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Approaches to mental health and addiction treatment have evolved significantly over the years.
Within the last couple of decades, the explosion of online resources further extended the availability of professional counselling and peer support.
This shift to online platforms has led many people to ask if online counselling methods work, or if traditional face-to-face approaches work better. I decided to dig into the academic literature on online counselling to answer the question.
Does online counselling work?
According to recent evidence, online counselling is effective for treating mental health and addictions. Multiple studies show it is generally as effective as face-to-face counselling and has the benefit of expanding access to mental health and addiction treatment.
Let’s take a closer look at the research.
Summary of Evidence for Online Counselling
The following consists of a summary of my brief review of the academic literature on online counselling.
Using Google Scholar, I searched for articles on the effectiveness of online counselling, studies comparing the effectiveness of online counselling vs. face to face counselling, and studies that particularly focus on addiction treatment.
Articles were not filtered based on their conclusions, and most of the studies included are systematic reviews and meta-analyses, meaning they are comprehensive studies of the studies themselves.
The major findings of each article are presented as excerpts, but you can click the title to view the full text.
Evidence for Treating Mental Health Conditions
“There is considerable evidence for the effectiveness of Internet-based interventions targeting depression, anxiety disorders, alcohol use and smoking. Small to moderate effect sizes have been reported for interventions targeting depression, anxiety and alcohol use, and smoking interventions have shown large effects.”
“There was support for the application of psychotherapeutic interventions through the Internet; online therapy was especially effective for treating anxiety and stress-effects that lasted after therapy ended and on average was as effective as face-to-face intervention.”
“…guided Internet‐delivered cognitive behavior therapy (ICBT) and face‐to‐face treatment produce equivalent overall effects.”
“Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance…”
Evidence for Treating Addiction
“The review concluded that Internet-based therapies for addictions are effective in achieving positive behavioral changes but that more research is required to determine the comparative effectiveness of various Internet-based therapies
and their components.”
“…computer-delivered interventions (CDIs) reduce the quantity and frequency of drinking among college students. CDIs are generally equivalent to alternative alcohol-related comparison interventions…”
“These results show a benefit for technology-delivered, CBT-based interventions as a
stand-alone therapy for heavy drinking or as an addition to usual care in specialty substance use settings.”
“…self-administered and predominantly self-help computer-based cognitive and behavioral interventions are efficacious, but some therapist contact is important for greater and more sustained reductions in addictive behavior.”
“Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy.”
Disadvantages of Online Counselling
In an article titled, Internet Help and Therapy for Addictive Behavior, by Mark Griffiths, PhD, he reviews some of the potential disadvantages of online counselling.
Legal and ethical considerations: It may increase the opportunity for unqualified or unskilled counsellors to market their services without proper oversight.
Confidentiality: As opposed to using paper records and in-person encounters, technological communications present an element of cyber-security risk.
Severity of client problems: Sensitive areas such as extreme trauma or grief counselling might be better conducted in person.
Client referral problems: If a client requires other types of services, a counsellor who is not from the same region will likely be unfamiliar with local resources for referral.
Establishing client rapport: Technological lag can sometimes result in unintended interruptions or requests to repeat statements, making natural rapport slightly more difficult.
Commercial exploitation: If you are visiting websites for online counselling, advertisers may be able to track your browser cookies, using the information to target advertising.
Convenience: The level of convenience could encourage dependency on the counsellor through frequent casual checking in rather than fostering client autonomy.
Advantages of Online Counselling
In the same article cited above titled, Internet Help and Therapy for Addictive Behavior, by Mark Griffiths, PhD, he also reviews some of the potential advantages of online counselling.
Convenience: This could encourage clients to enter treatment and maintain a regular focus on recovery that is logistically simple.
Cost-effective for clients: Clients who are not covered by insurance can often find lower prices by shopping around online. Note that it is not necessarily advisable to go for a bargain on this type of service. Also, note that expense is not always a guarantee of quality.
It overcomes barriers that otherwise prevent people from seeking face-to-face help: For someone suffering from extreme social anxiety or agoraphobia, online counselling can be a way to begin an effective therapeutic relationship.
It helps overcome social stigma: Rather than having to enter into a facility or attend a meeting in-person, clients can gain further anonymity.
It allows therapists to reach an exponential amount of people: Online counselling provides increased access to treatment, particularly for rural clients or clients with unique conditions requiring specialized practitioners.
In general, the evidence for online counselling is somewhat preliminary but shows great promise as an effective approach for treatment.