How Does Online Therapy for Mental Health Work?

Jul 4, 202413 min
Author's Profile picture
Snigdha Samantray
Digital Mental Health Specialist | Clinical Psychologist
Doctor tele-consulting via online, mental health patient on laptop

Finally, technology has entered the world of mental health therapy and has now become an integral part of modern-day mental health care. So, do we call it Online Therapy? Teletherapy?  Remote Therapy? Virtual Therapy? e-Therapy, Tele-Mental Health? or Digital Mental Health? The answer is, “it’s all!”

While we may thank or blame the COVID, the reality is that the use of technology in telemedicine has prevailed since 1924. In April 1924, a visionary cover of the magazine Radio News predicted the future of telemedicine by illustrating a "radio doctor" connected to a patient through both audio and live video. 

This imaginative depiction came true at a time when radio had only recently started to enter American households, and it wasn't until 1927 that the first experimental television transmission took place. 

Later in the 1960s, emerging telecommunications technology led physicians to adapt innovative clinical protocols, addressing the real-world challenges in patient access for remote populations.

Patient access even eased further with the invention of mobile phones in the 1970s and its widespread use in households by the mid-1980s. Before 2020, the adoption of mobile phones in telehealth was low and targeted. And with the onset of the pandemic, the rest is history!

The Centres for Disease Control and Prevention (CDC) reports that the onset of COVID led to a 154% increase in telehealth sessions during the last week of March 2020 alone. Fast forward to 2024, the rise of telehealth visits, including online mental health therapy has become the norm and there have been no signs of slowing down ever since then. 

According to one particular market research (Zion Market Research), the global online therapy services market size was worth around USD 9.7 billion in 2023 and is predicted to grow to around USD 69.7 billion by 2032 with a compound annual growth rate (CAGR) of roughly 24.5% between 2024 and 2032. 

With the rapid spread of smartphones, high-speed internet, and video conferencing platforms, accessing mental health support has never been more convenient and there is no looking back now.

What is Online Therapy? Is Online Therapy Right for You?

If you want to explore a convenient yet effective option for Mental wellbeing, then Online Therapy could be your preferred choice. Online therapy refers to mental health services delivered over the internet through various communication methods such as video calls, messaging, and chat rooms. This method offers a convenient and effective way to access mental health care for mental health conditions like Anxiety, Depression, Obsessive-Compulsive Disorder (OCD), and Adult Attention-deficit/Hyperactivity Disorder (ADHD), Personality Disorders etc.

Online therapy provides several advantages over traditional in-person therapy. Numerous studies have shown that online therapy can be just as effective as traditional therapy for various mental health conditions, and the quality of the therapeutic relationship is often maintained.

One such study published in The American Journal of Psychiatry, 2022, found that patients who received Cognitive Behavioural Therapy (CBT) via videoconference improved just as much as patients who received in-person CBT. These outcomes could be driven by certain advantages that are exclusive to technology-driven therapy as discussed below:

1.Enhanced Accessibility

Integrating technology into therapy significantly enhances accessibility. Online therapy platforms allow individuals to receive therapy from their own homes, removing barriers such as transportation difficulties, mobility issues, or residing in rural or remote areas with limited mental health services. This broadened accessibility ensures therapy is available to a wider audience who might otherwise have limited access.

2.Increased Convenience

Technology also makes therapy more convenient for both therapists and clients. Online therapy eliminates the need for commuting to a physical office, saving time and reducing stress. Sessions can be scheduled beyond traditional office hours, accommodating clients with busy schedules or those in different time zones. This flexibility enhances the therapy experience and promotes consistent participation. 

3.Anonymity

The online format can provide an increased sense of privacy that encourages individuals to seek help.

Moreover, the anonymity afforded by digital platforms may reduce the stigma associated with seeking mental health treatment, encouraging more people to seek help when needed.

4.Personalized and Customized Therapy

Online therapy platforms provide therapists with tools to tailor therapy to the unique needs of each client. Online assessments, digital journals, and interactive therapy apps allow clients to engage with therapy in ways that suit them best. These tools help therapists track progress, set goals, and deliver interventions aligned with each individual's preferences and learning styles.

5.Continuous & Sustained Care

Maintaining continuity of care can be challenging in a fast-paced world. Online Therapy helps bridge this gap by facilitating communication and collaboration between therapists and clients outside of sessions. Secure messaging platforms, video check-ins, and virtual support groups enable ongoing support and connection, fostering a sense of continuity and accountability in the therapeutic relationship.

6.Cost Effectiveness

One significant advantage of online therapy for mental health is its cost-effectiveness. By eliminating the need for physical office space, travel expenses, and other overhead costs associated with traditional in-person therapy, online therapy can reduce the financial burden on both therapists and clients. Clients save on transportation costs and time away from work or other responsibilities, while therapists can reach a broader clientele without the constraints of geographical location.

Additionally, the flexible scheduling of online sessions can increase the efficiency of both parties, allowing for more appointments and potentially lower session fees. This overall reduction in costs makes mental health services more affordable and accessible to a wider range of people, enhancing the reach and impact of therapeutic care.

7.Driving Innovation

The integration of technology in therapy drives innovation and advancements in mental health care. Technologies such as virtual reality exposure therapy for phobias and AI-driven chatbots for immediate support introduce new therapeutic interventions and expand the tools available to therapists. These innovations have the potential to improve treatment outcomes and enhance the overall quality of care.

Online therapy offers numerous benefits and it can be leveraged to enhance the therapeutic experience and empower the consumers in their journey toward healing and growth.

While there are no such contraindications of online therapy, despite its convenience, it isn't for everyone. Online mental health therapy is not recommended in certain situations where the severity or nature of the mental health condition requires more intensive, in-person care.

For instance, individuals experiencing severe or chronic mental health disorders that necessitate hospitalization or close medical supervision may not benefit adequately from online therapy alone. Additionally, young children, who often require specialized therapeutic approaches involving play therapy or other interactive methods, might not engage effectively through virtual platforms.

Situations involving acute crises, such as suicidal ideation, self-harm, or severe psychosis, also demand immediate, in-person intervention to ensure the safety and well-being of the individual. In these cases, the limitations of online therapy highlight the necessity for direct, face-to-face contact and a controlled environment that online sessions cannot provide.

How Does Online Therapy Work for Mental Health Conditions: Different Approaches

Online therapy can have several formats or approaches, each suited to the different needs and preferences of the consumer as discussed below:

1.Video Calls: 

This approach provides real-time, face-to-face virtual interactions which is pretty much similar to traditional therapy sessions.

2.Messaging: 

This approach is an asynchronous communication that allows clients to send messages at their convenience and receive messages from the therapist at a scheduled time.

3.Chat Rooms: 

This approach is a real-time text-based communication between the clients and therapist, which can be individual or group-based.

4.Bot-Generated Chat Rooms:  

This approach can provide immediate support and resources to individuals in need, offering a safe space to share feelings and access information. These AI-driven bots can help bridge the gap between professional therapy sessions, providing consistent and non-judgmental assistance around the clock.

Typical Structure of an Online Therapy Session

Traditional therapy sessions and online therapy sessions both have very similar structures. A major difference between both could be the choice of assessments that are made, as not all psychometric tests or assessments can be done online. In that case, online assessments that are more client-friendly yet effective are chosen. A typical structure of online therapy may involve:

1.Initial Assessment: The therapist conducts a comprehensive evaluation to understand the client's issues and develop a treatment plan.

2.Goal Setting: The therapist and client set specific, measurable goals tailored to the individual's condition.

3.Therapeutic Formulation: The therapist uses a comprehensive understanding of a patient's psychological difficulties by integrating their experiences, behaviours, and underlying thought patterns and creates a personalized treatment plan in collaboration with the client.

4.Execution of Treatment Plan: The therapist uses different evidence-based techniques that are employed in the therapy sessions depending on the condition.

For example,

a. In Anxiety, techniques may include CBT to address negative thought patterns and exposure therapy to reduce avoidance behaviours.

b. In Depression, therapists might use behaviour modification techniques like activity scheduling, CBT to address thinking errors or interpersonal therapy (IPT) to improve mood and coping skills.

c. In OCD: ERP is commonly used to help clients face their fears without resorting to compulsive behaviours.

d. In ADHD, therapists may use strategies that often focus on behaviour management, organizational skills

5.Evaluation of Goals: The therapist regularly assesses a client's progress towards their therapeutic objectives, ensuring that the treatment remains effective and relevant. This process allows for adjustments to be made to the therapy plan, fostering continuous improvement and alignment with the client's evolving needs.

6.Termination of Therapy: This includes collaboratively ending the therapeutic relationship once goals are achieved, with a focus on consolidating gains and planning for the future. This phase includes strategies for relapse prevention, ensuring that clients have the tools and support needed to maintain their progress and manage potential setbacks independently.

Is Online Therapy Effective for Conditions Like Anxiety, Depression, OCD, and ADHD?

Digital Mental Health Consultancy

Research studies have backed the effectiveness of online therapy for treating a variety of mental health conditions. For example, studies have demonstrated that internet-based cognitive-behavioural therapy (iCBT) is highly effective in treating anxiety and depression. Meta-analyses or large research studies have found that iCBT produces significant reductions in symptoms, with results comparable to face-to-face therapy.

Another study found that people with a social anxiety disorder who underwent eight sessions of virtual reality exposure therapy (VRET) had a significant decrease in anxiety symptoms compared to those who didn't receive any treatment at all. 

We've covered, how online therapy for social anxiety disorder works.

One research study reported the largest cohort of OCD patients treated with video teletherapy, proved highly effective in reducing both obsessive-compulsive and comorbid symptoms while enhancing quality of life. 

Know, How Do Psychiatrists Treat Obsessive-Compulsive Disorder (OCD)?

Notably, this method achieved significant results using less than half the total therapist time compared to standard weekly outpatient treatments, translating to considerable time and cost savings. The effect size was substantial, compared to in-person exposure and response prevention (ERP) therapy

Similarly, online therapy for ADHD often includes behaviour management strategies and organizational skills training, which can significantly improve daily functioning. One such research showed that online interventions for ADHD are an effective intervention.

What to Expect from An Online Mental Health Therapist Specializing in Your Condition

Online therapists specializing in mental health conditions like anxiety, depression, OCD, and ADHD are typically licensed professionals with extensive training in evidence-based approaches.

Additionally, they also hold special training and experience in digital mental health and are aware of the ethical and legal aspects of delivering therapy online. They may also hold degrees in psychology, counselling, or clinical psychology and have additional certifications or training specific to mental health conditions.

Finding a therapist who specializes in your specific mental health needs is crucial for effective treatment. Specialists who are familiar with the nuances of the mental health condition you are seeking can tailor their approach accordingly. For instance, a therapist experienced in anxiety disorders will be adept at using CBT and exposure techniques, while a depression specialist might focus more on CBT and Interpersonal therapy. There are also therapists who specialise in addressing more than one mental health disorder.

How Much Does Online Therapy Cost?

The cost of online therapy may vary widely depending on several factors as discussed below:

  • Platform: Some platforms charge a flat fee per session, while others offer subscription models.
  • Therapist's Experience: More experienced therapists may charge higher rates.
  • Online Therapy Frequency: The overall cost will also depend on how often you attend sessions.
  • Online Therapy Duration: The overall cost will also depend on the duration of the sessions you choose
  • Inclusion of Psychological Assessments and Testing: Generally psychological assessments and tests are charged separately in addition to the therapy sessions. This also varies on the type of assessment needed and the duration for the same.

The cost of online therapy in India can vary widely depending on the platform, the therapist's qualifications, and the type of services offered. On average, online therapy sessions can range from ₹500 to ₹2500 per session. 

Some platforms may offer subscription plans that reduce the per-session cost, while others might have sliding scale fees based on the individual's financial situation. 

Additionally, many insurance providers now cover online therapy sessions, making it more affordable. It's advisable to check with your insurance provider regarding coverage for mental health services, including anxiety treatment, depression therapy, OCD therapy, and ADHD management.

Can I Use My Insurance for Online Therapy for My Specific Mental Health Condition?

The Mental Health Act, India, 2017, directs every health insurance provider to add mental health insurance to their existing scheme.  Insurance coverage for online mental health therapy is becoming increasingly common. Many insurance plans now include coverage for conditions like anxiety, depression, OCD, and ADHD. 

Under the Ayushman Bharat, the flagship program of the Government of India, Ayushman Bharat PM-JAY scheme, the world's largest insurance scheme has coverage for mental health disorders.

It covers mental health conditions like Mental retardation, mental disorders-organic, including symptomatic, schizophrenia, schizotypal, and delusional disorders, neurotic, stress-related and somatoform disorders, mood (affective) disorders, behavioural syndromes associated with physiological disturbances and physical factors, mental and behavioural disorders due to psychoactive substance use. It also includes coverage for treatments like Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS)

Several Indian private insurance companies now offer coverage for mental health conditions as part of their health insurance plans. Some of these companies include HDFC ERGO My Health Suraksha, ICICI Lombard, Max Bupa, Digit Healthcare Plus and Aditya Birla Health Insurance.

These companies provide varying levels of coverage, so it's essential to review the specific policy details and terms to understand the extent of mental health coverage offered. Some plans may also require a referral from a primary care physician or only cover sessions with certain therapists.

How Many Sessions Will I Need for My Specific Mental Health Concern?

The number of online therapy sessions required varies based on individual needs, the severity of the mental health condition and the type of mental health condition. Some people may find significant improvement after a few sessions, while others may benefit from longer-term therapy.

For example, people diagnosed with Anxiety may need a few sessions to manage symptoms, while people having Personality Disorders may require more extended treatment long-term treatment.

On average, the number of online therapy sessions may range between 6-12 sessions with a minimum gap of 7 days between sessions. The duration of therapy should be discussed with your therapist, who can provide an estimate based on your initial assessment and progress.

What Happens to My Mental Health After Termination of Online Therapy?

After completing your online therapy sessions, it's crucial to continue practising the coping mechanisms and strategies developed during sessions. Therapists often work with clients to create a relapse prevention plan to maintain mental wellness. This plan may include:

  1. Regular Self-Check-ins: you regularly monitor your symptoms and progress.
  2. Continued Practice: you practice regularly the techniques learned in therapy.
  3. Support Networks: you stay connected with your network of support or peers facing similar challenges

Under any scenario of relapse or the return of symptoms, you can always get in touch with your therapist for further evaluation.

Taking the First Step: 3 Tips for Starting Online Mental Health Therapy Sessions

The first step to starting online mental health therapy sessions begins with finding the right platform for your specific mental health needs and this involves researching and comparing different options based on your specific needs, preferences, and budget.

Various online therapy platforms cater to different mental health concerns with unique features. Researching these platforms ensures that you find a service that aligns with your specific mental health needs. When looking for online mental health therapy, keep these three key considerations in mind:

1.Credentials and Expertise

Ensure the platform is HIPAA compliant and complies with all the data protection laws as stated in the Personal Data Protection Bill, 2019. Ask questions as to what measures the platform takes to preserve your confidentiality and protect your data. Ask what happens to your data once your treatment is over.

It’s also important to ensure that the platform has licensed and qualified therapists who specialize in the areas relevant to your needs, such as anxiety, depression, or OCD. Go through the user testimonials and ratings and research about the platform.

2.Communication Methods: Look for a platform that offers communication methods that suit your preferences, whether it's video calls, phone calls, text messaging, or a combination of these. Research states that video-based therapies are more effective than chat-based, especially when looking at long-lasting outcomes.

3.Cost and Insurance: Check the pricing of the services and whether they accept your insurance or offer financial assistance. Ensure that the cost fits within your budget while providing the level of care you require.

Although online therapy presents numerous benefits, it also comes with unique challenges and considerations. Ensuring privacy and confidentiality in a digital context is crucial, demanding strong security protocols and strict adherence to ethical standards. Moreover, online therapy may not be applicable for severe mental health disorders and conditions that require rehabilitation or hospitalisation.

The Future of Online Mental Health Therapy

With ongoing technological advancements and evolving societal attitudes towards mental health, the future of online mental health therapy appears bright. Innovations such as virtual reality (VR) therapy, AI-powered chatbots, and mobile mental health applications, are transforming digital mental health care. 

Additionally, the COVID-19 pandemic has sped up the adoption of telehealth services, solidifying the importance of online mental health therapy in the future of mental health care delivery.

At Mave Health we think futuristic. We aim to address mental health issues through innovative, non-invasive brain stimulation technology and holistic care programs. Our flagship product, Arc, uses transcranial Direct Current Stimulation (tDCS) to treat depression without side effects. 

Mave Health's comprehensive 12-week program includes psychotherapy sessions, continuous chat support, psychiatry consultations, nutrition advice, fitness classes, and a dedicated personalized program coach. This approach aims to provide faster and long-lasting results, with a high success rate in improving mental health outcomes.

If you're seeking solutions, Mave Health backed by a team of specialized experts, has been enhancing lives for over the past few years. Utilizing evidence-based, holistic, personalised, gold-standard treatment methods, we help individuals manage psychiatric disorders effectively. Reach out to us today to book a consultancy Remember, technology is the next disruption in mental health care!

References:

Digital Intervention for Cognitive Deficits in Major Depression: A Randomized Controlled Trial to Assess Efficacy and Safety in Adults 

Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020

The Invention of Mobile Phones 

Online Therapy Services Industry Prospective:

Efficacy of Online Intervention for ADHD: A Meta-Analysis and Systematic Review 

Internet-delivered psychological treatments: from innovation to implementation 

Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study

Telemedicine: A Guide to Assessing Telecommunications in Health Care.

Mental health insurance scenario in India Where does India stand?

Author's Profile picture
Snigdha Samantray
Digital Mental Health Specialist | Clinical Psychologist
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