Ilisa Nussbaum worked as a nutritionist at Yale-New Haven Hospital on the front lines of the pandemic in the spring of 2020. One of her tasks was to ensure that COVID-19 patients on ventilators met their nutritional needs. Quickly, she realized that she needed psychological support to cope with this difficult time.
„I was paralyzed by fear of things that shouldn’t be frightening, like walking past a railing at work that overlooks an atrium,“ she recalls. But all the local therapists she contacted were too busy to take on new clients.
One evening, while scrolling through Facebook, Nussbaum saw an ad for a mental health app. It was a talk therapy chatbot that helps users monitor their mood. „A little robot asked me questions and sent me articles and videos on how to cope with my feelings during the pandemic,“ she says. „I found it very useful, especially when I felt overwhelmed and helpless.“
Research shows that the app she tried can be effective. According to a 2017 study, young adults aged 18 to 28 who used it daily for two weeks experienced more than a 20% reduction in depression symptoms compared to a control group (JMIR Mental Health).
As the COVID-19 pandemic continues, stories like Nussbaum’s are becoming more common. A study from October 2021 in the Lancet found that nearly one-third of adults in the US in 2021 had symptoms of depression, compared to 27.8% in the early months of the pandemic in 2020 and 8.5% before the pandemic. Therefore, online therapy platforms that connect users with a psychologist at the click of a button, as well as mental health apps, are in high demand.
Pros and Cons
With anxiety and depression on the rise and a shortage of personal therapists, there are many reasons why people find it appealing to share their concerns conveniently from the couch with a therapist.
„Online platforms provide an easy entry point and are often more affordable than traditional therapies,“ says Lynn Bufka, PhD, Senior Director of Practice Transformation and Quality at the American Psychological Association.
Research also supports online therapy. An analysis of 20 studies from 2018 compared the effectiveness of online and in-person cognitive behavioral therapy, which helps patients change their negative thoughts and feelings. The study concluded that online cognitive therapy was just as effective as the in-person version for treating anxiety and depression.
During the COVID-19 pandemic, online therapy could be even more valuable, as it does not require precautions like wearing a mask during sessions, says Judson Brewer, MD, PhD, Director of Research and Innovation at the Mindfulness Center at the Brown University School of Public Health in Providence, Rhode Island.
„You can see each other face-to-face, which is important for therapists, as 70–80% of all communication is nonverbal,“ he says. „I can see a patient’s facial expressions and better understand their emotions.“
The greater concern with online therapy is whether it can sufficiently support people with moderate to severe depression, says Bufka. „If someone is in a mental health crisis, I worry that an online therapist won’t be able to intervene and direct them to local resources that can provide emergency help,“ she says.
Experts are cautious about online text therapy, where you send a message to your therapist in a secure chat window on your phone and they reply. „Emojis are a very weak substitute for body language and facial expressions,“ says Brewer, noting that there is very little research on this type of communication. This format may be good for someone with very mild depression or a temporary stress or anxiety episode to test the waters, says Dr. Ashley Zucker, Chief of Psychiatry at Kaiser Permanente in San Bernardino County, Southern California.
Nussbaum sees the automated app she used in the same light. Although she feels it is sufficient for coping with the stress of the pandemic at the moment, she warns that it is not for everyone.
„I consider the…app as a stopgap for someone with depression and anxiety until they can go to therapy, or as an adjunct for someone currently in therapy,“ she says. „If you have something specific that’s bothering you, ultimately you want to talk to a person, not a robot.“
Find the Right App for You
When considering online therapy or a mental health app, Bufka suggests asking the following questions:
Is the therapist licensed in your state? „This matters a lot: it shows that the provider has achieved the minimum level of training, has a good reputation and gives you the option to file a complaint if things are not going well,“ Bufka explains.
Is there research behind it? This is particularly important for mental health apps, as „anyone can publish one in the app store,“ says Brewer. Look on the app’s website to see if there are published research findings behind it or if it was developed by someone at a major university.
Ultimately, online therapy and apps can be part of your overall self-care. „One of the best things about the app I used was that it required my full attention—I couldn’t look at it while making dinner or sitting on my exercise bike,“ says Nussbaum. „The act of sitting down and focusing on it alone helped me stop racing thoughts. It encouraged me to relax, take deep breaths, and cultivate mindfulness—all of which are so important.“