disruptions, with people forced to switch to internet-based therapy. Many mental health providers agree that in-person therapy is by far the best because interpersonal contact is crucial for developing a trusting therapeutic relationship, but new research suggests that internet therapy is just as effective.

Research overview

The study took place in Sweden and its results were published this month in JAMA Psychiatry. There were 204 participants in the study who were randomly assigned to an in-person CBT intervention or an internet-based CBT intervention for issues related to health anxiety. Each treatment type took place over 12 weeks and both groups covered the same material. Once the data was analyzed, the researchers concluded that online CBT was “noninferior” to in-person CBT, plus it costs less.


There are few things to be cautious about when looking at these results. First, the mental health issue addressed in this study was anxiety focused on a person’s health but did not indicate what severity of symptoms the participants experienced, only that they did not have co-occurring bipolar disorder, psychosis, severe depression, substance use disorder, or suicidal ideation.

Also, the study was conducted in Sweden, which is culturally different from the U.S. These two points tell us that although this research provides interesting insights into internet therapy, those insights may not generalize to other countries or mental health conditions.

Another interesting factor involves the treatment interventions. Although the interventions were the same, the delivery was significantly different. The in-person group participated in weekly sessions over 12 weeks, with the first session lasting 80 minutes and the rest lasting 50 minutes. The internet CBT group used the same 12 chapters as the in-person group, but the communication between client and therapist was conducted via an email system without any interaction in real time.

The good news

The research further supports the use of internet-based therapy. Demonstrating success in this way provides further evidence for internet interventions and the more research that supports this delivery platform, the more likely insurance companies will be to begin paying for all methods of internet-based therapy. Furthermore, internet-based therapy can make treatment more accessible to more people. As noted in this study, a therapist conducting internet therapy spent 78% less time with the client, which means one therapist could help more people. Given the current mental health provider shortage, this would be a significant development. Also, if internet-based therapy conducted via an email platform demonstrates success, adding the interpersonal component via online video is likely to increase the efficacy.

Furthermore, if therapists can provide online therapy to more people, then people who need a therapist who specializes in a less prevalent condition like trich might have more access to qualified providers.

Axelsson E, Andersson E, Ljótsson B, Björkander D, Hedman-Lagerlöf M, Hedman-Lagerlöf E. Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety: A Randomized Noninferiority Clinical Trial. JAMA Psychiatry. Published online May 13, 2020. doi:10.1001/jamapsychiatry.2020.0940

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