Online Therapy for Anxiety and Stress

Anxiety disorders are one of the most common mental disorders in the United States. It is estimated that 18% of the adult population suffers from an anxiety disorder. Some have argued that given these large numbers, the use of Internet-based interventions would appear to be a viable alternative to solely providing traditional face-to-face clinical interventions.

In one study, 15 young adults between 16 and 25 years of age with anxiety and depression were recruited to participate in an Internet-based cognitive-behavioral intervention consisting of eight online modules facilitated by an online therapist. Symptoms of anxiety and depression were reduced and quality of life was reported to have improved following the intervention.

A systematic review on the effectiveness of Internet-based cognitive-behavioral therapy for depression and anxiety replicated these findings among those with chronic illness.

Social phobia is a form of anxiety disorder whereby the individual experiences anxiety in social situations to the extent that it produces significant negative consequences and impairment. Because individuals with social anxiety may be embarrassed to seek traditional counseling, Internet-based interventions could be a viable treatment option for this group. One experimental study compared the effects of a nine-week, Internet-based intervention that utilized a self-help manual based on a cognitive behavioral modality.

This Internet-based intervention (the experimental group) consisted of nine modules that provided information on social phobia and exposure exercises. Each module ended with three to eight essay questions.

Participants were asked to describe the most important topic covered in each module, to provide records of their thoughts and feelings, and to describe their experience with and outcome of their exposure exercises. Therapists responded to the participants via e-mail.

The findings were promising. Participants in the Internet-based intervention experienced significant improvement on measures of social anxiety, fear, avoidance, depression, and general anxiety compared with their counterparts in the control group, who received no treatment. Furthermore, their overall quality of life increased.

The post-treatment and one-year follow-up outcome scores were stable. The authors recommended Internet-based treatment as a complement to traditional cognitive-behavioral interventions. Furthermore, because clients with social phobias differ in terms of history and severity, a careful evaluation should be done to determine the specific intervention employed (use of a self-help manual, psychoeducational group, Internet-based group, etc.).

In another study that examined the effectiveness of online group counseling for social phobia, 105 adults were randomized to the treatment group, which consisted of e-mail contact with a therapist, lessons to be completed online, homework assignments, and discussions in an online forum; the control group simply consisted of those on a waiting list. Both groups experienced decreased levels of social phobia symptoms, but the participants in the treatment group had greater improvements.

Practitioners are increasingly using virtual environment technologies for the treatment of various anxiety and stress disorders. Malbos, Mestre, Note, and Gellato described an intervention using virtual reality for six patients with claustrophobia; the intervention consisted of education, relaxation, and cognitive and behavioral strategies.

Participants “experienced” enclosed spaces such as houses, corridors, hallways, underground facilities, and elevators, and the amount of space in each of these scenarios was manipulated. Overall findings showed a decrease in fear of enclosed spaces, and these improvements were sustained at the 6-month follow-up. After completion of the intervention, participants reported they were able to use the elevator alone, stay in a cellar, and use public toilets .

A virtual reality smartphone application was developed for individuals with social anxiety disorder; no therapist facilitation was provided. Twenty-two subjects diagnosed with social anxiety disorder and 30 subjects with no diagnoses engaged in the two-week, eight-session program. In both groups, social anxiety scores decreased and there were improvements in speech length as well as self-reported amount of nervousness.

The question of whether exposure of a threat in a virtual reality can truly imitate real-life exposure in a way that produces similar psychophysiologic responses is also a source of debate. In a meta-analysis of 38 studies, researchers found that virtual reality does trigger psychophysiologic arousal, particularly electrodermal activity.

In another meta-analysis of 23 studies of anxiety and virtual reality, individuals given a stimulus in virtual reality therapy experienced anxiety symptoms, and over time, the virtual reality exposure therapy produced similar outcomes in terms of reducing anxiety symptoms compared with face-to-face interventions with in-vivo exposures.

These positive improvements exhibited following virtual reality exposure treatment persisted into the long term and the dropout rates were similar. Overall, it is important to remember that virtual reality therapies for anxiety disorders are not a new form of therapy, but are an application of technology in an evidence-based treatment.

A 2019 systematic review found that Internet Acceptance and Commitment Therapy appeared to be effective in reducing anxiety symptoms. However, more randomized controlled trials are needed.