Is Online (Group) Therapy the solution for you?

An article by Valentina Bianchini

Here’s what you should consider before deciding.

It’s no secret that the world is facing deep changes due to digitalization — a trend that has been extremely accelerated by the recent pandemic. Among all the services that have been affected, mental health is no exception.

Within the expanding branch of internet-based mental-health solutions that have been recently implemented, a brand new idea has been adopted by very few tech pioneers so far — I’m talking about online group therapy. Among those pioneers is the Lisbon-based, social impact startup, Hug-a-Group.

However, before you directly jump into boosting your mental wellbeing from the comfort of your living room, there are some factors you might want to consider. First of all: “Are these new internet-based mental-health solutions effective at all, or is it just the next trend, born in the tech-hipster-startup world?” — fair-enough question asked by my colleagues at university , who like to keep a quite sceptical mindset about technology.

Thankfully, research has a lot to say on the topic. What exactly? Spoiler alert: studies assessed the efficacy of online individual and online group therapy and clearly identified great opportunities in terms of positive social impact, accessibility to psychological support and normalisation of mental issues.

If you are hungry for more details, keep on reading.

Is online therapy effective at all?

The term ”online therapy” encompasses a bunch of different interventions implemented via email, chat boxes, videoconference, non-guided web courses and more. Online group therapy is also included in this drawer. Internet-based solutions can address and alleviate various mental health issues, such as anxiety, depression, addictions, body image , chronic pain, dementia, work-related stress — just to mention some of them — and target heterogeneous groups, from children to teenagers living in the city, or elderly people and their caregivers living in rural areas .

Navigating all the different types of interventions and target groups, researchers have tried to assess the overall efficacy of online therapy.

A meta-analysis (a statistical analysis combining results from different scientific studies) including 92 studies (Barak and colleagues, 2008) confirmed the efficacy of online therapy across various mental issues (e.g. PTSD, anxiety, depression) and intervention methodologies (e.g. CBT, behavioural therapy). Interestingly, among those 92 studies, 14 compared online psychotherapy with traditional face-to-face therapy, where participants were randomly assigned either to the online or in-presence intervention. Results showed that online therapy was as effective as in-presence!

Note that in all 14 studies participants had been randomly assigned either to the online or the face-to-face therapy, so the results are not likely to be explained by personal preference, individual disposition of patients or by other external factors (participants randomization is a key feature in experimental designs because it allows researchers to balance the effect of human individual characteristics and of environmental confounding variables).

A second meta-analysis (Spijkerman and colleagues, 2016) supported these previous results by analyzing 15 scientific studies and concluding that online mindfulness-based interventions were effective in addressing anxiety, depression, well-being, stress and mindfulness.

Overall, research shows that online therapy is effective across different therapeutic approaches, target groups and psychological problems.

So how about the newest trend in the tech-mental-health field — online group therapy? Is it also effective? What are its pros and cons?

Online group therapy shows promising results

To answer these questions, researchers reviewed the results of all scientific literature published in the last 20 years related to the topic.

The most up-to-date review (Gentry and colleagues, 2019) includes 40 studies implementing online group therapy to address depression, anxiety, mood disorders and PTSD — among other issues. The results show that participants improved after the treatment and were generally happy and satisfied with the online group interventions.

Among these 40 studies, 11 assessed the efficacy of online group therapy against face-to-face group therapy, with results showing no difference in patients’ positive changes between the two intervention modalities. In other words, online group therapy was as effective as face-to-face group interventions.

Similar results were found by Banbury and colleagues (2018). Interestingly, the studies included in the review also consistently showed a decrease in patients’ feelings of anxiety, loneliness, isolation, and an increase in social and emotional support. These findings have also been independently confirmed by Naslund and colleagues (2016).

So, recent research stands for the efficacy of online group therapy across a wide range of mental issues and target groups.

Efficacy is not everything

Apart from the efficacy of the therapeutic intervention itself, online group therapy brings a lot of advantages along with it. For example, it can be a very convenient solution if you are living in a rural area, if you have difficulties moving around, if your working hours don’t allow you to attend face-to-face therapy, or if you are afraid of new social situations. Moreover, since the costs can be divided between the group members, online group therapy is very accessible for every pocket.

Besides the logistical advantages, patients strongly benefit from the indirect consequences embedded in online group therapy: feelings of bonding, group belonging, social and emotional support increase, while feelings of loneliness, isolation, anxiety, depression are normally mitigated.

Online group therapy also improves people’s lives by providing a safe space for participants to share their personal stories with peers experiencing similar situations, to exchange coping strategies for their daily life and to normalize the stigma around mental illness.

Last but not least, it seems that interacting with peers helps people gain more information about mental health, which helps them make better decisions regarding their well-being (Naslund & colleagues, 2016; Breuer and Barker, 2015; Banbury and colleagues, 2018).

On the other hand, online group therapy also comes with some difficulties: tech issues to be solved, people getting distracted doing other things, participation and commitment being lower compared to face-to-face group interventions.

Additionally , people attending the online group sometimes do not feel safe enough to share their most private feelings and beliefs, out of fear of being judged, misunderstood, or of negatively affecting the rest of the group. However, this issue can be overcome by an experienced psychologist who is able to successfully facilitate the sessions.

Another important aspect to consider is how fake information might spread among patients and how to create a safe environment by managing unhealthy interactions happening either in videoconference or within the online community.

Interpreting results carefully

Recent scientific evidence strongly supports the efficacy of online group therapy not only due to the effect of the mere therapeutic intervention, but also because of factors mostly connected to its accessibility and to the group setting.

Nevertheless, we need to contextualize these findings, as further research is needed to overcome some limitations of the current studies. For example, most of the studies done until now are pilots and do not have an experimental design: they lack a control group, participants are not always randomly assigned to the therapy conditions, and samples tend to be very small. These design limitations might not allow us to identify some confounding factors affecting the results.

Just to give you an example, if a study does not include a control group (a group of people who do not receive any therapy), we cannot be sure that the patients’ improvements after the therapy are specifically due to the intervention because we don’t have a point of comparison. It could be, indeed, that some of them started practising sports, eating healthier or dancing the tango, and that’s why they showed improvements.

However, these methodological limitations are mostly due to the very recent growth of online group therapy. To summarise, the results of scientific studies done until now are indeed very promising.

So, what now?

As the world is switching to online — and our post-pandemic society, in particular — online therapy is being established alongside traditional approaches. In this context, online group therapy is emerging as a brand new solution, showing very promising results in terms of efficacy across various therapeutic approaches, target groups and psychological issues. Last but not least, online group therapy seems to be particularly accessible for people who, due to logistic, economical and personal reasons, would otherwise not benefit from psychological support.

So, if you feel you might need help dealing with any mental health issues and you are struggling to cover the costs, or can’t find an available therapist in your area, or maybe are having difficulties finding time to attend the sessions, online group therapy might be an interesting solution to consider (you might want to check out Hug-a-Group). You also might want to share this article and its resources if you know a person that is in need of psychological help.

If you are facing a situation of psychological emergency or if you know somebody who is facing it, online group therapy might not be the right solution. In that case, reach out to the emergency number in your country.

References:

• Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services, 26(2–4), 109–160.
• Banbury, A., Nancarrow, S., Dart, J., Gray, L., & Parkinson, L. (2018). Telehealth interventions delivering home-based support group videoconferencing: systematic review. Journal of medical Internet research, 20(2), e25.
• Breuer, L., & Barker, C. (2015). Online support groups for depression: benefits and barriers. Sage Open, 5(2), 2158244015574936.
• Gentry, M. T., Lapid, M. I., Clark, M. M., & Rummans, T. A. (2019). Evidence for telehealth group-based treatment: A systematic review. Journal of telemedicine and telecare, 25(6), 327–342.
• Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences, 25(2), 113–122.
• Spijkerman, M. P. J., Pots, W. T. M., & 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.