Digital psychotherapy as an effective and timely treatment option for depression and anxiety disorders: Implications for rural and remote practice

Abstract

Patients in regional, rural and remote communities experience perennial difficulties accessing mental health treatments in a timely manner, which contributes to inequitable outcomes when compared with their metropolitan counterparts. This situation frequently stems from a shortage of specialised face-to-face psychotherapy services available in local areas. The recent development of digital psychotherapy as an alternative treatment delivery method provides an opportunity to address this healthcare gap and to avoid the challenges related to workforce maldistribution. This article provides a targeted narrative review of the relevant evidence base, and discusses the potential applications within the rural and remote context. Multiple randomised controlled trials and a large meta-analysis demonstrate that digital psychotherapy, particularly cognitive-behavioural therapy, is as effective as face-to-face psychotherapy. Its use has consequently been endorsed across international clinical practice guidelines as an efficacious and practical way to provide mental healthcare. Despite this, the adoption of digital psychotherapeutic options has been limited to date. Increased awareness of the available options may improve access to psychological treatments in rural and remote populations. Digital psychotherapy should be considered an option for patients with depressive or anxiety disorders of mild-to-moderate severity.

Tele–Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction

“…Clinicians are often reluctant to adopt tele–mental health because of concerns about the ability to establish a satisfying doctor–patient relationship and lack of knowledge of relevant privacy, transparency, and confidentiality issues [ 75 , 76 ]. A digital divide exists among patients, which excludes a large share of them from tele-mental health interventions [ 74 , 77 ].…”

Adherence With Online Therapy vs Face-to-Face Therapy and With Online Therapy vs Care as Usual: Secondary Analysis of Two Randomized Controlled Trials

“…Regarding satisfaction with the aftercare, the participants in the online aftercare groups indicated higher satisfaction values than the participants in the F2F group. This can be explained by the advantage of requiring less time for commuting to the therapist [ 8 ] and the absence of the fear of stigmatization in online therapies [ 15 ]. Further studies are required for a precise clarification.…”

“…This can overcome the problems with F2F therapies, which furthermore are often not readily available in all regions and where they are needed, resulting in patients promptly starting with their online intervention instead of waiting a long time (which is typical for F2F therapies due to limited availability of therapists [ 13 ]). Moreover, patients in psychotherapeutic interventions may miss their F2F sessions or drop out of therapy because they feel as if the location of the therapy is too far away [ 15 ]. Thus, online mental health interventions can bridge the gap between patients and therapists when the patient cannot travel to the intervention site (eg, [ 7 ]) or both are limited in their mobility.…”

Digital Mental Health Amid COVID-19

“…Challenges and limitations related to the adoption of the reported interventions were common (55%) and greater heterogeneity is required given 45% of interventions were specific to China. A narrative review of digital psychotherapy found evidence of effectiveness for depression and anxiety disorders, of mild-to-moderate severity, from multiple randomized controlled trials and a large meta-analysis [67]. An online survey of the use of digital information and communication technologies in psychological counseling before and during a COVID-19 lockdown found overall positivity in the use of technologies and web-based interventions, with most practitioners noting approximately the same client involvement/adherence rates [68].…”