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How Effective Is Online Cognitive Behavioural Therapy (CBT)?

You may be asking yourself ‘how effective is Online CBT Therapy compared with seeing a therapist face-to-person? ’ Read about the body of research that exists demonstrating its effectiveness.

You may be asking yourself ‘how effective is online Cognitive Behavioral Therapy compared with seeing a therapist in person? ’ A number of research studies have been conducted to find the answer to that question.

To date, positive results have been found indicating that online or internet-based CBT therapy is not any less effective than in-person therapy.


In fact, results are the same for many psychological disorders such as depression, OCD, health anxiety or panic disorder.

This is the evidence that exists showing the effectiveness of online CBT therapy.

Depression

A study by Dr. Kessler and colleagues (2009) found that Cognitive Behavioral Therapy was effective for the treatment of depression when delivered online in real time by a therapist. Dr. Kessler and colleagues concluded that CBT online could be useful in areas where access to psychological treatment is not easily available and for patients whose first language is not English.

It could make access to psychotherapies more equitable by providing a service to patients in areas or even countries where psychological treatment is not readily accessible.

"Real-time online CBT offers the flexibility and responsiveness of face-to-face CBT and is appropriate for people with severe symptoms. It affords an opportunity for reflexion and review as part of the therapeutic process, which could enhance its effectiveness.” (p.364)

Health Anxiety

Another study by researchers from the Karolinska Institutet in Stockholm found significant benefits of online CBT in the treatment of health anxiety. Using a sample of 81 participants, 41 of them were treated online by a CBT therapist.

The rest were treated using a discussion forum. These participants acted as the control group. The researchers found that after 12 weeks, those that had access to the live therapist, 27 of 41 participants no longer met the criteria for health anxiety, with reports of significantly reduced anxiety and depressive symptoms.

The control group obtained very poor results as only 2 of the 41 participants no longer met the criteria for health anxiety, the other 39 were as anxious as when they were assessed. Moreover, those participants who were treated by the live therapist, maintained their therapeutic gains after 6 months.

The researchers concluded from that study that internet-based CBT therapy was an effective treatment in reducing symptomatology of health anxiety as well as general anxiety and depressive symptoms.

Obsessive Compulsive Disorder (OCD)

Taylor and colleagues (2003) recently reported positive results among 33 OCD patients given telephone-delivered CBT. Effectiveness levels were similar to those obtained in other trials of CBT delivered via face-to-face, office-based sessions.

Due to potential difficulties arising from the treatment of participants suffering from severe levels of depression and suicidality via the telephone, those patients were excluded from that trial.

This limitation, although necessary, is significant given that approximately one quarter of treatment-seeking OCD patients meet concurrent criteria for major depression at intake (Brown, Campbell, Lehman, Grisham, & Mancill, 2001).

Panic Disorder

There is growing evidence that internet-delivered CBT is just as effective in the treatment of Panic disorder compared with a treatment delivered by a therapist in person.

Two trials have been conducted to determine the effectiveness of Internet-based CBT and face-to-face therapy for panic disorder by Klein, Richards & Austin, 2006 and Richards, Klein, & Austin, 2006.

The researchers found that 69.6% of participants allocated to the online treatment group were panic free compared with 72.5% of the face-to-face group.

The authors concluded that there were no differences in the treatment of panic disorder either delivered online or office-based. Other independent research groups are finding similar results and to date, the output studies are pointing in the direction that online CBT therapy is proving to be just as effective as receiving CBT treatment in person (Andersson, 2009).

What About The Therapeutic Alliance?

It is myth what some believe may believe regarding the experience of online CBT therapy (I am not referring here to just online general counselling but specifically, CBT).

Some may think that the therapeutic relationship and rapport may not be well developed between the client and the psychotherapist. From personal experience, I have not found this to be an issue. However, this is not just my view.

A study by Manchanda & McLaren (1998) found that online therapy has no impact on the therapeutic relationship in terms of the therapist warmth, empathy and genuineness. Overall, Internet-based treatments tend to generate a strong therapeutic alliance (Knaevelsrud & Maercker, 2007).


So far, most of the research has found that CBT-based therapies that are delivered online by qualified cognitive behavioural psychotherapists via teleconferencing are just as effective as face-to-face interventions in treating a wide range of mood and anxiety disorders. Seeking CBT treatment online does not seem to affect therapy outcomes. Other factors were not affected either, including the all important therapeutic alliance.

The Effectiveness of Internet-Based Cognitive Behavioral Programs

Dr Sylvia Buet, a Psychologist and Cognitive Behavioral Psychotherapist, after her PhD, developed two internet-based CBT programs to help people get over a breakup: The Breakup CBT Cure and the Get Out Of My Head.

If what you want to discover the effectiveness of these types of programs , please click on the following studies:

A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis.

Treatment of panic disorder via the internet: A randomized trial of a self-help program.

Overcoming Depression on the Internet (ODIN) (2): A Randomized Trial of a Self-Help Depression Skills Program With Reminders.


Guided and unguided self-help for social anxiety disorder: randomized controlled trial.


Online Obsessive-Compulsive Disorder Treatment: Preliminary Results of the “OCD? Not Me!” Self-Guided Internet-Based Cognitive Behavioral Therapy Program for Young People.


Computerised cognitive behaviour therapy for depression and anxiety.


Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomized controlled trial.


Internet-based cognitive behavior therapy for depression, social anxiety disorder, and panic disorder: Effectiveness and predictors of response in a teaching clinic.


An internet-based treatment for flying phobia using 360° images: A feasibility pilot study.


The impact of internet-based cognitive behaviour therapy for perfectionism on different measures of perfectionism: a randomised controlled trial.


Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis.


Internet-based Cognitive Behavioral Therapy for Tinnitus.


An Internet-Based Cognitive Behavioral Therapy Program for Anxiety and Depression (Tranquility): Adaptation Co-design and Fidelity Evaluation Study.

The Effectiveness of Internet-Based Cognitive Behavioral Therapy in Treatment of Psychiatric Disorders.

References

Andersson, G. (2009).Using the Internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175-180.


Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime cormorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology,110,585-599.


Hedman, E., et al. (2013). Cost effectiveness and long-term effectiveness of Internet-based cognitive behaviour therapy for severe health anxiety. Psychological medicine 43.2, 363-74. ProQuest Research Library.


Kessler D., Lewis G., Kaur S., Wiles N., King M., Weich S., Sharp D.J, Araya R., Hollinghurst S., & Peters TJ. (2009). Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. The Lancet, 374, 9690, 628-634.


Klein, B., Richards, J. C., & Austin, D.W. (2006). Efficacy of internet therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry,37,213-238.


Knaevelsrud, C., & Maercker, A. (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry, 7, 13.


Manchanda, M., & Mclaren P. (1998). Cognitive behaviour therapy via interactive video. J Telemed Telecare, 4, 53.


Taylor, S., Thordarson, D. S., Spring, T., Yeh, A. H., Corcoran, K. M., Eugster, K., et al. (2003). Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Cognitive Behavior Therapy,32,13-25.

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