Internet-based cognitive behavioral therapy (CBT), delivered in real time, can effectively reduce depression and may expand treatment options beyond a therapist’s office, according to research published this August in the journal The Lancet.
CBT has been shown to effectively treat depression, and previous studies have shown that CBT when combined with an anti-depressant drug is more effective than either treatment alone. Internet-based CBT could extend therapy’s reach and give psychiatrists another tool in the fight against depression.
Insurance companies do not cover Internet-based CBT. However, the study’s lead author, David Kessler, a psychiatrist from the University of Bristol, is optimistic that Internet-based CBT will be widely available within two to three years.
“We’ve found a very encouraging effect of delivering cognitive behavioral therapy using [the Internet],” said Kessler. “Therapists that want to deliver it this way and patients that want it this way should take heart.”
For the study, CBT was delivered via the Internet in real time by a therapist, in a conversation similar to instant messaging. The treatment was given to 113 randomly assigned individuals who were previously diagnosed with depression. Patients who received Internet-based CBT were twice as likely to recover from depression after four months, compared to a control group that received only the usual care from their general practitioner while on a waiting list for online CBT.
Patients for the trial ranged from mildly to severely depressed (Beck Depression Inventory (BDI) score ≥14). The patients received 10 sessions, each 55 minutes long, over 16 weeks. Researchers assessed therapy transcripts using the cognitive therapy rating scale. They reassessed patients’ BDI scores four months later to measure short-term gains, and then again after eight months to see if their improvements were sustained. After eight months, the patients’ chances of recovery were slightly lower than after four months, but Internet-based CBT still roughly doubled their chances of recovering from depression.
In this study, if seven people are treated using Internet-based CBT, one person will recover from depression.
While Internet-based therapy may still be years away from common usage, researchers see this therapy as a potential game changer, since using Internet therapy increases access and also may reduce inhibitions normally associated with in-person therapy. Internet-based CBT could also change the way sessions are organized.
CBT is typically delivered face to face by therapists during separate blocks of time, each close to an hour long. Internet-based CBT will help therapists break up the sessions so patients have greater access to treatment.
“The serving size of psychotherapy is 50 minutes. This makes it possible to change serving size,” said Gregory Simon, psychiatrist at Group Health Cooperative in Seattle. Simon authored a comment in the same issue of The Lancet about the study and urged psychotherapists to push the boundaries when it comes to new approaches to treatment.
Internet-based therapy has the potential to reduce psychotherapy costs. Psychotherapy is basically a cash business, according to Simon, because insurance companies do not usually cover treatments. Internet-based therapy can reduce patients’ time spent with therapists, and therefore reduce patients’ bills.