Is ‘online therapy’ making patients worse?

Scientists in Sweden are studying whether web-based cognitive behavioural therapy (CBT) is ineffective in some people, potentially making patients worse.

The psychologist behind the research say that while many people who suffer from depression and anxiety are helped by seeing a therapist, psychological treatment can have negative side effects, like any intervention.

“We know now that therapy is an effective treatment for different forms of mental illness,” says Dr Alexander Rozental, a licensed psychologist with a PhD in psychology. “What we don’t know so much about is whether certain patients can actually get worse or have other types of side effects from their treatment.”

He has been looking at the effectiveness of online CBT which he describes as being akin to following a self-help book with the support of a psychologist through email. The method is recommended by the Swedish National Board of Health and Welfare guidelines which Sweden’s local governments rely upon heavily.

Rozental is the first to examine the side effects of internet-based therapy in detail. “That’s why this research is so important. If we’re going to use this method widely, we have to be aware of the risks,” he says.

The research found that internet-based therapy showed that around 6% of the 3,000 patients studied got worse during treatment. In a separate study, people who had received psychotherapy in an outpatient psychiatric setting, in the past few years were asked if they had experienced other types of negative effects.

“We saw that a third of people had a difficult memory resurface, had more anxiety, or felt stressed,” says Rozental. “It was also not uncommon to have a poor relationship with the therapist or low-quality treatment.”

It’s not so surprising that people can feel worse when dealing with unpleasant experiences in therapy. It’s also true that a treatment than can have a positive effect on some people can affect others negatively, just like medicine. What is needed is a better understanding of side effects, both for catching patients who become worse earlier and protecting patients from rogue therapists.

‘I hope that psychologists and psychotherapists become more aware that there can actually be side effects and that they need to ask patients whether they are experiencing any. I also think that society should regulate who is allowed to provide treatment. There are currently no laws preventing an unlicensed person from working in mental health,’ he says.