
Psychotherapy via Internet found as good as or better than face-to-face - ca98am79
http://www.mediadesk.uzh.ch/articles/2013/psychotherapie-via-internet-wirkt-gleich-gut-oder-besser-wie-im-sprechzimmer_en.html
======
jrubinovitz
This is the actual paper documenting the study the article refers to:
[http://www.sciencedirect.com/science/article/pii/S0165032713...](http://www.sciencedirect.com/science/article/pii/S0165032713005120)

"Method A total of 62 participants suffering from depression were randomly
assigned to the therapist-supported internet-based intervention group (n=32)
and to the face-to-face intervention (n=30)."

"Limitations Due to the small sample size, it will be important to evaluate
these outcomes in adequately-powered trials."

"Conclusions 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. "

They go in depth into the limitations of the study in section 4.1, but in a
nutshell the sample size was too small and heterogeneous. I look forward to
seeing more research in this area, but one cannot make the claim
"Psychotherapy via Internet found as good as or better than face-to-face" just
yet.

~~~
duaneb
> one cannot make the claim "Psychotherapy via Internet found as good as or
> better than face-to-face" just yet.

Actually, they did find it as good or better, just not conclusively.... not
that one ever could.

(I agree with the analysis—a larger sample size is definitely needed—but I get
annoyed by people who discard studies entirely. This is far, far better than
no study.)

~~~
ForrestN
I would say "found as" is a little misleading when the size is so small. Maybe
"initial evidence suggests" or something would be more accurate.

~~~
bigfudge
I think there's actually an argument not to discuss these small pilot studies
outside of the immediate community of researchers. The studies aren't powered
to detect a difference, and history tells us we're more likely to be mislead
than enlightened by interpreting the results of small trials.

~~~
duaneb
> we're more likely to be mislead than enlightened by interpreting the results
> of small trials

Potentially yes, but when you consider anecdotal evidence to be trials with
sample size 1, this is still a large improvement.

------
girvo
I did CBT online on the advice of my doctor to learn coping strategies for my
severe depression.

That was a year ago, and while I've had an episode since, I got help within
days and was better within weeks. Sure beats the 6 months it usually takes!

Only an anecdote, but it worked well for me, and my ex girlfriend (severe
anxiety). I think it's great for those who don't want to play Psychologist
Roulette.

~~~
polymatter
Can you recommend a particular site?

~~~
gxs
Seconding your request!

~~~
38f7h3iifjh63h
All the upvotes so that all we depressed hackers can get some solid
recommendations on e-therapy to get started on a path to wellbeing.

~~~
oblique63
Well, here's one app that's already available on iOS (and supposedly coming
soon to android):
[http://www.biasmodification.com](http://www.biasmodification.com)

It's a slightly different branch of therapy called CBM (cognitive bias
modification), but research shows it to be just as effective, while being much
simpler (IMO). Here's an interesting documentary that deals with it:
[https://www.youtube.com/watch?v=rs046iOPlqM](https://www.youtube.com/watch?v=rs046iOPlqM)

~~~
AsymetricCom
CBM sounds like a bad idea to me. "Get over your anxiety by ignoring pertinent
information in your environment!"

~~~
oblique63
Well, that is kinda the point... It has long been known that people with
depression technically have a more realistic view of the world, I doubt that's
coincidence (speaking from personal experience).

People need the ability to heavily filter input in order to function properly.
Failure to do so (i.e. over-sensitivity) is strongly correlated with issues
like depression/anxiety/autism and a whole slew of other things. Just think of
how many faces you see when you walk down the street, and how many of those
you actually remember just a few minutes later -- that's your selective
attention kicking in to prevent you from getting your memory overloaded with
_useless_ information. Same thing here.

~~~
ChrisNorstrom
This. CBT helped me a lot. It's real, it works, and it works because it's
realistic and asks you to observe yourself, understand yourself, and only then
can you "change yourself".

It's amazing just a few days ago there was an article on the front page about
how tripping on LSD or Magic Mushrooms was life changing for the better.

Sometimes depression is caused by lack of sunlight, exercise, poor diet, bad
environment (stressful) and other times it's caused by seeing the world for
what it really is: A depressing cesspool of suffering, death, meaninglessness,
and no purpose or hope. Sometimes all it takes is realizing that the universe
and laws of nature are "evil", rewarding the most violent and aggressive
species while punishing the weak or passive with miserable deaths, is all it
takes to fall into a subtle depression. CBT teaches you to recognize the
pattern of thinking that leads to those thoughts and training yourself to stop
before you reach that state of mind.

------
aridiculous
"Patients treated online had to perform one predetermined written task per
therapy unit – such as querying their own negative self-image."

Smells like bad experimental design. Shouldn't the face-to-face subjects also
be completing written tasks in session as a control? There are entire schools
of psychotherapy that require in-session activities.

If not, then they should compare standard talk face-to-face therapy with
online CBT "chat."

As an addendum: I think social sciences are categorically separate from harder
sciences (good social scientists understand this) and attempts at
laboratory/population experiments are typically laughable. They're usually
just done because that's what the people and organizations that fund the
departments want.

~~~
thelamest
I get the sentiment, but attempts at experiments are what makes science a
science. Psychology actually drove a lot of progress in statistics, because of
the fuzzy character of data.

------
pessimizer
I thought that it was pretty well known that all talk therapy is equally good,
regardless of content or delivery system. Here's a couple other references:

Phone Based Cognitive Behavioral Therapy Works as Well as In-Person Therapy:

[http://www.choosehelp.com/news/emotional-health/study-
phone-...](http://www.choosehelp.com/news/emotional-health/study-phone-based-
cognitive-behavioral-therapy-works-as-well-as-in-person-therapy)

Talking treatments work equally well for depression:

[http://www.webmd.boots.com/depression/news/20130529/talking-...](http://www.webmd.boots.com/depression/news/20130529/talking-
treatments-depression)

edit: I guess it's not. It's true, though. Even religious counseling works
just as well as reality-based. The content doesn't really matter.

~~~
thelamest
If anyone wants to read up on this, the controversy is called Dodo bird
verdict
([https://en.wikipedia.org/wiki/Dodo_bird_verdict](https://en.wikipedia.org/wiki/Dodo_bird_verdict)).

~~~
pessimizer
Thanks for this! Didn't know it had a name.

------
salleh
Hi all,

I'm a PhD candidate in clinical psychology who just started building a new
website to address this issue. If anyone here is interested in
telepsychotherapy (therapy using any form of digital communication), I'm
currently looking for a talented dev/designer to join me as cofounder. It's an
exciting time for my field, and I think with the right mix of innovation and
professional standards, the mental health world will soon see a revolution in
the types of services we offer and the populations we treat.

The Birgit et al. article is just one of a growing number of studies that
supports the efficacy of telepsychotherapy. It's true that --as some
commentators have mentioned-- the study has limitations. That can be said
about a vast majority of RCTs and other clinical-science studies. But we can
expect to see more and more of this research in the coming years. A number of
professional mental health organizations have recently formed task forces and
developed guidelines for ehealth practitioners, and those in the legal realm
are working on reducing regulatory/statutory barriers to telemedicine.

There are, of course, certain limits to telepsychotherapy. For example, it's
not a replacement for in-person treatment of individuals with severe mental
illness (e.g., suicidal tendencies). However, it carries a world of potential,
both for developing new multimodal services and for reaching persons who would
not otherwise receive services. Medicare already reimburses teletherapy for
persons in rural areas.

I can be reached at cerark@gmail.com - would be happy to hear from anyone who
is interested in discussing further.

~~~
themodelplumber
I discussed the suicidal tendencies a friend had in another comment in-thread,
but do you know why it is considered worse than in-person treatment for severe
illness? Certainly the friction of online contact is lower for people who
generally avoid personal/social contact, which I thought would be a good thing
/ possibly help otherwise incapacitated people get started.

~~~
Daishiman
You can be the best academic social scientist in the world, but being a good
psychotherapist is, fundamentally, about being good with people, and non-
verbal cues are fundamental for that.

It's one thing being open about normal depression, it's another to talk about
highly problematic mental disorders.

------
DenisM
In related news, reading the "Feeling Good" book on CBT was shown to be as
effective as professional theraphy. Get the book, you have nothing to lose.

~~~
aw3c2
Reference for that research?

~~~
artjumble
Not sure if there is any outside research. I believe that newer additions has
this info in the preface. But I can say I felt good while reading it. I need
to do that again.

------
casca
The details of the design of studies is critical in assessing most research
and the field of psychology is no different. While it is incredibly
frustrating that it's not possible to see the full paper to make a reasonable
assessment, this small result with no long-term data is likely to become
headline fodder.

It would be great if it were true, but there's not enough information
available to draw any conclusions at this point.

------
crazygringo
I'm not surprised at all. A lot of therapy is being able to admit
undesirable/guilty thoughts, or not worry about if the therapist is judging
you, etc.

It makes a lot of sense that you might be more inhibited in a room with the
actual therapist, and more disinhibited if it's just over the phone, or
looking at your laptop screen.

And therapy is just talk -- it's not like a doctor who has to judge your blood
pressure.

------
dergachev
Is there any control for the exact therapists participating? I'd imagine that
therapists who are willing to work online are very different than people who
work face to face. If online therapy involves written correspondence, that
seems it's more demanding of a therapist than just conversing with a patient.

------
ca98am79
weird, I submitted the article with this link:
[http://www.kurzweilai.net/psychotherapy-via-internet-
found-a...](http://www.kurzweilai.net/psychotherapy-via-internet-found-as-
good-as-or-better-than-face-to-face)

But at some point it was changed to this (not by me):
[http://www.mediadesk.uzh.ch/articles/2013/psychotherapie-
via...](http://www.mediadesk.uzh.ch/articles/2013/psychotherapie-via-internet-
wirkt-gleich-gut-oder-besser-wie-im-sprechzimmer_en.html)

Why did this happen?

------
lsiebert
Also see
[http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna...](http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018001)

which discusses social anxiety, and compares cognitive behavior therapy
without direct interaction over the internet, vs group cognitive behavior
therapy.

That said, it's difficult to deal with confounding factors if you only see
your patient during assessments. And the possibility that staring at a monitor
is itself a form of phototherapy comes to mind.

------
themodelplumber
I have a friend who attempted to sign up for online therapy via email but was
turned down during the intake process because he admitted to having suicidal
thoughts. This was a few years ago, so I'm not sure if the landscape has
changed much, but he was pretty excited about trying it out and pretty
disappointed he would have to get out and push himself to visit a typical
brick-and-mortar (? :-) therapist.

------
adammil
With NSA spying, would anyone seriously suggest exposing that level of
personal communication to the Internet?

~~~
JulianMorrison
Do you think your mood doesn't leak all over Facebook, email, and HN comments?

------
Falling3
I just started therapy a weeks ago after several years of debating it. It is,
at times, extremely difficult for me to say things out loud. There are even
things I have trouble admitting to myself. Every time I go in for a session, I
wish there were some option other than a face-to-face.

I think this is great.

------
jawerty
I highly doubt the problems people have who attend online Psychotherapy are
the same as the face-to-face interactions. Not to discredit any patients (at
all) but it takes a different type of person to get analyzed in person than it
does via the Internet.

~~~
AndrewDucker
In this case the people were randomly assigned to either face-to-face or
internet counselling, in order to prevent that bias having an effect.

------
GalacticDomin8r
I use online psycotherapy to treat my Internet addiction. I can tell you it
works great. I always feel better during a session. Coming back down is a
little rough so I found another online psycotherapist for that.

------
dhm116
I'm pretty sure this has been proven already -
[http://www.imdb.com/title/tt1343865/](http://www.imdb.com/title/tt1343865/)

------
jheriko
no control group? i'm 'sure' (by which I mean hope) psychotherapy is effective
in the general case... but i'd rather have data.

my 'gut' reaction to this is 'does psychotherapy work at all?' rather than 'i
wonder why this is true.'

------
kristopolous
I really want to crack an eliza joke here, but I'm just not clever enough.

~~~
Gormo
Not directly referencing ELIZA, but with it in mind, I was thinking of
something along the lines of "I bet a few of those psychotherapists might even
be able to pass the Turing test".

------
drKarl
dr Sbaitso!

------
willaaye
This is one of the reasons we started
[https://www.liveninja.com/](https://www.liveninja.com/) \- therapy is just as
effective and more affordable via the web which allows more people access to
the treatments they need.

