Do Virtual Therapy Programs Work?

Chloe Hudson, Ph.D., contributed to this article. Dr. Hudson is a post-doctoral fellow at the McLean Hospital in the Behavioral Health Partial Hospital Program and Cognitive and Affect Research and Education (CARE) lab.

If you have received mental health treatment over the past two years, odds are that you accessed that treatment from the comfort of your own home. Since the beginning of the COVID-19 pandemic in March 2020, treatment for mental health difficulties has been predominately virtual (Sampaio et al., 2021; Saunders et al., 2021). People have attended monthly, weekly, and sometimes even daily therapy appointments without having to worry about catching the bus, fighting traffic, or packing a lunch.

Many experts believe that virtual therapy is here to stay (APA, 2021). However, before we make virtual treatment programs permanent, it’s crucial to know whether they are effectively treating mental health concerns, and what people attending the virtual programs like (or dislike) about them. This month, researchers at McLean Hospital examined the answers to these questions based on people’s experience in the virtual Behavioral Health Partial Hospital Program (BHP).

What is the BHP?

The BHP is a two-week, partial hospital treatment program (PHP) designed to help people transition out of acute inpatient care and back into the community, or as an alternative to inpatient hospitalization (Beard et al., 2016). BHP’s main treatment components include group and individual therapy, case management and aftercare planning, medication consultation and treatment, and vocational counseling consultations as needed.

In March 2020, the BHP transitioned to an entirely remote delivery (Hom et al., 2020). To investigate the treatment outcomes of this virtual treatment program, researchers at McLean Hospital surveyed nearly 300 people who attended the virtual BHP (Hudson et al., in press). Patients completed daily assessments of both anxiety and depression symptoms over the course of the program. Once they finished the program, patients were also asked to share feedback about what they liked and disliked about the virtual BHP. The results of this study highlighted both “pros” (advantages) and “cons” (disadvantages) of attending a virtual PHP.

Pros of Attending a Virtual Treatment Program

1. It works.
Researchers found that on average, people attending the virtual BHP experienced a significant reduction in anxiety and depression symptoms. In addition, most people attending the virtual BHP reported that they felt “much improved” after completing the program.

Researchers also assessed whether the virtual BHP was more or less effective at treating symptoms of anxiety and depression compared to the in-person version of this program that operated prior to the onset of the COVID-19 pandemic. The results suggested that there were no differences in the effectiveness of the two programs.

2. It’s convenient.

One of the most commonly mentioned advantages of virtual BHP was that it was convenient. For example, people reported that “No daily commute to and from the hospital meant less disruption from daily schedule” and “The commute to the hospital every day would have been a major stressor.”

Others reported that the convenience of being at home brought a sense of comfort. For example, one person explained that “it was nice to disconnect during breaks and really have a few minutes to myself.”

3. It reduces barriers to accessing care.

Related to the convenience of the program, accessing the program from home reduced typical barriers to treatment for nearly half of respondents (e.g., not being able to commute to the hospital, living too far away to commute daily, and/or significant mental health symptoms that made it difficult to leave home). For example, one person reported, “On bad days, it was much easier to get myself up and to my computer than it would be to get up and drive to the hospital.” Some people reported that they likely would not have received treatment if not for the virtual format. These results suggest that, in some cases, a virtual treatment program may be the only feasible treatment option.

Cons of Attending a Virtual Treatment Program

1. Unable to connect with other patients.

Although the BHP is a group-based program, patients have little opportunity to speak one-on-one with other members of the program on our virtual platform. This limits learning and bonding with others who are going through similar struggles.

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This was by far the most commonly cited drawback to the virtual program, with approximately a third of patients reporting that wished they had more connection with other group members. For example, one person reported that “There were many people that I wish I could have had a private conversation with regarding things we have in common or be able to let them know about resources that might useful for them.”

2. Therapy can be hard to do at home.

Therapy is often exhausting and emotionally draining. Some people reported that it can be challenging to do this intensive work in your own home because there is no separation between “therapy space” and “home space.”

For example, one person reported that “It’s hard to get into a new headspace when sitting at my workstation” while another person reported that “My home is now a clinical space and I can't turn it off.” Although this concern was cited by only 5 percent of participants, it is worth considering whether this separation is important for you before pursuing virtual care.

3. Technological issues.

Technology can be both a blessing and a curse. Although it allowed access to care from across the state, it can also present its own unique challenges.

For example, people who are less technology-literate had difficulties navigating the online platform. Other times, clinicians or patients had internet connection issues that caused disruptions to appointments. Although these technology glitches were few and far between, they could influence treatment, as illustrated by one person’s response: “Occasional blips in technology, like frozen video or a pause in audio (not enough to make the technology ineffective for use) could be distracting”

Main Takeaways

Virtual treatment may be just as effective as in-person treatment, while being more convenient and comfortable for patients. For a group-based treatment program, the main drawback to virtual care was the lack of connection with other patients. This appears to be the prominent advantage of in-person partial hospital treatment, as it is full of natural opportunities for social connections (e.g., eating lunch together, chatting in the lobby in between group therapy sessions).