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Cognitive-Behavioral Therapy May Be More Effective Online

Studies find that CBT treatment for depression may be more effective online.

Photo by Bruno Emmanuelle on Unsplash
CBT online may be more effective than in-person.
Source: Photo by Bruno Emmanuelle on Unsplash

In the age of Covid-19, many therapists (myself included) have transitioned to providing online sessions exclusively. It keeps clients and therapists safe, reduces parents’ stress having to find childcare, reduces driving time, and generally creates a more relaxed atmosphere. An added bonus of online therapy is the client’s ability to show the therapist his or her living environment. Learning about a client’s surroundings can help navigate the counseling process.

Now there is scientific evidence that online therapy may be more effective than in-person therapy, specifically cognitive-behavioral therapy (CBT) for depression. CBT is a type of talk therapy that is goal-oriented and short-term. In CBT sessions, you learn how to identify and then change your ways of thinking and self-talk, or "cognitive distortions." Two CBT interventions include your therapist assigning "homework" for you to do between sessions, and role-playing an anxiety-provoking social interaction. Research has found that CBT leads to significant improvement for a wide range of mental health issues. Due to Covid-19, many therapists are now providing CBT online rather than in the office. There is good news — online CBT may be even more effective than face-to-face CBT.

A systematic review and analysis of 17 studies by Luo et. al (2020) found that electronically-delivered CBT (eCBT) was more effective than face-to-face CBT at reducing the severity of depression symptoms. The rate of satisfaction was the same for both face-to-face CBT and eCBT in the studies, and eCBT was viewed as being more cost-effective than face-to-face CBT.

Another systematic review of studies regarding eCBT found that it caused significant decreases in anxiety and depression symptoms (Gratzer & Khalid-Khan, 2016). Overall, reductions in anxiety and depression symptoms with eCBT were equal to or better than face-to-face CBT results. eCBT was found to be just as effective as face-to-face treatment for panic disorder. eCBT was also found to be significantly effective in treating post-traumatic stress disorder, panic disorder, and specific phobia as compared to people in a wait-listed group.

In yet another systematic review of 14 studies by Andersson et al. (2018) found that eCBT led to a 50% improvement rate in symptoms of panic disorder, social anxiety disorder, generalized anxiety disorder, depression, obsessive-compulsive disorder, compulsive gambling disorder, stress, and chronic fatigue. The duration of treatment was from eight to fifteen weeks.

eCBT can reach people in remote areas. It can also decrease therapy-related costs, such as childcare, parking, and travel time. In addition, depression can cause difficulties with motivation and the ability to attend appointments face-to-face. eCBT creates fewer hurdles for people with depression to attend treatment.

What does this mean for you, the consumer? It means that online therapy can provide you with the help you are seeking and may be just as, if not more, effective than going to see a therapist in person. And in the age of Covid-19, it is safer and healthier to see your therapist online. So if you were concerned online therapy wouldn't be as effective, rest assured that you will still get the same opportunity to discuss issues and find solutions. You may hear a dog barking in the background occasionally and there may be some tech glitches, but you may have an even better experience than in person.

One more note: Make sure your therapist is using a HIPAA-compliant video service. Keep in mind that some video services, like Zoom and Skype, are not automatically HIPAA-compliant. A therapist pays for an added layer of privacy and confidentiality to reach HIPAA-compliance, known as "HIPAA-enabled" by video conferencing providers.


Gratzer, D., & Khalid-Khan, F. (2016). Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness. CMAJ, 188(4), 263-272.

Andersson, G., Rozental, A., Shafran, R., & Carlbring, P. (2018). Long-term effects of internet-supported cognitive behaviour therapy. Expert Review of Neurotherapeutics, 18(1), 21-28.

Luo, C., Sanger, N., Singhal, N., Pattrick, K., Shams, I., Shahid, H., ... & Puckering, M. (2020). A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis. EClinicalMedicine, 100442.

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