Online Therapy Types

Type 1: Teletherapy

Teletherapy is a term that encompasses a large category of online mental health care modalities that include traditional psychotherapy, cognitive behavioral therapy (CBT), mindfulness-based therapy, and psychodynamic therapy. These therapies take place through technology instead of at an in-person meeting. Counseling services (e.g., psychotherapy) can be administered through various websites or video conferencing platforms such as Skype, FaceTime, and Zoom.² Teletherapy can occur on its own or in conjunction with traditional face-to-face talk therapy. This option has been available for more than 3 decades, and indicators of its validity and reliability have grown each year.³

Teletherapy is suited to address a range of mental health issues including anxiety and related disorders, depression, eating disorders, addiction, sleep issues, trauma, and more.^2,3,4,5 Like in-person traditional talk therapy, teletherapy sessions generally occur weekly and last for approximately 1 hour. Health insurance usually covers teletherapy sessions, but coverage may vary depending on your provider.

Pros

• Teletherapy allows you to receive treatment from the safety and comfort of your own home.
• Some teletherapy programs match you with a therapist.
• In teletherapy, your information is kept confidential; your therapist must use specialized software, approved by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), that offers security and privacy.^6,7,8
• Teletherapy can be used to reach difficult-to-access populations and may be a good option for remote areas.
• Teletherapy is often cheaper than face-to-face therapy.

Cons

• Teletherapy may be less intimate than in-person therapy.
• Technological issues may occur because WiFi signals, computers, and phones can be unreliable.
• Nonverbal communication within teletherapy is minimal or even eliminated.
• Finding a private location for sessions may be difficult.

Type 2: Therapy Session Smartphone Applications

Another form of online mental health care, similar to teletherapy, is the use of smartphone applications to provide therapy. These apps require little effort, and you can easily incorporate them into everyday habits.⁵ People can enter information about themselves into this type of app, and the app will then match them with well-suited therapists. Individual therapy sessions through apps are usually held weekly, but a professional is often available at any time, day or night, if needed. Communication may occur through instant messaging, emailing, and/or video chatting.⁹

Some of these applications include Talkspace, BetterHelp, ReGain, and LARKR. The fees to participate in this type of app-based therapy may vary; some companies have a subscription model where you pay monthly or per session. Some insurance providers cover fees for these services, but some do not; contact your provider for more information.

Pros

• Applications may allow users to provide frequent feedback to the company and the therapists on their services.
• Applications are easily navigable.
• Applications often offer a variety of payment plans.
• Most applications rely on multiple modes of communication (e.g., text messaging, FaceTime, Skype, and email).
• Some platforms focus solely on specific issues or demographics that may be relevant for users (e.g., relationship counseling, LGBTQIA+, teen counseling, or trauma).
• Applications often enable users to remain anonymous if they wish.

 Cons

• Time zone differences between users and therapists may be an issue for some people.
• Users may be required to sign up for monthly services even if they want day-to-day plans or weekly options.
• Typing speed differences may limit how much users and therapists can express to each another.
• The risk of miscommunication may increase if users and therapists communicate only through modalities (e.g., texting) they are unaccustomed to using for self-expression.
• Nonverbal communication within applications is minimal or even eliminated.

Type 3: Online Support Groups

Online support groups operate differently from teletherapy and smartphone applications. Support groups create spaces for people who wish to build a community or support system with other people who have similar backgrounds (e.g., sexuality, gender identity, race, or mental health struggles). Some groups may be more structured than others, and professional counselors may or may not participate. In general, they are places where people can share their experiences—unique and similar—with others.^10,11 Individuals within online support groups or communities are usually available for messaging at any time of the day or night.¹²

Pros

• An online community may offer strong emotional support, especially for people who lack such support in person.¹²
• Online support groups offer 24/7 support.
• Online support groups are usually free.¹²
• Online support groups can help as an adjunct to other forms of therapy or support by providing an additional avenue to express yourself.¹³

Cons

• The structure of each support group may vary significantly.^11,14
• Miscommunication can occur because conveying tone and meaning accurately in online forums may be challenging for some people.¹¹
• Cyberbullying is a large problem within online platforms because chat rooms and message boards are so easy to access.¹⁵
• Membership opportunities in online support groups are often continuous and rolling, so individuals may enter a community at different stages of development or therapy. This may make it difficult for some members to obtain maximum benefit from the support group.
• Several organizations and licensing boards are still debating whether online support groups should be considered a form of digital mental health service because of their associated ethical and legal concerns.^8,14

Type 4: Mental Health Self-Help Smartphone Applications

Examples of smartphone applications designed to support individual mental health have increased in recent decades. Electronic mental health aids have become easily accessible and cost-effective as applications such as Calm, Headspace, notOK, Happify, Worry Watch, Recovery Record, and AnxietyCoach have entered the market. These applications use various strategies to offer mental self-help resources; some teach CBT techniques to manage negative thoughts and behaviors, and others track anxiety symptoms or provide relaxation exercises. Some applications help users master their fears or worries by using lists. Countless other applications allow users to increase their positive emotions, learn how to meditate to reduce anxiety and stress, and improve their attention and awareness.

If you choose not to participate in traditional therapy, mental health self-help applications may be useful alternatives that allow you to learn what strategies work best for you and to implement various techniques.¹³ These resources may be integrated easily into your daily routine alongside other activities that support mental health, such as journaling or meditation. In addition, they offer helpful methods for overcoming stress, burnout, depression, and anxiety and for improving diet, exercise, and sleep.¹⁶

 Pros

• Mental health applications have high rates of user engagement.
• Mental health applications are cost-effective and very accessible.
• Mental health applications provide an excellent introduction to mental health care because you can start to learn how to take care of your mental well-being.
• You can remain anonymous.

Cons

• Currently, few rigorous scientific studies of the efficacy of mental health applications have been conducted, so little is known about how and to what extent such applications help people.
• People who use mental health applications have an increased risk for incorrect or misinformed self-diagnoses compared to other forms of mental health care.
• Unlike traditional therapy and teletherapy, some mental health applications focus on only one condition and therefore may be a less holistic, comprehensive, and inclusive form of treatment.
• There is little federal, technological, and disciplinary regulation.

Future Directions

As technology and mental health research expand rapidly, new technology-enabled, evidence-based modalities may become available. Technological developers, medical practitioners, and scientific researchers are increasingly focusing on solidifying the effectiveness of these therapies, and many articles in peer-reviewed journals already report their great promise.^2,3,5,10