Online Mental Health Services: Overview and Effectiveness

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Online Mental Health Services: Overview and Effectiveness

THC Editorial Team January 13, 2021
Image of woman using smartphone
Photo by Bruno Emmanuelle on Unsplash


What Are Online Mental Health Services (Digital Mental Health Services)?

Digital mental health services include any form of therapy that occurs online, via the internet, or through a technology-based medium. They represent a new direction in therapy that has the potential to increase the accessibility of evidence-based mental health treatments and the quality of care while providing cost-effective services. Although researchers have demonstrated the effectiveness of many face-to-face, evidence-based cognitive and behavioral treatments, many barriers (e.g., structural, social, financial) exist to access such services.1 Technology has the potential to revolutionize the mental health care system and to eliminate barriers to access by expanding availability to populations that have traditionally been difficult to reach, such as underserved minorities, rural residents, and people who have disabilities. As a result, a growing number of people globally have expressed interest in therapy that occurs remotely. This new trend toward internet-delivered interventions is bolstered by the accessibility of technology, the pervasiveness of the COVID-19 pandemic,1 and the availability of online mental health services at lower costs. Given that one out of every four individuals suffers from a mental health disorder,1 online therapy or teletherapy may offer a cheaper, more convenient, more consistent, and more private service option.

How Does Online Mental Health Therapy Work?

Online mental health therapy relies on methods similar to those used in face-to-face talk therapy. The major difference is the medium through which sessions occur. Online mental health services include a wide array of digital communication options such as teletherapy, smartphone applications, text messages, online workshops, social media engagement, virtual reality simulations, online mindfulness interventions,2 and wearable technology. In teletherapy, for instance, people may conduct sessions through email, text messages, video calls, and online messaging services.

Regardless of the form of the online mental health service, clients are able to access licensed therapists, psychiatrists, clinical psychologists, and social workers from the comfort of their own homes. Additionally, some services allow clients to sign up for treatment under a pseudonym, which allows clients to protect their privacy by keeping their identities hidden.

The cost of online therapy varies and will depend heavily on the company’s policies or the therapist offering the services and on your insurance status or type. Some options require monthly or yearly subscription plans, some may offer a sliding payment scale, and others use the same payment methods as traditional psychotherapy.

Some online psychotherapy websites are TalkSpace, BetterHelp, Amwell, and ReGain. Examples of smartphone applications include MoodTools, SuperBetter, Mindstrong Health, and PTSD Coach. Google’s search engine can locate these online services for you by typing “online therapy” in the search bar. Additionally, you can ask your primary care provider if they know of any online resources. If you want to locate therapy or mental health apps, you can search through application stores on smartphone devices. It’s important to check reviews and meet with various therapists until you have found the most appropriate fit for your needs.

Online mental health can be used to treat the following conditions:3,4,5,6,7,8

How Effective Is Online Mental Health Therapy?

The efficacy of online therapy has been heavily debated in recent years,9 but many scientific journals and mental health professionals have published articles on or have offered evidence of its effectiveness.10

Research has demonstrated that teletherapy, combined with face-to-face clinical care, is very effect at treating depression, anxiety, and emotional distress related to mental illness.11 In a study conducted in 2019, researchers at the Beth Israel Deaconess Medical Center demonstrated that mental health smartphone applications are most effective when they are customizable and address each patient’s personal goals.3

Researchers, building on a framework developed by The American Psychiatric Association, created a recommendation list for smartphone applications by evaluating each against specific criteria.12 The application evaluation framework first assesses the applications background information, including its credibility, medical claims and business model, then their privacy and security, following the evidence established, then the ease of use and finally the data integration.12 Digital mental health services are more accessible and scalable than traditional face-to-face therapy, and they display promising evidence for behavioral change.3

Research findings demonstrating the effectiveness of online mental health include the following:

  • Brief smartphone-based mindfulness training was found to impact biological stress factors. Compared to the control group, the experimental group experienced a reduction in their cortisol levels—a stress hormone—and their systolic blood pressure.2
  • Smartphone-based therapies have been shown to most benefit individuals who experience mild to moderate depression.13
  • A meta-analysis revealed that smartphone-delivered interventions, when paired with face-to-face therapy or internet-delivered therapy, reduced total anxiety for individuals with anxiety disorders.8
  • A review of studies on the use of smartphone apps for treating symptoms of schizophrenia found high adherence, positive user experience, and increased physical activity.14
  • Internet-based cognitive behavioral therapy was found to be just as effective as face-to-face cognitive therapy for anxiety and depression.15

Overall, according to a number of randomized control trials and meta-analyses, online therapy is as effective as traditional in-person talk therapy.15 In the future, technology-enabled therapy may become the norm rather than the exception.


  1. Torous, J., Andersson, G., Bertagnoli, A., Christensen, H., Cuijpers, P., Firth, J., Haim, A., Hsin, H., Hollis, C., Lewis, S., Mohr, D. C., Pratap, A., Roux, S., Sherrill, J., & Arean, P. A. (2019). Towards a consensus around standards for smartphone apps and digital mental health. World Psychiatry,18(1), 97–98.
  2. Lindsay, E. K., Young, S., Brown, K. W., & Creswell, J. D. (2018). Acceptance lowers stress reactivity: Dismantling mindfulness training in a randomized controlled trial. Psychoneuroendocrinology.
  3. Tutty, S., Spangler, D. L., Poppleton, L. E., Ludman, E. J., & Simon, G. E. (2010). Evaluating the effectiveness of cognitive-behavioral teletherapy in depressed adults. Behavior Therapy, 41(2), 229–236.
  4. Deady, M., Mills, K. L., Teesson, M., & Kay-Lambkin, F. (2016). An online intervention for co-occurring depression and problematic alcohol use in young people: Primary outcomes from a randomized controlled trial. Journal of Medical Internet Research, 18(3), e71.
  5. Kladnitski, N., Smith, J., Allen, A., Andrews, G., & Newby, J. M. (2018). Online mindfulness-enhanced cognitive behavioural therapy for anxiety and depression: Outcomes of a pilot trial. Internet Interventions, 13, 41–50.
  6. Spijkerman, M. P., Pots, W. T., & Bohlmeijer, E. T. (2016). Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review, 45, 102–114.
  7. Serdar, K., Kelly, N. R., Palmberg, A. A., Lydecker, J. A., Thornton, L., Tully, C. E., & Mazzeo, S. E. (2014). Comparing online and face-to-face dissonance-based eating disorder prevention. Eating Disorders, 22(3), 244–260.
  8. Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2015, March). Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews.
  9. Rochlen, A.B., Zack, J.S.,&Speyer, C. (2004). Online therapy: Review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60, 269–283.
  10. Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2018). A randomized controlled trial of three smartphone apps for enhancing public mental health. Behaviour Research and Therapy.
  11. Wentzel, J., van der Vaart, R., Bohlmeijer, E. T., & van Gemert-Pijnen, J. E. (2016). Mixing online and face-to-face therapy: How to benefit from blended care in mental health care. JMIR Mental Health, 3(1), e9.
  12. Henson, P., David, G., Albright, K., & Torous, J. (2019, June). Deriving a practical framework for the evaluation of health apps. Lancet, 1(2).
  13. Firth, J., Torous, J., Nicholas, J., Carney, R., Pratap, A., Rosenbaum, S., & Sarris, J. (2017). The efficacy of smartphone-based mental health interventions for depressive symptoms: A meta-analysis of randomized controlled trials. World Psychiatry, 16(3), 287–298.
  14. Firth, J., & Torous, J. (2015). Smartphone apps for schizophrenia: A systematic review. JMIR mHealth and uHealth, 3(4), e102.
  15. Wagner, B., Horn, A. B., &Maercker, A. (2014, January). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders, 152–154, 113–121.

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