Could online therapy help you?

If you only use the net for checking emails and catching up on TV you could be missing out. Find out how it could boost your mental health…

The internet has been a source of therapy since it exploded into our lives. First came sharing problems in chatrooms, then offloading in blogs. Most significantly, though, the internet has become a place to ‘get therapy’ in the way we more typically think of it. Websites offering courses of therapy online first sprang up in the early Noughties, and they’ve gained in popularity over the decade. The users of one website for depression, www.beatingtheblues.co.uk, doubled last year to around 40,000. ‘The Internet has become a way of life for most people,’ says psychologist and co-founder of www.psychologyonline.co.uk, Sue Wright. ‘People aren’t suspicious of it and they communicate through it in many ways, such as Facebook and Twitter, so this is really just a natural extension of that.’

Virtual boom
And online therapy has gained expert approval, too, with the NHS getting in on the virtual act. Up until recently, sufferers of mild to moderate depression or anxiety were referred by their GP to a therapist for cognitive behavioural therapy (CBT), which teaches positive patterns of thought and behaviour. But in 2006 the National Institute for Health and Clinical Excellence (NICE) found that computerised CBT (CCBT) was an effective treatment for these conditions, and now this is widely prescribed by GPs and offered free on the NHS.
For anxiety, a program called FearFighter (www.fearfighter.com) is recommended. Users click through screens to learn more about their condition and then a range of behavioural and practical skills (problem solving, goal setting, challenging negative thoughts etc) pop up on screen to help them manage their condition. The popular CCBT programme for depression, www.beatingtheblues.co.uk, is now available in 120 of 150 primary care trusts. This works in the same way as FearFighter, although it also includes video clips to support lessons.
Another form of online therapy for depression is so-called ‘real-time’, which involves ‘speaking’ to a therapist in chatroom-style appointments. An NHS trial of the real-time site www.psychologyonline.co.uk found that patients were two-and-a-half times more likely to recover with the online therapy than through normal GP care.
The effectiveness of online CBT isn’t limited to depression and anxiety. Recent American studies have found it’s as good as face-to-face therapy for treating insomnia, with 80 per cent of users finding their condition improved. There are other kinds of online therapy aside from CBT too, including psychotherapy, hypnotherapy and addiction counselling which are delivered in various ways from Skype (video and phone communication via computer), in chatrooms, by email or through structured, click-through programmes.
‘CBT is most popular because it has the most extensive evidence base of all the therapies – around 300 randomised controlled trials worldwide that all say it works,’ says John Smith, chief executive of Ultrasis, which owns Beatingthe blues.co.uk. With ongoing research, more treatments could be available on the NHS in the near future.

What are the benefits?
So why are people turning to their computers for help? The anonymity of web therapy is a big draw, points out Wright. ‘It’s quite difficult to meet and discuss a problem with a stranger, especially if it’s something you feel shame about,’ she says. ‘Research has shown that people tend to open up more online because the other person is “removed”. Issues that are difficult to confront face-to-face are easier to disclose virtually.’
And for others, online therapy is just practical. ‘If you have anxiety, the last thing you want is to take time away from commitments, such as work, for your session,’ says Smith. With a programme at your fingertips you can do it anytime. And being able to have therapy in the convenience of your own home might suit people who may not otherwise be able to travel; for example those who are immobile or living remotely where access to specialists may be limited.
As NHS waiting lists can be astronomical, online therapy offers instant access to treatment. And it works – in one NHS centre offering Beating the Blues, around 75 per cent of patients are discharged after completing the programme. Those who need further face-to-face sessions require fewer than four, rather than the usual 15, freeing up appointments for other NHS patients. It saves money, too. ‘A course of Beating the Blues costs the NHS £50-£80 whereas face-to-face is £700-£1500,’ says Smith.

It won’t ‘click’ with everyone
Sound good so far? Not everyone agrees. ‘Most websites are not suitable for help with anxiety and depression because the advice offered is not one-to-one, you don’t necessarily know who it’s coming from, and you can’t always speak to them whenever you need to,’ says David Kelnar, chief executive of www.greatvine.com. On this site you search a database of accredited experts that deal with your kind of problem and select the one that you’d like to speak to. Appointments are then carried out over the phone instead of online.
Kelnar also finds fault with the concept of ‘real time’ sites. ‘For most people phone therapy is much more effective than “type chat” because you can express yourself more fluidly and your tone of voice and pauses all help the therapist understand your symptoms better. So you’re likely to get a better outcome,’ says Kelnar. ‘Also, because most people can speak much faster than they can type, it’s more efficient and therefore less expensive.’
The creators of online therapy sites admit limitations. ‘There are some people this will never be applicable for. Some people want human interaction,’ says Smith. And everyone agrees it isn’t suitable for people with severe conditions who need close monitoring.

How to get it
But for many, online therapy could be the answer. If you suffer with anxiety or depression and want to try CCBT, ask your GP about a free course.
If you don’t want to see your GP but think web therapy would be beneficial, you can access and pay for it yourself. But Googling ‘online therapy depression’ alone gets over nine million results, so choose carefully. Check the experts are from a recognised body like The British Psychological Society and ensure there’s security and encryption to protect your personal details. Good sites refer you to your GP if your condition is serious.
Although it’s unlikely that your computer interface will replace your GP, virtual health is definitely growing. ‘Video appointments with your therapist as on www.appointmentrooms.com will be the next big thing, combining the intimacy of face-to-face and the convenience of online,’ says Wright. ‘We’re looking at technology to add social networking to our site,’ says Smith. ‘This would enable you to have a discussion about your problem with a community of people with similar problems,’ he says.
Technology experts are in agreement that variety is the way forward, as each kind of therapy – face-to-face, phone and online – has its pros and cons. ‘We’re not advocating that everyone uses online therapy, but it’s about offering choice and reaching more people,’ says Wright. The future of therapy, it seems, is all about experimenting with what works best for you.

To find out how online therapy helped one reader, click here

Words: Jessica Powell