Cognitive behavioral therapy (CBT) is a tool used to treat a number of mental and physical health issues, and due to its flexibility, CBT online offers many of the benefits found in the face-to-face model. CBT is widely available online, so people experiencing unwanted symptoms linked to anxiety, depression, and other conditions should view it as a viable option to treat their overall well-being.
Central Concepts of Cognitive Behavioral Therapy
At its core, CBT via online therapy holds true to the central concepts of in-person cognitive behavioral therapy, including:
The Interconnectedness of Thoughts, Feelings, & Behaviors
CBT treatment is based on the notion that:
- Thoughts affect behaviors and feelings
- Behaviors affect thoughts and feelings
- Feelings affect thoughts and behaviors
With these ideas in mind, CBT therapists believe that unhelpful ways of thinking and behaving lead to psychological problems.1
Time-Limited With Structured Sessions & Homework
Each session will focus on:2
- Reviewing the previous session
- Discussing noteworthy events that transpired since the last session
- Reviewing homework
- Setting the agenda for this session
- Summarizing and concluding session
Sessions will always vary, but this general framework will anchor many CBT sessions.
Focused on Present Life & Events
CBT is primarily focused on the present—the here and now. It is more interested in how you feel, behave, and think right now than how you thought, felt, and acted years ago.3 Though CBT is present-oriented, it does attend to the past when needed. Often, in order to change patterns of thinking and behavior, a person sometimes needs to recall the history of the issue to identify the issues perpetuating the problem.
Therapeutic Relationship
At the center of the CBT relationship is trust. Trust helps the client feel confident that the therapist has their best interests in mind. At times, the therapist may need to challenge the client to engage in a homework assignment or exercise that feels uncomfortable, and the trust will help them follow through with the process.
How Is Online CBT Different From In-Person CBT?
Online CBT will be able to replicate some of the best features of in-person CBT closely. The core principles, techniques, focus on homework, and effectiveness of CBT will remain in place when the treatment is online.
CBT, when performed online, can provide positive additions such as:6
- Convenience: Early in the morning, late at night, or anytime during the day, online CBT is available to help address a person’s needs. Online options add a level of convenience that in-person therapy cannot match.
- A more comfortable experience: Many people feel much more comfortable communicating through their phones than another person face-to-face. With this ease of communication, fewer barriers to enter treatment exist, especially for people in their teens and early twenties.
- Increased accessibility: Someone in a rural community could be very far from a mental health provider, and even if one is close, they may not offer the CBT treatment desired. Others may struggle to leave the home due to a disability. Online options allow clients to choose between a number of providers, which inspires a sense of control over the process. It can also shorten the amount of time spent waiting for a therapist.
- Possibility for lower cost: Websites, apps, and other online providers can offer special pricing for people who do not wish to use their insurance. Over the course of treatment, these therapies could provide a lower cost compared to in-person treatments.
Though in-person treatments will always vary from online options, the gap is becoming smaller. As internet speeds improve and new technologies emerge, more parity between face-to-face and online therapy will exist.
What Can Online CBT Help With?
With CBT’s long history of being researched and tested, the treatment style has been proven effective for a long list of mental health and physical health disorders. Even better, CBT skills can help people lead happier, healthier lives, regardless of their health status.
Here are specific mental health concerns that CBT has been proven to help:5
- Anxiety disorders
- Social anxiety
- Panic disorder
- Depression
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- ADHD
- Fibromyalgia
- Chronic fatigue
- Irritable bowel syndrome
CBT is flexible enough to address other issues like self-esteem, public speaking, focus, and other issues that may disrupt a person’s ability to perform and feel well.
Is Online CBT Effective?
One study found that online CBT sessions for people with depression yielded results that equaled a group receiving face-to-face treatments. Three months after treatment, though, the online therapy group maintained their results while the in-person group experienced an increase in depressive symptoms.7 In this way, online CBT can offer an even greater benefit than traditional sessions.
Studies and reviews of online CBT have found:
- Electronically-delivered CBT (eCBT) was as effective as traditional CBT and also cheaper and more accessible.9
- CBT delivered over the internet showed promise in helping people with depression or bipolar disorder increase behavioral activation.10
- Online therapy shows promise with anxiety and depression as well as PTSD.11
- Online CBT for kids was more helpful than controls but may not be as effective as in person treatments.12
- Online CBT is equally as helpful as in person CBT, but online options can help more people stay in treatment over time.13
- Research shows that online CBT may not be right for all groups and all conditions, but for a large number of people, the treatment can be effective and convenient.
In general, video-based CBT is a very effective tool. Read more about the effectiveness of therapy.
Potential Risks of Online CBT
All therapies carry some risks, and online CBT may have issues linked to confidentiality, rapport, and worsening symptoms:6
- Confidentiality: Knowing that the information a client shares with their therapist stays safe is paramount. A therapist could be conducting therapy in an unsecured location, they could be careless with client data, or they could utilize online services which are prone to breaches. In all cases, the client should seek providers who engage in measures to maintain privacy. Always have a conversation with your therapist about the risks before treatment to limit the challenges.
- Rapport: In CBT, the therapeutic relationship is a valuable component. The risk of online treatment is that building a strong relationship with someone electronically will be more challenging than in-person. Plenty of these obstacles exist whether or not you meet online, so a person should be open and direct with their therapist to discuss issues.
- Worsening symptoms: CBT can be an uncomfortable treatment style, at times, because the therapist may encourage someone to confront the situations that trigger stress. Entering into this process unprepared could lead to worsening symptoms. This risk is present with in-person and online CBT sessions, but assessing symptoms online may be more complex for the therapist.
Online CBT Examples
Whether online or in-person, CBT sessions generally will follow a similar path for similar problems.
Here are a few examples of what online CBT might look like for different concerns:
Fear of Heights
Specific phobias, like a fear of snakes or a fear of heights, can be effectively treated with CBT through a process of systematic desensitization. Here, a client will discuss their fear with a therapist before building a list of situations that cause fear related to heights.1
After a period of skill-building to learn relaxation techniques, the therapist will encourage the client to start by engaging in a situation that triggers a low level of distress. Over time, the client moves through their list by challenging themselves to complete more distressing tasks until they reach the scariest item. Since most of these behaviors take place outside of the session, the appointments focus on processing the previous events, encouragement, and planning for the next item.
Depression
After a thorough functional analysis of depression and its impact on the client’s life, sessions shift towards the therapist providing education and skills linked to cognitive distortions and reframing.
The client and therapist can work together to identify the cognitive distortions with the most significant impact and begin challenging them. With homework assignments geared towards identification and reframing, sessions continue to refine the skills until the client has successfully changed their thinking habits.
Substance Use Disorder
CBT for substance use disorders will begin with educating the client about the impact of substances in the body and brain.
Therapeutic interventions will focus on:
- Identifying the people, places, and things that trigger thoughts of use
- Engaging in the cognitive reframing process to help build new and maintain established healthy habits
- Learning healthy coping skills to improve distress tolerance, relaxation, and communication
- Creating a relapse prevention plan that outlines the specific techniques to use when cravings occur
Online CBT sessions may also focus on understanding the history of use and the role of underlying co-occurring mental health conditions that promote addiction and dependence. By addressing the present functional analysis and the past reinforcers, the client and therapist can gain a complete picture of the presenting problem.
How to Find an Online CBT Therapist
With technological advances and widespread acceptance, finding CBT online will be as simple as finding CBT in-person. In some ways, online therapists trained in CBT may be more accessible than traditional CBT sessions, especially for people with restrictive schedules.
When setting out to find CBT online, a person must consider what types of treatment they seek. Online CBT may involve phone calls, video chats, text-based therapy, specialized apps, and even standardized online programs that offer very little therapist contact.
When deciding between treatments, ask yourself how much contact you desire with a therapist. Some therapies, like iCBT, provide lesson plans built on CBT fundamentals for an affordable cost, but they tend to lack personalized care from a therapist.
If you’re ready to begin online CBT, find a great therapist on Choosing Therapy’s directory.
Who Is Able to Provide CBT Online?
For people interested in receiving CBT online, they will encounter many options for their treatment. Those seeking a personalized touch should be easily able to find therapists who offer online CBT sessions. Although these professionals will differ in their education and experience, they will all carry a license in their state to practice as a mental health professional.
It is unlikely they will possess an additional certification to practice online, but they may have participated in continuing education programs to become more effective in an online setting.
Cost of Online CBT
The average cost of online CBT may range from $80-$130 per session, while some providers may offer monthly or yearly subscription fees in exchange for a set amount of sessions. Because of the nature of online CBT, it typically does not cost more than an in-person session. The cost of therapy can vary based on your location and the therapist’s level of education, but online therapy can make it easier to access appropriate treatment.
People looking for the most cost-effective options can find apps that cost as low as five dollars.8 These programs cannot replicate the benefit of a therapist, but they could serve as a way to test CBT and online CBT as helpful treatment strategies.
Key Questions to Ask a Therapist When Considering Online CBT
With the service being relatively new, there will be vast differences between online CBT providers, so asking questions will be essential to find an appropriate match. Not every therapist uses CBT, so you will also need to specifically ask if it will be used.
Consider asking your potential online therapist:
- What are your credentials for providing online CBT?
- Will you charge my insurance or do I pay out-of-pocket?
- How will you maintain my privacy and confidentiality?
- How can I contact you between appointments?
- Do I have the option of seeing you in person if needed?
- Is CBT online an appropriate way to treat my symptoms?
- When would you expect my condition to improve?
No question is a bad question to ask at the beginning of therapy. CBT clinicians should provide clear and honest answers while considering a level of uncertainty with mental health concerns. You can find video-based therapist and book an online appointment with them using the Choosing Therapy Directory.
What to Expect at Your First Online CBT Appointment
Your first appointment of online CBT will contain many of the important facets of in-person CBT, just without the commute to and from an office and the time spent sitting in the waiting room. Online CBT can all happen from the privacy and comfort of your living room, or wherever you can find some privacy.
Like other forms of CBT, the first session of CBT online will cover elements like:4
- Learning about the therapist’s background, education, and experience
- Basic elements of CBT including its strengths and limitations
- Establishing firm goals for treatment
- Predicting how long therapy may be needed to achieve those goals
- Discussing how long each session lasts and the flow of sessions
- Disclosing the chief complaint and presenting problems that brought you to therapy
Because the therapeutic relationship is valuable in CBT but more complicated to form with online methods, the therapist may spend extra time and energy getting to know you. By asking questions about your favorite movies, music, or hobbies, the therapist can learn more about you while building a relationship built on trust and understanding. You can help this process along by doing a little preparation for your first therapy session.
The CBT therapist will discuss the level of access to treatment and options for forms of communication including phone, video chat, email, texting, and app access. Establishing a safety plan is also a key aspect of the initial therapy session.
Online CBT Infographics
For Further Reading
- Read our review of BetterHelp vs Talkspace to find the right online CBT option for you
- Check out all the top online therapy options of 2022
- There are lots of CBT Apps available if you’re looking to supplement psychotherapy
