Cognitive behavioural therapy (CBT) delivered remotely, with therapist guidance, appears to be as effective as in-person therapy for a range of mental health problems, according to new research published in CMAJ (Canadian Medical Association Journal).
“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,” notes Dr. Jason Busse, McMaster University, Hamilton, Ontario.
CBT is commonly used in psychotherapy to help modify unhelpful thoughts and behavioural patterns, and it is effective for a variety of mental health problems as well as chronic pain. 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.
There is evidence for the effectiveness of in-person CBT, but the effectiveness of remote therapist-guided CBT is uncertain.
In this systematic review and meta-analysis, researchers included 54 randomized controlled trials (RCTs) with 5463 patients that looked at CBT treatment of anxiety and related disorders, depression, insomnia, chronic pain, chronic fatigue syndrome, tinnitus, and alcohol use disorder. These RCTs compared in-person and remote CBT.
“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,” write the authors. “This finding was unaffected by type of clinical condition, length of follow-up, or whether CBT was provided individually or through group sessions.”
Affordability is a barrier to accessing mental health support. An August 2023 poll by Mental Health Research Canada found that the number of people who were unable to access mental health care because of cost increased from 18 per cent the previous year to 29 per cent.
These findings should interest policy-makers as they underscore the usefulness of remote delivery of CBT, which is also more convenient for many people. The authors urge the provinces and territories to consider funding online therapist-guided CBT to widen access to effective and much-needed mental health care.
“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 higher risk for chronic pain and mental health disorders,” write the authors.
“Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials” was published March 18, 2024.