Internet CBT for anxiety on par with in-person, study finds

The effects of internet cognitive behavioral therapy (CBT) are in line with face-to-face treatment, according to new research published in the journal JAMA Psychiatry.

Researchers at Karolinska Institutet in Sweden compared two ways of delivering CBT to treat people with health anxiety, a condition that may increase in the wake of the novel coronavirus (COVID-19). Out of about 200 study participants, half received CBT online and half were treated with conventional face-to-face CBT.

The results show that internet-delivered treatment had comparable effects and could serve as an alternative to physical meetings in helping people who are worried about their health.

Health anxiety, also referred to as hypochondriasis, is characterized by an excessive and persistent fear or worry about serious illness. It often leads to significant suffering and functional impairment. About 3.5 percent of the general population and up to 20 percent of patients in medical clinics are estimated to suffer from the condition.

In face-to-face CBT, which typically involves weekly sessions with a mental health clinician, about two thirds of patients respond to treatment. However, given the prevalence of health anxiety and scarcity of mental health professionals, the need for treatment far exceeds the availability of evidence-based face-to-face therapy. The researchers therefore wanted to examine the effect of an internet-based treatment where the patient has access to information online and communicates regularly with a therapist through an email-like system. The patient also engages in behavioral changes in their day-to-day life, just as in the case of face-to-face CBT.

In the study, 204 adults with health anxiety were randomized to receive either face-to-face or online CBT for a period of 12 weeks. The participants were asked to rate their level of health anxiety each week using a standardized questionnaire, the Health Anxiety Inventory.

According to the researchers, online CBT had effects largely on par with the face-to-face treatment. This was even though the average internet therapist spent only 10 minutes per patient per week compared with about 45 minutes in the other group.

Another positive aspect of online CBT is that patients who are reluctant to seek psychological treatment due to perceived stigma may be more inclined to seek help, according to Erland Axelsson, PhD, psychologist and researcher at the Department of Clinical Neuroscience, Karolinska Institutet.

“One significant advantage is that the therapist can help more patients in the same time, but also that the treatment can be delivered regardless of the patient's geographical location, including to people living in rural areas," said Axelsson in a statement. “The fact that you can access the content and communicate with your therapist at any time of the day also means that people who struggle to take time off from work can take part in treatment.”