Online psychological therapy can cut waiting times

mental health, instegrated care

Mental disorders are one of the most significant public health challenges in Europe today, with 27% of the adult population having experienced at least one mental disorder over the past year, with an estimated 83 million people affected.

With mental health and wellbeing near the top of every government agenda, eMental health tools provide a much-needed panacea. Not only have eMental health tools already acquired a strong evidence base - in particular internet-based cognitive behavioural therapy (iCBT) – but they could also provide a cost-effective – and easy to access – alternative to face-to-face treatment.

The ‘gold standard’ - CBT

Cognitive behavioural therapy, or CBT, has long been the ‘gold standard’ treatment for depression and anxiety, the two most common forms of mental illness. But not only is there a long waiting list – anywhere from several weeks to one year - it can be difficult for those who live a long way from a hospital, or cannot afford to take time off work or have difficulties arranging child care, to access it.

Internet-based cognitive behaviour therapy (iCBT), however, is helping reach the people that its offline relative cannot – and with good results: “The evidence reveals that internet-based CBT is effective in treating depression - and there are even some studies that show that it is more effective than pharmacological treatments for certain populations,” says Kevin Power, Area Head of NHS Tayside Psychological Therapies Service and Honorary Professor of Psychology at the University of Stirling in Scotland.

“The research suggests, too, that e-interventions have been shown to be more effective than non-intervention – particularly in the case of depression and anxiety or substance misuse. And the estimation is that they are as effective as face-to-face inventions.”

A case study from Canada

In 2014, the Scarborough Hospital became the first hospital in Canada to deliver iCBT through its outpatient clinic. Psychiatrist Dr David Gratzer says it’s often the only way for someone with significant anxiety or phobia issues to try it.

The patients are emailed exercises to do in their own time, watch videos on a designated website, complete their homework, and then submit the modules to their therapist online.

Trained TSH psychotherapists then email the patients feedback or speak to them by phone personally, if needed. Patients still have that human connection with their therapist that is crucial to making therapy work, Gratzer says, but each therapist can potentially remotely help many patients at once.

“Therapist-guided CBT doesn’t require as much time for the therapist as one-on-one therapy. In fact, some of the Swedish studies found it takes one-sixth as much time. And as a result, the costs were much lower,” he says, adding that iCBT has been offered across Sweden for years.

iCBT – ‘not for everyone’

While internet-delivered mental healthcare is still a new idea to Canada, it makes sense for us, says Gratzer. Not only is it less labour-intensive than traditional CBT, it allows patients to receive a proven therapy method that they wouldn’t otherwise be able to access.

“We see this as having numerous benefits: one is convenience; two is empowerment (because the treatment is self-directed); and three is it can help address some of the access problems we have in Canada,” he says.

What’s more, the method works. Gratzer says his clinic has been tracking its own progress and has found that even though the people who choose iCBT are often just as ill as those doing traditional CBT, the dropout rate is lower with the internet-based format, and the patients report better scores in mood and anxiety after completing the program.

Gratzer says iCBT is not for everyone. It’s not well suited to those with severe depression, for example or those with difficulty managing the technology involved. Nor is it meant to replace traditional CBT. Indeed, many patients prefer the face-to-face of group therapy, and that’s still offered as an option.

“We’re not arguing that this is for everyone. This is just another tool in the toolkit,” he says.

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