Feeling Anxious or Sad? Why E-Therapy Might Help

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Most of us could probably benefit from some psychological counseling every now and then, but we’ve got a list of well-worn excuses for why not to commit. It’s time-intensive, it’s expensive, it’s embarrassing. But new e-therapy models are attempting to make mental health services more affordable and accessible than ever. And we’re not just talking about Skyping with your trusted psychologist, either.

One Silicon Valley company now lets you get psychoanalyzed via text message. For $35 a week, Betterhelp.com matches you with a licensed therapist who will respond to an unlimited number of your texts — within several hours to a day. “There are no set rules,” explains chief executive officer and founder Alon Matas. “Maybe during the weeks you’re in crisis you would use it a lot. The concept is to have someone to talk to whenever you need it.” That means you could use the subscription service for everything from firing off a morning update on your mood to punching out a detailed description of the fight you’re having with your boyfriend — and asking for advice on how to respond to his texts.

If you can’t imagine tapping out your innermost feelings via iMessage, other companies, such as Breakthrough or LivePerson, offer live chats, instant messaging or webinars that cost much less than your typical face-to-face session with a real therapist or psychiatrist. (Your insurance might cover it — just check with your provider to find out.)

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Why E-Therapy Isn’t as Weird as You Think

Preliminary research shows these e-therapy models might even be as effective as conventional office visits. In one study of 62 patients suffering from moderate depression, researchers at the University of Zurich assigned one group to eight sessions of traditional in-person cognitive behavioral therapy (CBT) and another group to online treatment for the same duration.

“Business models are popping up right and left, but they’re not all sound clinical interventions.”

At the end of the treatment, about half of patients in both groups reported a full recovery. Even more encouraging for e-therapy advocates was the finding that the online group’s improvements seemed to be longer-lasting. Three months later, 57 percent of online patients said they did not experience any more symptoms of depression, compared to 42 percent of those who were treated the traditional way.

These models definitely fill a need in the marketplace, considering that only 17 percent of U.S. adults are in a state of good mental health, according to the U.S. Department of Health and Human Services. Another survey by the Substance Abuse and Mental Health Services Administration found that of the 20 percent of American adults who are estimated to live with a mental illness, only about 40 percent receive mental health services. The biggest barrier was cost.

The Risks of Baring Your Soul Digitally

Despite the perks of convenience and cheaper prices, critics say some of the new models might not adhere to the same rigorous standards that govern traditional therapy, and these lapses could hurt patients.

“Business models are popping up right and left, but they’re not all sound clinical interventions. Some aren’t ethical or even legal and engage clinicians across state lines,” explains Marlene Maheu, PhD, executive director of the Telemental Health Institute, a training center for counselors who are interested in using technology in their practices. “How could I explain informed consent to you via text? I have to understand that you understand what’s involved and what can go wrong.”

For example, she says clients need to know that she has a professional obligation to report confessions of child abuse or intentions to kill oneself or others. “If you make any threat that I consider a reasonable threat, I have to contact the intended victim and police. Consumers have a right to know about that ahead of time.”

Then there are the challenges of getting the technology right. Maheu says the practice of offering counseling via satellite or Internet has been used successfully for decades to reach patients in remote areas, such as jails, ships or rural nursing homes. But the connections must be secure to protect a patient’s privacy. “You have to have a designated site. You have to have approved clinicians. You have to use proper equipment and protocol,” says Maheu. “It’s not just a matter of jumping on the Internet and talking to someone through Skype.” 

Digital Therapy: The Best Fit For a Texting Generation?

“People who suffer from anxiety are great candidates for self-guided learning.”

Matas says his goal in creating texting-based BetterHelp.com wasn’t just to make conventional therapy more readily available. “The only advantage to that is convenience,” he says. Rather, he wanted to rethink the entire concept of therapy to connect with a texting generation. 

“As a society we’ve gotten used to communicating this way. People text each other more than call,” says Matas, adding that many clients don’t want the stigma of being officially diagnosed with a mental health condition and prefer faceless interactions.

Since launching the service last fall, BetterHelp has amassed 3,000 patients and a network of 300 counselors. While most come for help with depression, stress and anxiety, he’s also been able to find help for clients with specific needs, such as eating disorders or transgender issues. 

Manhattan-based psychologist Chloe Carmichael, PhD, who developed a webinar that specializes in anxiety-reduction techniques, says the precise appeal of the digital format is that it’s not intimidating. “People who suffer from anxiety are great candidates for self-guided learning. They can do their homework on their own time in a comfortable environment and call for phone support when they need it,” she says.

The ability to go through the material at his own speed was what prompted Val, 41, to plunk down $49 for the webinar. After moving from Europe to New York with his wife four years ago, Val struggled with crippling anxiety during the two years it took him to find a new job.

“It wasn’t a fun time,” he says. “I liked that the tools were interactive so I could focus on my situation.” For example, he credits one “thought-mapping” exercise with helping him see the upsides of stressful job-hunting, such as the excitement of starting something new and making work friends. “I liked being able to go back to something I missed and see it at a different angle.”

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