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I've red a number of articles claiming that online therapy, in particular for mental disorders, is more effective than in person therapy. Though they do site studies, I find this very hard to believe and am looking for details as to how such a study could be done properly. Especially with mental disorders how can they divide the control group vs online group evenly because how can they tell if person A's case is of equal severity to person B's? Also since there's so many mental ailments, it seems like a sweeping statement to say they all can be.

It may be important to clearly define terms in this question: therapist, councillor, psychiatrist and psychologist can all have very similar meanings. It's my understanding that psychiatrist is the one who most commonly prescribes medication (for example for schizophrenia) and I find this hard to believe it can be done online (wouldn't they need to get their blood tested in person?).

claims:

http://www.dailymail.co.uk/femail/article-2385437/The-future-therapy-Online-counselling-proven-MORE-effective-face-face-sessions.html

http://www.metanoia.org/imhs/alliance.htm

http://www.dailymail.co.uk/femail/article-2385437/The-future-therapy-Online-counselling-proven-MORE-effective-face-face-sessions.html

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  • I think there's a line between the sceptical SE and actual considerations of the validity of psychological experiments.
    – Alec Teal
    Oct 23, 2015 at 21:29
  • I started to edit this, but found I couldn't get a question out of it. "since there's so many mental ailments, it seems like a sweeping statement to say they all can be." -> you haven't shown anyone making that claim.
    – Oddthinking ♦
    Oct 24, 2015 at 2:18
  • "how can they tell if person A's case is of equal severity to person B's" This is off-topic for Skeptics, but the answer is large sample + random assignment to control group, so any differences average out.
    – Oddthinking ♦
    Oct 24, 2015 at 2:19

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The Metanoia referenced report is just an op-ed piece.

The Daily Mail report is of the quality expected from the Daily Mail and is best glossed over. It references, and is badly paraphrased from the Daily Dot (no idea), which is taken from the executive summary published by the University of Zurich newspaper, which is taken from the executive summary of the original report: Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial, B Wagner, A Horn, A Maercker, University of Leipzig, 2013.

Their summary includes: "This study shows that an internet-based intervention for depression is equally beneficial to regular face-to-face therapy. However, more long term efficacy, indicated by continued symptom reduction three months after treatment, could be only be found for the online group." and "Due to the small sample size, it will be important to evaluate these outcomes in adequately-powered trials"

The summaries and summaries of summaries originally referenced imply this was a comparison between "traditional" therapy and "computerized" therapy, and neither is the case. Traditional therapy might include counselling or psychoanalysis from the descriptions given and the stock pictures used. Computerized CBT (CCBT) is of interest to the profession but this is not being considered here.

One half of the small (n=30) group was assigned to a team of therapists offering an eight week course of CBT. The other half of the group (n=32) was assigned to the same group of therapists using online contact only. Primary testing of depression was by a standard test for depression (BDI) and four further tests for secondary outcomes were used (but not reported on).

The online therapy was high intensity, highly personalized, and with a strong emphasis on homework. The face to face to therapy wasn't specified and there is no mention of homework.

The drop out rates are reported but not referenced in the summary and the drop outs appear to have been removed from the figures; in reality, getting people to stay in therapy for depression is a big part of the problem. The drop out rate for the online course was seven people (22%) and from the face-to-face was two people (7%).

The primary test for outcomes is as given once the drop outs have been removed: there was no difference between the groups after eight weeks. However, the figures with the drop outs counting as failures show the opposite of the headline result: more people got better results from the face to face therapy than from the online therapy at completion.

The follow up data at three months isn't statistically significant.

I note that eight weeks is very brief therapy for depression. I also note that homework, and the motivation to do homework, is a very good indication of success for CBT.

I would conclude from reading the report that "for a small sample, there wasn't much difference between CBT delivered face to face and online (where homework was emphasized), by the same team, and with the same amount of client-therapist contact in each methodology, for the clients who completed the course, but that the drop out rate from the online course was much higher."

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