By Eftyhia Helis and Barbara Greenwood Dufour
Recent reports suggest that, in Canada, a long-term and systematic approach over the past few years to increase mental health awareness has led to a reduction of mental health stigma, with more and more people being comfortable discussing mental health. However, although mental health is now recognized and discussed more broadly, access to mental health services remains a challenge for many. In an era where technology has become an integral part of our daily lives, e-therapy options could play an important role in creating additional access points for mental health care, thus reducing wait times and facilitating timely access to effective treatment. These options may be also preferred by some patients over face-to-face treatments due to a variety of reasons including, for those living in rural or remote areas, limited access to treatment centres close to home.
What is considered an e-therapy?
e-therapy is when mental health treatments are offered remotely via information technology platforms such as the internet or mobile phones (e.g., using apps or via SMS). While some of these treatment options are already available in Canada, health care decision-makers, including patients, want to make sure that they are effective before adopting and implementing them. CADTH — an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures — has completed a number of evidence reviews to assess the clinical effectiveness of e-therapy for a range of mental health conditions including depression, anxiety, post-traumatic stress disorder (PTSD), and substance use and addictions. Below is a summary of relevant findings.
e-Therapy interventions for the treatment of patients with depression
Cognitive behavioural therapy (CBT) is the most evidence-based psychotherapy used to treat depression. In traditional CBT, the patient works face-to-face with a therapist to identify, challenge, and evaluate the thoughts that maintain the depressive mood. With e-therapy, this treatment is delivered using online written materials or audio/video files or a combination of the two, and can be provided either without assistance (self-help) or with the assistance of therapists by phone, video, or email.
According to a CADTH review, evidence from a small number of studies show that e-therapy with therapist support may lead to a larger reduction of depressive symptoms in adults with depression and major depressive disorder compared with no treatment, wait list, or treatment with antidepressant medications. Therapist-guided e-therapy was also found to be equivalent to standard face-to-face CBT for adults with major depressive disorder.
e-Therapy interventions for the treatment of PTSD
Psychotherapy is frequently used to treat PTSD, a debilitating condition that generally results from exposure to one or a series of traumatic events.
CADTH assessed the effectiveness of therapist-guided e-therapies for PTSD from evidence identified in eight studies, which suggest that e-therapy with therapist support may be a promising option for managing PTSD symptoms when compared with waitlist, treatment as usual, or other active treatment. However, the studies typically had a low number of participants and were of variable quality. And it’s unknown whether patient characteristics such as age, type of trauma experienced, level of computer literacy, and educational level impact the effectiveness of the treatment. We need better quality evidence to confirm if e-therapy is effective for PTSD and for which patients.
e-Therapy interventions for the treatment of anxiety
Generalized anxiety disorder — the most common mental disorder seen in primary care — is characterized by constant and excessive worry and anxiety that causes significant distress and impairment. Panic disorder and social anxiety disorder are other common anxieties that can cause significant impairment and impact quality of life.
Alternative treatments for depression: Time-tested or too soon to know?
CADTH evaluated the evidence from 10 studies on the effectiveness of therapist-guided e-therapy interventions for generalized anxiety disorder, panic disorder, or social anxiety disorder. Overall, these interventions were found to be more clinically effective compared with waitlist, care as usual, the provision of information, or psychological placebo for all three disorders; and it appears that these interventions may have similar effects to face-to-face CBT.
e-Therapy interventions for the treatment of substance use disorders and other addictions
e-therapy interventions are also used to treat substance use disorders and other addictions. A CADTH review of the evidence found that therapist-guided e-therapy might reduce problematic alcohol consumption or cannabis use compared with no treatment and wait list, but it seems to have only a small effect.
Current evidence indicates that therapist-guided e-therapy for several mental health conditions may provide effective alternatives to conventional treatment modalities while improving access to care. However, awareness and implementation of e-therapies is still limited in Canada. While e-therapy technologies are changing at a fast pace, in time, more evidence including evaluation of these programs will become available, which may lead to the increased availability of such treatments in the future.
The CADTH evidence reviews mentioned in this article are just a few of several that CADTH has undertaken on the topic of mental health. You can find all of our related evidence at cadth.ca/mentalhealth. You can also follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Officer in your region: cadth.ca/contact-us/liaison-officers.
Eftyhia Helis and Barbara Greenwood Dufour are knowledge mobilization officers at CADTH.