Does Online CBT Work?
Let’s start off with the basics… what is CBT?
Cognitive Behavioural Therapy (CBT) is what is known as a talking therapy. It is a treatment in which you talk with a trained professional about your thoughts, feelings, and experiences to help improve your mental health and wellbeing. CBT is also an evidence-based therapy, meaning that clinical trials have shown it to be effective in treating a wide range of mental health problems. These include anxiety disorders, depression, chronic pain, addiction, and many more.
Talking therapies such as CBT have traditionally taken place face-to-face, in a therapy room with both therapist and client present. However, in more recent times (particularly since the COVID-19 pandemic), many psychology services now offer CBT online.
Why am I talking about this?
I trained as a CBT therapist during the pandemic, so all of my teaching and client work was delivered online. Even once the pandemic ended, online sessions continued (and for good reason, which I’ll come on to later). I did not see a client for face-to-face CBT until two years after I qualified. Even now, I continue to see a mix of both online and face-to-face clients.
I have seen excellent outcomes with my online clients. However, on several occasions I have noticed a raised eyebrow or a look of disapproval from therapists who have been in the field for a long time and are very accustomed to face-to-face work. There can be an unspoken question of how CBT can truly be effective if it is delivered online.
I find this surprising, given how much of our everyday communication now takes place online. We regularly connect, work, and build relationships through screens — so why should we not extend the benefits of technology into the world of therapy?
So, does online actually CBT work?
As mentioned above, CBT is an evidence-based therapy, so we cannot rely solely on anecdotal experience from my own clinical work. Fortunately, there is a substantial body of research showing that online CBT can be just as effective as face-to-face treatment for a wide range of mental health difficulties (Axelsson et al, 2020; Lundström et al, 2022; Pontén et al, 2024).
That said, as with any form of treatment, online CBT has both advantages and limitations. The purpose of this article is to explore some of these pros and cons, with the aim of helping anyone who may feel sceptical or unsure about online CBT to make an informed, evidence-based decision.
Still not sure about online CBT? Read on…
As I mentioned earlier, once lockdowns lifted and the COVID-19 restrictions began to ease, the popularity of online CBT didn’t fade. In fact, many clients who could have switched to face-to-face sessions chose to stay online. So, let’s take a look at some of the benefits of online therapy.
From my experience, and based on client feedback, online therapy is extremely convenient. For many people, it removes the need to take significant time off school or work for weekly appointments. Travelling to a clinic can mean losing an entire morning or afternoon, whereas a one-hour online session can easily fit in before school or work, during a lunch break, or in the evening. Many therapists also offer sessions outside of standard working hours to accommodate this. For busy parents, the same applies. Online sessions take up less time in the day, so they can fit around school runs, playdates, and nap times.
This convenience also extends to flexibility. When unexpected disruptions occur—such as a child being off school sick, or needing to stay home for an important delivery—online sessions can still go ahead rather than being cancelled. Fewer cancelled sessions often mean more consistent progress and quicker outcomes in therapy.
Another major benefit of online therapy is that you can remain with your chosen therapist even when life circumstances change. In therapy, you develop a strong therapeutic relationship built on trust and openness, which can take time to establish. However, life may require you to move house, relocate temporarily, or even live in a different country—situations that would normally mean ending therapy and starting again with someone new. Online therapy offers flexibility across locations, allowing you to continue working with the same therapist wherever you are.
One common criticism of online CBT is that it feels less personal than face-to-face therapy because you’re communicating through a screen. However, it is absolutely possible to build meaningful connections online. In fact, the online format can make therapy accessible to people who might otherwise be too anxious or physically unable to attend in-person sessions. In this way, online therapy promotes inclusivity and equal access to mental health support.
Finally, another advantage of online CBT is the ease of sharing resources digitally—through screen sharing and without needing to print out materials. This makes online therapy a more cost-effective option compared to face-to-face sessions.
Ok, but what are the downsides?
We’ve discussed the benefits of online CBT, but it wouldn’t be a fair or helpful article if we didn’t present a balanced point of view. While I champion the positive outcomes associated with online therapy, I also understand that it might not be for everyone. Therefore, it is important that we talk about the potential challenges of conducting therapy sessions online.
The first and most obvious challenge when doing anything online is internet glitches. Most of us will have been on a Zoom meeting or video call where the screen quality is poor and sound drops in and out. While we can accept these issues occasionally as part of modern life, if they happen frequently during therapy, they can disrupt the flow of conversation and use up valuable session time. However, these issues can be overcome by ensuring you have a strong and stable internet connection before committing to online therapy. If you know you will be in a location with unreliable internet, rearranging the session for that week can help avoid frustration.
Another technology-related issue is that online CBT is only suitable for people who have access to a computer and are comfortable using it. So, while CBT can improve access for people who would find it physically challenging to attend in-person sessions, it can exclude those who are less tech-savvy—such as some older adults, people with certain disabilities, or young children.
We have already discussed the flexibility of online sessions as a benefit. However, this flexibility can also be a downside. Sometimes people will engage in a therapy session when it would have been best to cancel—perhaps to avoid a cancellation fee or because they worry about disappointing the therapist. This can lead to sessions taking place in a suboptimal environment. For example, I have conducted sessions where unexpected childcare issues mean clients have needed to attend to young children throughout the session, making it difficult to fully focus on the therapeutic work. I have also had clients join sessions feeling unwell or intoxicated, and not in the best frame of mind to gain benefit from the session.
The final challenge of online CBT that I will mention, is the difficulty with collaboration. Collaboration is the idea that both client and therapist share responsibility for the session, meaning the client does not passively follow instructions but takes an active role in planning, sharing ideas, setting goals, and making progress in therapy. Collaboration may be easier when done in person. However, it can be achieved to the same standard during online therapy—it just involves a little thinking outside the box. This may include features such as screen sharing, an online whiteboard, chat functions for sharing written information, or shared online worksheets that you can complete together in real time.
I feel more informed about online CBT. What do I do next?
As a therapist with over a decade of experience in the field of mental health, my own view is that the format of therapy is often the least important factor. Neither face-to-face nor online CBT will be effective without a strong therapeutic relationship and a shared commitment to the therapeutic process from both therapist and client.
For this reason, when searching for a therapist, it can be far more helpful to consider their ethos, values, and areas of specialism, rather than focusing solely on how the therapy is delivered. Feeling safe, understood, and free from judgement is what creates the conditions for emotional exploration, meaningful change, and personal growth, regardless of whether that happens in a therapy room or through a screen.
If you’re considering online CBT and would like to explore whether it could be right for you, Thrive Psychology Services offers online CBT sessions tailored to your individual needs. You can find out more about my approach, availability, and how online therapy works by exploring the CBT page on my website, or get in touch to arrange a free initial consultation.
References:
Axelsson, E., Andersson, E., Ljótsson, B., Björkander, D., Hedman-Lagerlöf, M., & Hedman-Lagerlöf, E. (2020). Effect of internet vs. face-to-face cognitive behavior therapy for health anxiety: A randomized noninferiority clinical trial. JAMA Psychiatry, 77(9), 915–924. https://doi.org/10.1001/jamapsychiatry.2020.0940
Lundström, L., Flygare, O., Andersson, E., et al. (2022). Effect of internet-based vs. face-to-face cognitive behavioral therapy for adults with obsessive-compulsive disorder: A randomized clinical trial. JAMA Network Open, 5(3), e221967. https://doi.org/10.1001/jamanetworkopen.2022.1967
Pontén, M., Jonsjö, M., Vadenmark, V., Moberg, E., Grannas, D., Andersson, G., & Jensen, K. (2024). Association between expectations and clinical outcomes in online vs. face-to-face therapy: An individual participant data meta-analysis. Psychological Medicine, 54(6), 1207–1214. https://doi.org/10.1017/S0033291723003033