Online psychotherapy has shown effectiveness that is comparable to in-person psychotherapy. Several studies have found medium effect sizes for online interventions for various psychiatric disorders. While there are challenges like lack of nonverbal cues, benefits include increased accessibility, lower costs, and flexibility. More research is still needed directly comparing online and in-person psychotherapy.

1. Sujit Kumar Kar
Associate Professor of Psychiatry
King George’s Medical University, Lucknow, U.P
Online Psychotherapy:
Evidences so far

2. Online psychotherapy
E-therapy
Online counselling

3. •Scarcity of human resource
•Feasibility
• Extensive digitalization
• Cost-effective
•Effectiveness
Grohol, J. M. (1997). Why Online Psychotherapy? Because there is a need. Retrieved October, 9, 2002.

4. Cost-
effective
affair
Access to
the experts
in the field
Easy
accessibility
Exaggerated
perception
of
anonymity

5. Legal issues
(cross-nation
variations)
Confirmation
of the
qualification
and expertise
of the therapist
Anonymity
Lack of
nonverbal
communication

6. Effectiveness of online psychotherapy
• Meta-analysis
• 64 studies
• 9764 participants
• Various Internet-based psychological interventions for different
psychiatric disorders
• Mean effect size: 0.53 (medium effect)
• 14 studies compared the effectiveness of online Versus face to face
psychotherapy: No significant difference
Barak A, Hen L, Boniel-Nissim M, Shapira N. A comprehensive review and a meta-analysis of the effectiveness of Internet-
based psychotherapeutic interventions. National Library of Medicine. PubMed Health. 2008 [cited 2015 Sep 26].

7. Evidences
• Online mindfulness-based intervention: Effectiveness & Feasibility
• 76 participants, 8 weeks, 4 groups, Pre & post assessments
• Four groups: group mindfulness-based intervention (GMBI), self-
direct mindfulness-based intervention (SDMBI), discussion group (DG)
and blank control group (BCG).
• Result: Participants in GMBI and SDMBI had significant pre- and post-
test differences on mindfulness, emotion regulation difficulties,
and psychological distress, with medium to large effect sizes
Ma Y, She Z, Siu AF, Zeng X, Liu X. Effectiveness of online mindfulness-based interventions on psychological distress and the
mediating role of emotion regulation. Frontiers in psychology. 2018;9:2090.

8. Evidence
• Online health services on workplace related stress-associated impairment in
adult employees
• Online health interventions: Movement and relaxation exercises, imparting of
knowledge, cognitive-behavioral/social-behavioral interventions, risk
communication, health coaching, mindfulness, and career identity training
• 13 RCTs*
• Beneficial effect of online intervention: 4
• No beneficial effect: 9
*Only two are high quality studies
von Hofe I, Latza U, Lönnfors S, Muckelbauer R. Online health services for the prevention of stress-associated psychological
impairments at the workplace. Gesundheitswesen. 2016;79(3):144-52.

9. Evidences
• Systematic review of 17 studies
• Online Crisis intervention
• Contexts of intervention: Disaster, Suicidal behaviour, Trauma
• Major modality of therapeutic intervention: CBT
• Most commonly in Netherland & Australia
• Favourable outcome of online intervention
Silva JA, Siegmund G, Bredemeier J. Crisis interventions in online psychological counseling. Trends in psychiatry and
psychotherapy. 2015 Dec;37(4):171-82.

10. Evidences
• Health technology assessment (evaluation of clinical benefit, value for
money, and patient preferences and values related to the use of iCBT
for the treatment of mild to moderate major depression or anxiety
disorders)
• Conclusion: Guided iCBT represents good value for money and could
be offered for the short-term treatment of adults with mild to
moderate major depression or anxiety disorders.
Note: Uncertainty about the effectiveness of iCBT compared with individual or
group face-to-face CBT.
Health Quality Ontario (2019). Internet-Delivered Cognitive Behavioural Therapy for Major Depression and Anxiety Disorders: A
Health Technology Assessment. Ontario health technology assessment series, 19(6), 1–199.

11. Evidences
• iCBT provides greater control over the time, pace, and location of
therapy.
• It also improves access for people who could not otherwise access
therapy because of cost, time, or the nature of their health condition.
Health Quality Ontario (2019). Internet-Delivered Cognitive Behavioural Therapy for Major Depression and Anxiety Disorders: A
Health Technology Assessment. Ontario health technology assessment series, 19(6), 1–199.

12. Evidences
• 10 studies with 720 participants
• Considerable heterogeneity among the included studies
• Conclusion: Some beneficial effects of I-C/BT for PTSD
• Evidence: The quality of the evidence was very low due to
the small number of included trials
Lewis, C., Roberts, N. P., Bethell, A., Robertson, L., & Bisson, J. I. (2018). Internet‐based cognitive and behavioural therapies for
post‐traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, (12): CD011710.

13. Evidences
Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH. Therapist‐supported Internet cognitive behavioural therapy for anxiety
disorders in adults. Cochrane Database of Systematic Reviews. 2016(3):CD011565.
• Study sites: Sweden (18 trials), Australia (14
trials), Switzerland (3 trials), the Netherlands
(2 trials), and the USA (1 trial)
• Therapy used: Variety of ICBT protocols.
• Conclusion: Therapist-supported ICBT
appears to be an efficacious treatment for
anxiety in adults.
Disorders No. of
trials
Social phobia 11
Panic disorder with or
without agoraphobia
8
Generalized anxiety disorder 5
Post-traumatic stress
disorder
2
Obsessive compulsive
disorder
2
Specific phobia 2
Range of anxiety disorder
diagnoses
8

14. Evidences
• Online Acceptance and Commitment Therapy (iACT) intervention
• N = 68; 85% female; 19-32 years old University students
• Coach-guided, seven week intervention
• Result: iACT participants had significantly higher gains in wellbeing
(between group, d = 0.46), life satisfaction (d = 0.65), and mindfulness
skills (d = 0.49). In addition, iACT participants' self-reported stress (d =
0.54) and symptoms of depression (d = 0.69) were significantly
reduced compared to the participants in the control group.
Räsänen P, Lappalainen P, Muotka J, Tolvanen A, Lappalainen R. An online guided ACT intervention for enhancing the
psychological wellbeing of university students: A randomized controlled clinical trial. Behaviour research and therapy. 2016
Mar 1;78:30-42.

15. • Predictors of higher adherence to online psychological
interventions
• Female gender
• Higher treatment expectancy
• Sufficient time
• Personalized intervention content
Beatty L, Binnion C. A systematic review of predictors of, and reasons for, adherence to online psychological interventions.
International journal of behavioral medicine. 2016 Dec 1;23(6):776-94.

16. Summary points
The future of psychotherapy: E-
therapy
Psychotherapy at the door step
Psychotherapy online:
Psychotherapy anytime
Online Psychotherapy: Ethical
challenges