Remote therapy for depression as effective as meeting in person, metastudy finds
A systemic review of 17 randomized control trials has concluded cognitive behavioral therapy does not need to be conducted in person to be effective. The study found, for depression, the therapy was as effective when administered remotely using video conferencing, phone and email tools, as face-to-face sessions.
Cognitive behavioral therapy (CBT) is a common type of psychotherapy used to treat a number of mental health disorders, including depression and anxiety. For many practitioners, the face-to-face element of psychotherapy seems fundamental to its efficacy, and despite technological advances in recent decades allowing for more comprehensive forms of remote communication, CBT is still primarily delivered in person.
"The common understanding was that face to face psychotherapy has the advantage of the connection with the therapist and this connection is in part what makes the difference in treatment," says Zena Samaan, corresponding author on the new study.
In the largest systemic review conducted to date researchers from McMaster University gathered data from 17 randomized controlled trials, conducted over the past 20 years. The clinical trials included in the review focused on comparing the efficacy of electronically delivered CBT (eCBT) to face-to-face CBT specifically in treating major depressive disorder (MDD).
The study defined eCBT as any form of electronically-mediated therapy session. This includes video conferencing, emails, texts, or other types of web-based applications.
Strikingly, the data suggests eCBT is possibly more effective than face-to-face CBT. The meta-analysis concludes there is “moderate evidence” to suggest remote therapy improves symptoms better than in person treatment. However, Samaan notes the heterogeneous nature of the clinical studies means a more cautious general conclusion is that eCBT is, at the very least, as efficacious as conventional CBT.
"Although this study started before the current COVID-19 pandemic, it is timely and assuring that treatment delivered electronically works as well if not better than face to face and there is no compromise on the quality of care that patients are receiving during this stressful time," says Samaan.
The researchers hypothesize a number of factors may underpin why remotely administered therapy can be effective. Despite the somewhat counter-intuitive nature of the findings, Samaan suggests the ease of undergoing CBT remotely seems to outweigh the loss of any benefits conferred by the therapist and patient being in the same room together.
“…it is not surprising that electronic interventions are helpful in that they offer flexibility, privacy and no travel time, time off work, transport or parking costs,” she adds. “It makes sense that people access care, especially mental health care, when they need it from their own comfort space."
Considering the uniquely isolating nature of the COVID-19 pandemic, its associated looming mental health implications, and the established efficacy of remote therapy, the study recommends broad use of eCBT if preferred by patients and therapists.
"Electronic options should be considered to be implemented for delivering therapy to patients," notes Samaan. "This can potentially vastly improve access for patients, especially those in rural or underserved areas, and during pandemics."
The new study was published in the Lancet journal EClinicalMedicine.