Remote therapy just as good as in-person care, researchers find

Cognitive behavioural therapy (CBT) delivered remotely, with therapist guidance, appears to be as effective as in-person therapy for treating a range of conditions, according to a new study from McMaster researchers.

The findings, published March 18 in the Canadian Medical Association Journal, underscores the usefulness and convenience of remote delivery of CBT.

The authors are urging provinces and territories to consider funding online therapist-guided CBT to widen access to effective and much-needed mental health care.

“The World Health Organization has designated CBT as essential health care, but access remains an important barrier for many Canadians. Our findings suggest that therapist-guided, remotely delivered CBT can be used to facilitate greater access to evidence-based care,” says Jason Busse, a professor with the department of Anesthesia and senior researcher of the study.

In this systematic review and meta-analysis, researchers included 54 randomized controlled trials with 5,463 patients that looked at treatment of anxiety and related disorders, depression, insomnia, chronic pain, chronic fatigue syndrome, tinnitus and alcohol use disorder with CBT. These trials compared in-person and remote CBT.

“Our systematic review found moderate-certainty evidence that there is probably little to no difference in effectiveness whether CBT is delivered in-person or remotely with therapist support,” write the authors. “This finding was unaffected by type of clinical condition, length of follow-up or whether CBT was provided individually or through group sessions.”

Mental health and CBT in Canada

Mental health illnesses affect millions of Canadians every year. According to the Centre for Addiction and Mental Health, by the age of 40, half of Canadians will have experienced a mental health illness.

Affordability is a barrier to accessing mental health support. An Aug. 2023 poll by Mental Health Research Canada found that the number of people who were unable to access mental health care because of cost increased from 18 per cent to 29 per cent from the previous year.

“Access to psychotherapy is an important barrier for many Canadians, particularly those living in remote or rural areas, including military veterans and Indigenous populations, both of which are at higher risk for chronic pain and mental health disorders,” the study states.

CBT is commonly used in psychotherapy to assist with unhelpful thoughts and behavioural patterns and is effective for a variety of mental health issues as well as chronic pain.

In Canada, CBT is largely offered by registered psychotherapists, social workers and psychologists, making it costly as it is not covered by many publicly funded health systems and is capped by many private benefit plans.

“Several options for providing remote psychotherapy are available and use of this delivery method for CBT is likely to rapidly evolve,” the study states.

Researchers say advancements in artificial intelligence tools could hold the key to furthering CBT options. This could see treatments with less involvement from human therapists. Researchers also highlight more work is needed to better understand how patients prefer to receive care.

“Future studies should explore whether certain patients have strong preferences for in-person or therapist-guided remote CBT, the comparative effectiveness of different types of remote CBT, and the effectiveness of remote CBT compared with stepped care, whereby remote CBT is provided first, and then non-responders are offered in-person CBT.”