Is remote therapy as effective as in-person sessions? What new research says 

Cognitive behavioural therapy (CBT) done remotely with a therapist is just as effective as in-person sessions, according to a new study published in the Canadian Medical Association Journal (CMAJ).

The study, published Monday in the CMAJ, found that “moderate-certainty evidence” showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders.

CBT is a form of psychotherapy that helps people recognize and modify detrimental thought patterns and behaviours; it’s been proven effective for a variety of mental health problems, like depression and anxiety but also chronic pain.

“The World Health Organization has designated CBT as essential health care, but access remains an important barrier for many people in Canada. Our findings suggest that therapist-guided, remotely delivered CBT can be used to facilitate greater access to evidence-based care,” Dr. Jason Busse, professor in anesthesia at McMaster University in Hamilton, Ont., said in a Monday media release.

Following the COVID-19 pandemic, virtual healthcare, spanning from walk-in appointments to therapy sessions, has surged in popularity because of its convenience and accessibility, particularly benefiting individuals residing in remote communities.

In 2022, more than five million Canadians met diagnostic criteria for a mood, anxiety, or substance use disorder, and one in five adults live with chronic pain, the study said.

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

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While evidence supports the effectiveness of in-person CBT therapy, the study underscores uncertainty regarding a remote form of this therapy.

To find this data, the researchers looked at 54 randomized controlled trials with more than 5,400 patients. These trials looked at the effectiveness of CBT in treating various conditions such as anxiety, depression, insomnia, chronic pain, chronic fatigue syndrome, tinnitus, and alcohol use disorder. They also specifically compared the outcomes of in-person CBT with those of remote CBT.

The types of remote CBT included interactive voice response technology, computerized CBT, telehealth and telephone-based CBT, videoconference, and online. The study also found that research has found that most patients are willing to receive psychotherapy in person or remotely.

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

In August 2023, Mental Health Research Canada commissioned a poll of 3,189 Canadian adults, revealing a notable rise in participants citing financial constraints as a barrier to accessing mental health care, increasing from 18 per cent to 29 per cent compared to the previous year.

The authors argue that barriers to accessing therapy extend beyond financial constraints and also include geographical factors.

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“Access to psychotherapy is an important barrier for many people in Canada, particularly those living in remote or rural areas, including military veterans and Indigenous populations, both of which are at high risk for chronic pain and mental health disorders,” they said.

Remote CBT imposes fewer demands on patients’ time as travel for face-to-face sessions is unnecessary, the authors said. It also may be more cost-effective than in-person, “particularly when the intervention is supported by therapists, rather than being delivered remotely in real-time.”

The study concludes that Canada’s provinces and territories should consider funding access to therapist-guided remote CBT to facilitate greater access to evidence-based care. Currently, only two provinces, Saskatchewan and Ontario, provide funding for remote CBT.

“Several options for providing remote psychotherapy are available and use of this delivery method for CBT is likely to evolve rapidly. Recent advances in artificial intelligence tools may open further avenues for providing CBT with reduced involvement of human therapists,” the authors stated.