A study at the University of Amsterdam by Dr. Marit Sijbrandij, Ivo Kunovski, and Dr. Pim Cuijpers investigated whether ICBT could improve the accessibility of mental health care for individuals diagnosed with PTSD, compared to inactive-treatment patients and active-treatment patients. The ICBTs under consideration varied slightly in form and usually consisted of either self-help ICBT (without a therapist) and therapist-assisted ICBT. As they compiled the data, the researchers found that ICBT was in fact superior to both the inactive controls and active controls. However, what they did note was that the positive clinical effects in the studies analyzed were strongest when ICBT interventions were therapist-assisted and longer than eight sessions.
The larger clinical outcomes for therapist-assisted ICBT treatment for PTSD compared to self-help ICBT supports previous meta-analytical research on computerized interventions for symptoms of depression and anxiety. Reasons for this effect size are many, yet researchers believe that internet-delivered therapy programs that include therapist involvement can increase patient motivation to complete treatment, increase patient feedback and communication, and even help tailor a unique program that meets the needs of each individual patient.
Due to these results, the researchers became interested in whether therapist-assisted ICBT (arguably the most effective form of online therapy) would be less or more effective at treating conditions like depression and anxiety when compared with standard face-to-face therapy — a method that has easily succeeded in tailoring treatments to patients’ needs, optimizing communication, and lasting for longer periods of time.
A study published in The American Journal of Psychiatry led by Drs. Jesse and Andrew Wright compared the efficacy of therapist-assisted ICBT against standard face-to-face cognitive therapy and a control group without treatment for medication-free outpatients who were diagnosed with nonpsychotic major depressive disorder. The researchers assigned 15 patients with major depressive disorder to face-to-face cognitive therapy, 15 patients to therapist-assisted ICBT, and 15 to a waitlist control group (that is a control group that is first untreated, but eventually receives treatment at a later date).
Treatment with therapist-assisted ICBT included nine sessions over a period of eight weeks with a therapist (first session was 50 minutes and subsequent sessions 25 minutes) along with eight computer sessions that each lasted 20 to 30 minutes immediately after the first nine sessions. The standard face-to-face cognitive-therapy group was delivered in nine 50-minute sessions over a period of eight weeks with a therapist. Treatment assessments were completed by independent raters before treatment, after four and eight weeks of treatment, and three and six months post-treatment.
The researchers found that patients treated with therapist-assisted ICBT and standard face-to-face cognitive therapy achieved significantly more improvement in depression severity than the patients on the waitlist condition as assessed by both the Hamilton Depression Scale and the Beck Depression Inventory.
However, there was no evidence for treatment differences between the therapist-assisted ICBT and standard face-to-face cognitive therapy conditions. Even more fascinating was to see that the computer-assisted cognitive therapy group better maintained their treatment gains over a longer period of time.
In another study published in the journal World Psychiatry by Gerhard Andersson’s research team followed up on these results by conducting an analysis of 13 studies that examined the effectiveness of therapist-assisted ICBT as compared to standard face-to-face cognitive behavior therapy for the treatment of a variety of disorders. The disorders that were analyzed in the study included social-anxiety disorder, panic disorder, depression, body dissatisfaction, tinnitus, male sexual dysfunction, and spider phobia. Six of the studies utilized private face-to-face cognitive behavior therapy whereas seven studies utilized a group format.
Surprisingly, the researchers’ post-treatment analysis determined that therapist-assisted ICBT and face-to-face treatment (either delivered privately or in a group) actually produced “equivalent overall effects.” Even though this finding clearly supported the previous data from Wrights’ study, the researchers were quick to point out that there were only a few studies for each condition and that many more conditions were excluded from the study.
One condition left out of both Wrights’ and Andersson’s studies was psychosis — a condition with symptoms ranging from hallucinations and delusions to disturbing thoughts and lack of self-awareness.
Dr. Michael Terry — associate clinical professor and coordinator of the Psychiatric Nurse Practitioner Program at the University of San Diego — is an expert in disaster and trauma mental health programs, and has worked with diverse ethnic groups including migrant farmers, Alaskan natives, Southeast Asian refugees, multinational fisherman, and cannery workers.
In an interview, Terry recalled moments during his video-conferencing therapy work with patients throughout Alaska’s Aleutian Islands: “Once I was wearing a white jacket and the wall behind me was white. My face looked very dark because of the contrast, and the patient thought he was talking to the devil.”
Another time during his therapeutic work, Terry recalled that the lighting of the room, as seen in the computer camera, created a halo effect: “An adolescent thought he was talking to the Holy Spirit, that he had God on the line. It fit right into his delusions.”
