As a dietitian at Yale-New Haven Hospital, Elisa Nussbaum worked on the front lines of the pandemic in the spring of 2020. One of her responsibilities was to make sure patients on ventilators with COVID-19 were getting their nutritional needs met. I soon realized that she needed psychological support to help her get through this difficult time.
“I was paralyzed by a fear of things that should be relatively unintimidating, like walking by a banister at work overlooking a hallway,” she recalls. But all the local therapists I contacted were too busy to receive new clients.
One evening while browsing Facebook, Nussbaum saw an ad for a mental health app. It has been a speech therapy chatbot that helps users monitor their moods. “A little bot asked me questions and sent me articles and videos on how to deal with my feelings during the pandemic,” she says. “I found it very helpful, especially when I felt helpless and confused.”
Research shows that the app you’ve tried can actually be effective. When young adults between the ages of 18 and 28 used it daily for two weeks, they experienced a 20% reduction in depressive symptoms compared to a control group, according to a 2017 study in JMIR mental health.
As the COVID-19 pandemic continues, stories like that of Nussbaum are becoming more and more common. Study October 2021 in Lancet It found that nearly a third of adults in the United States had symptoms of depression in 2021, compared to 27.8% of adults in the early months of the pandemic in 2020 and 8.5% before the pandemic. As a result, online therapy platforms that connect users with mental health professionals at the click of a button are in high demand, as well as mental health apps.
Pros and Cons
With increasing anxiety and depression, and a shortage of personal therapists, there are many reasons why people find it attractive to express their problems to a therapist from the comfort of their couch.
“Online platforms provide easy entry, and are often more affordable than traditional therapy,” says Lynn Bufka, PhD, senior director of Practice Transformation and Quality at the American Psychological Association.
Research supports online therapy, too. A 2018 analysis of 20 studies compared the effectiveness of face-to-face online cognitive behavioral therapy. This type of therapy helps patients change their negative thoughts and feelings. The study concluded that online cognitive therapy was just as effective as the in-person version of anxiety and depression.
There may be more value in online therapy during the COVID-19 pandemic because you don’t have to take precautions like wearing a mask during sessions, says Judson Brewer, MD, PhD, director of research and innovation at the Mindfulness Center at Brown University School of Public Health. In Providence, RI.
“You can see face to face, which is really important for therapists because 70-80% of all communication happens nonverbally,” he says. “I can see the patient’s facial expressions, which helps me better gauge their feelings.”
Bufka says the biggest concern about online therapy is whether it can provide enough support for people with moderate to severe depression. “If someone is going through a mental health crisis, my concern is that an online therapist will not be able to step in and connect them to local resources that can provide emergency help,” she says.
Experts are more tepid about online text therapy, where you send a message to your therapist in a secure conversation window on your phone and they respond. “Emojis are a very poor substitute for body language and facial expressions,” says Brewer, who notes that there is very little research on this type of communication. This format might be fine for someone who is very mild depression, or has a temporary episode of stress or anxiety, to test the situation, says Ashley Zucker, MD, chief of psychiatry, Kaiser Permanente in San Bernardino County, Southern California.
Nussbaum feels the same way about the bot she used. While she feels that is enough now to get her out of the stress of the pandemic, she cautions that it’s not for everyone.
“I see … the app as a temporary solution for someone with depression and anxiety until they can go into therapy, or as an adjuvant for someone who is currently in treatment,” she says. “If you have something specific that bothers you, you ultimately want to talk to a person and not a bot.”
Find the right app for you
If you’re considering an online therapy or mental health app, says Bufka, ask the following questions:
Is the processor licensed in your state? “This does a few things: It shows that the provider has met the minimum level of training, is in a good position, and gives you protection to file a complaint if things don’t go well,” Bovka explains.
Is the platform HIPPA compliant? Bufka says that all licensed therapists need to adhere to patient confidentiality rules, whether treatment takes place in person or online. Their site must state, per their privacy notice, that they are using encrypted, web-based platforms that are HIA compliant, and Portability and Accountability Act. Some sites also have a “Shred” button next to each text message so you can delete your message history.
Is there research behind it? This is especially important for mental health apps, where “anyone can put one on the App Store,” Pryor says. Check the app’s website to see if it has any research published behind it or developed by someone at a top university.
Ultimately, online therapy and applications can be part of your overall self-care. “One of the best things about the app I’ve used is that it requires my full attention—I couldn’t look at it while I was eating dinner or while riding my gym bike,” says Nussbaum. “Just sitting down to focus on it helped my brain stop racing. It encouraged me to relax, take some deep breaths, and develop mental alertness – all of which are very important.”