Psychotherapy via Internet found as good as or better than face-to-face | Hacker News Reader

Psychotherapy via Internet found as good as or better than face-to-face

mediadesk.uzh.ch

118 pointsca98am7956 comments

This is the actual paper documenting the study the article refers to: http://www.sciencedirect.com/science/article/pii/S0165032713...

"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.

> 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.)

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.

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.

> 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.

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.

Can you recommend a particular site?

Seconding your request!

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.

Just go to Amazon and get a well reviewed book. The websites are just the same info delivered in bullet points for people that might not be as literate as your average HN user.

Not all. Moodgym is interactive and I found it helped a lot more than a book did.

Well, here's one app that's already available on iOS (and supposedly coming soon to android): 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

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

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.

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.

Moodgym.

Ha, yep.

It's a book, not a website, but I highly recommend "The Feeling Good Handbook." http://www.amazon.com/dp/0452281326

It's also been shown in experiments to be beneficial: see e.g. http://psycnet.apa.org/journals/ccp/63/4/644/ http://psycnet.apa.org/journals/ccp/65/2/324/

I know there's also another study that compared it to a placebo book instead of just a waiting list control group, and it was better than the placebo book too.

https://moodgym.anu.edu.au/welcome

That's what I and my ex girlfriend used. She introduced me to it. :)

"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.

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.

They're usually just done because that's what the people and organizations that fund the departments want

Is that not exactly the same for the 'hard sciences'?

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-...

Talking treatments work equally well for depression:

http://www.webmd.boots.com/depression/news/20130529/talking-...

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.

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

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

My understanding before reading your article is that CBT had consistently outperformed other types of talk therapy for at least some problems. And indeed, wikipedia ( https://en.wikipedia.org/wiki/Dodo_bird_verdict ) confirms there is evidence for this (although as usual everyone disputes everything). I think you are selling yourself short if you give in to the comforting simplicity of "oh, the only thing that matters is having someone to talk to". It's probably correct to first order, though.

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.

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.

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.

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.

Here it is http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/03808... at Amazon.

I can only directly recommend the '80s version, before the "Behavioral" bit was added, but I found it to be very very powerful. In 20/20 hindsight, so good that talk therapy afterwords hasn't been useful (there's no doubt a bit of Psychologist Roulette as grivo puts it involved, maybe there's a better therapist out there that I haven't found, but...).

Reference for that research?

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.

A friend who is a very experienced therapist told me that "10 Days to Self Esteem" was, despite the awful title, the book she recommended most. It contains a testing/evaluation method you can use to evaluate yourself without setting foot in a therapist's office, and functions more like a workbook. Seems pretty cool except I don't want to give the idea here that people should avoid the therapist.

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.

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.

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.

weird, I submitted the article with this link: http://www.kurzweilai.net/psychotherapy-via-internet-found-a...

But at some point it was changed to this (not by me): http://www.mediadesk.uzh.ch/articles/2013/psychotherapie-via...

Why did this happen?

Also see http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna...

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.

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.

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

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

Yes.

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.

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.

it takes a different type of person to get analyzed in person than it does via the Internet

Can you elaborate on that?

This sounds like online counseling, not actual psychotherapy. But subjects were randomly assigned so shouldn't be any self-selection bias going on.

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.

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.

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

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.'

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

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".

Beware of addictions.

dr Sbaitso!

This is one of the reasons we started 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.

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