Internet Cognitive Behavioral Therapy: Treatment For Mental Health Conditions

Can treatment methods of cognitive behavioral therapy (CBT) be done virtually?

Although effectiveness varies slightly depending on how cognitive behavioral therapy (CBT) is used, substantial evidence, including multiple controlled trial data and meta-analysis, suggests that CBT is effective when administered remotely. This includes treatment for various psychiatric disorders such as panic disorder, obsessive-compulsive disorder, moderate depression, and other conditions with depression symptoms.

As with all treatment methods, effectiveness can vary based on the needs of a specific individual. However, CBT, whether conducted in-person as conventional CBT or as internet-delivered CBT, is generally considered one of the most robust and effective therapies available today. 

Substantial research, including findings from a systematic review, has been conducted to determine if internet-based treatment, such as cognitive behavioral therapy, retains the utility of its in-person counterpart. A meta-analysis of studies that contain a randomized controlled trial to test the effectiveness of internet-based cognitive behavioral therapy indicated that, even when administered online, cognitive behavioral therapy remains a robust and effective option. 

Online CBT helps more people get support through primary care and general health care. It also fits into self-help programs, making therapy easier to access for those who can’t attend in person. This virtual method continues to be studied for its cost-effectiveness and broad reach.

How effective is internet-based cognitive behavioral therapy (CBT) as a treatment for various mental health conditions?

Internet-based cognitive behavioral therapy (ICBT) is known to be effective for a wide variety of mental health conditions. Internet-delivered CBT has research-based utility in treating and managing mental health problems, like depression, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, chronic pain, panic disorder, moderate depression, and phobias.

A systematic review and meta-analysis have confirmed its value in addressing psychiatric disorders through internet-based treatment. Several internet-based cognitive behavioral therapy studies have shown ICBT’s strong cost-effectiveness, further bolstering its utility. It’s also accessible through primary care and general health care settings and can be integrated into self-help programs.

Who should not use online therapy?

Experts have recognized the utility of online therapy, which is quickly gaining a reputation as a way to reduce barriers to therapy without sacrificing the therapeutic process. Online therapy has demonstrated effectiveness in treating many mental health conditions, including depression, general anxiety, social anxiety, and post-traumatic stress disorder. It has also demonstrated utility in treating health conditions by aiding diabetes management, assisting with smoking cessation programs, and assisting with health promotion for weight loss. 

These internet-based interventions, often structured as a treatment program, may include options such as internet-based CBT or guided internet-delivered CBT, which have shown promise in randomized controlled trials. Some platforms rely on therapist involvement, also known as therapist support, especially for issues like obsessive-compulsive disorder, panic disorder, and depressive symptoms.

While internet interventions show cost-effectiveness as an alternative to traditional care and are quickly becoming a powerful tool that may allow many people to access therapy who were unable to before, those with extremely severe or complex major depression or psychiatric disorders may likely benefit more from face-to-face psychotherapy, or face-to-face therapy. These cases may require structured psychological treatment, more frequent therapist contact, and personalized treatment protocols that are better suited to in-person formats 

What are the three C's of cognitive therapy?

The three C’s of cognitive therapy likely refer to a mnemonic that is taught to those undergoing therapy to help them remember the cognitive restructuring process. The three C’s are described below: 

• Catch. The first C refers to catching thought processes that are associated with negative emotions. 

• Check. The second C refers to checking those thought processes against rational evidence and considering other explanations. 

• Change. The third C refers to changing those thought processes into more positive and helpful responses. 

The three C’s are typically used when a person’s thought processes tend to drive unpleasant or unwelcome feelings and behaviors. For example, a person might use the three C’s to help them conquer negative self-talk and develop better self-esteem. When they find they are speaking negatively about themselves, they can “catch” the negative thoughts before internalizing them as true. They can then consider whether the comments they are saying to themselves are accurate and whether they can refute the negative thought process. Then, they might consciously choose to accept a more positive version of the thoughts that lead to unpleasant emotions. 

How long does it take for CBT to work for anxiety?

The length of time it takes for cognitive-behavioral therapy to be effective in treating anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, and panic disorder, depends on the severity of the anxiety and the specific needs of the person experiencing it. CBT is designed to be a short-term psychological treatment. Research and findings from pilot randomized controlled trials suggest that most people require about ten therapy sessions before their anxiety is resolved. However, the evidence further suggests that the number of sessions can vary considerably. Some may benefit from a longer treatment program, often ranging between five and 20. 

In studies assessing treatment adherence and post-treatment outcomes, individuals receiving therapist support, particularly through guided internet-delivered CBT, showed sustained symptom relief over time. For some, especially those who co-occur with depressive symptoms or obsessive-compulsive disorder, response time may vary.

Why is cognitive behavior therapy (CBT) criticized?

One of the most prominent criticisms of cognitive behavior therapy is its mechanistic and rigid approach. Critics claim that CBT fails to address the “whole patient,” instead targeting specific concerns that fall within the domain of behavior therapy. Many primary care professionals, especially those grounded in client-centered and humanistic mental health practices, advocate for integrative versions of the therapy that treat the patient holistically and address broader aspects of psychiatric disorders. 

CBT has also come under fire for relying too heavily on cognitive interventions. A meta-analysis and a systematic review suggest that the behavioral components of CBT are just as effective on their own, particularly for conditions such as panic disorder, obsessive-compulsive disorder, moderate depression, and post-traumatic stress disorder. Data from numerous controlled trials and clinical trials support these findings. Also, assessments like the Patient Health Questionnaire have shown comparable symptom improvements from behavior-only interventions in some studies.

Evidence-based practice suggests that the behavioral components of cognitive behavior therapy (CBT) are just as effective when used alone and not combined with the cognitive components of the treatment. A “third wave” of CBT techniques, including guided internet-delivered CBT and computer-based CBT, is currently being evaluated to address these and other concerns. These new modalities are also being assessed for cost-effectiveness in different health care systems and settings. As with any other empirically supported treatment, high-quality evidence, like a controlled trial, must be utilized to determine whether third-wave CBT adequately improves treatment outcomes. 

The rise of internet-based treatment and internet therapy has helped increase accessibility, particularly in the realm of self-help and remote care. Still, concerns around personalization and therapist engagement remain. Researchers and clinicians must divulge competing interests and ensure that new forms of CBT are used.

What are the long-term effects of cognitive behavioral therapy on your mental health?

Evidence suggests that most patients treated with cognitive behavior therapy (CBT) see sustained improvement for at least the first year following treatment. Long-term outcomes do vary somewhat depending on the specific condition being treated, such as generalized anxiety disorder, panic disorder, or obsessive-compulsive disorder, and its severity, but lasting benefits following CBT are likely a reasonable expectation. 

In some cases, the CBT techniques patients learned in therapy continue to provide benefits. Some patients continue to improve over time and further reduce depressive symptoms, especially those associated with chronic pain, psychiatric disorders, or adult depression. These improvements have been noted across various controlled trials and randomized controlled trials, including internet-based and face-to-face therapy platforms.

A meta-analysis published in a medical internet research journal supports the idea that even guided internet-delivered CBT can lead to lasting symptom relief. CBT may also show better cost-effectiveness than some alternative interventions, according to clinical trial data.

While long-term treatment gains vary across post-treatment assessments, the presence of continued therapist contact and follow-up care can positively impact outcomes for many experiencing mood disorders, major depression, or anxiety-related mental health problems.

Does CBT rewire your brain?

Yes, cognitive behavior therapy (CBT) can “rewire” the brain by changing neural pathways within it. Neuroimaging studies suggest that CBT modifies the neural circuits involved in the regulation of negative emotions and fear extinction. Brain scans of patients, many of whom had depressive symptoms, panic disorder, obsessive-compulsive disorder, or generalized anxiety disorder, were taken before and after they completed a course of CBT, and neurological researchers were able to identify changes in the structure and function of the brain attributable to the therapy. 

These findings are further supported by data from randomized controlled trials and clinical trial reviews, many of which are referenced in an open-access article and meta-analytic review. Whether delivered through computer-based CBT, guided internet-delivered CBT, or traditional face-to-face therapy, this form of behavior therapy continues to show promise across a variety of common mental disorders and psychiatric disorders.

While cognitive behavioral therapy (CBT) is often used in primary care settings or as part of internet-based therapy, it can also serve as a form of structured self-help, including web-based self-help options. Although different forms of CBT exist, research highlights its consistent impact on brain and emotional regulation, especially for those living with chronic pain, moderate depression, or other complex diagnoses. Many experts recommend future research into its cost-effectiveness, long-term secondary outcomes, and the role of CBT therapist guidance to optimize results.

What are the ABCs of cognitive behavioral therapy?

Albert Ellis developed the ABCs of CBT as part of his rational-emotive therapy, a critical component of CBT. The ABCs refer to a framework that describes how thought processes influence emotional outcomes. They are: 

• A: Activating event. The activating event refers to something that happens to or around someone. Anything can be an activating event. 

• B: Belief. The activating event leads a person to have a belief, which can be either healthy or unhealthy. 

• C: Consequence. Healthy beliefs lead to healthy consequences, and unhealthy beliefs lead to unhealthy consequences. 

The ABCs demonstrate a core tenet of CBT: A person does not need to change their environment to change how they are impacted by it. By changing a belief, a person can change the consequence associated with it, regardless of the activating event. For example, consider a person who is called into their boss's office and speaks to them about recent poor performance. The person believes they are not a good employee, leading to a consequence wherein their work performance suffers further due to self-doubt and insecurity. 

Consider the same situation, but this time with a person who believes they are a good, capable employee. The activating event is the same, but this time, the person thinks of the conversation with their boss as critical feedback designed to help them improve their performance. They use the information gained from the conversation to improve at work and advance their skills, a significantly more positive consequence than in the previous scenario. 

What is CBT ineffective for?

Evidence suggests that cognitive behavior therapy (CBT), a widely used form of behavior therapy, has limited utility in the treatment of schizophrenia and does not substantially reduce relapse rates. Similarly, CBT is not considered effective for the prevention of relapse in bipolar disorder.

In randomized controlled trials and a systematic review, cognitive behavioral therapy has shown substantial benefits for many conditions, such as panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, and moderate depression. Still, its effects are less intense for specific psychiatric disorders like schizophrenia. Although computer-based CBT and guided internet-delivered CBT have been explored in internet therapy settings and primary care, the evidence still indicates minimal improvement for these more complex diagnoses.

A meta-analysis and clinical trials have tested cognitive behavioral therapy (CBT) in combination with medication or as part of broader health care plans. However, even when cognitive behavioral therapy is delivered via guided internet-delivered CBT, conventional CBT, or internet-based treatment, it remains less effective for chronic psychotic disorders. A few studies have explored its use in computerized psychological treatments, but results have not consistently demonstrated a significant benefit. 

Also, the patient health questionnaire and secondary measures used in research highlight that cognitive behavioral therapy (CBT) tends to perform better in conditions involving depression symptoms, trauma-related symptoms, like post-traumatic stress disorder, or conditions benefiting from therapist guidance and structured self-help approaches. Still, for bipolar disorder, the cost-effectiveness and therapeutic outcomes may not justify CBT as a standalone or primary intervention.

Further research with transparent reporting on competing interests and adherence to randomized controlled trials is needed to determine whether adaptations of CBT could have better results for these populations or if face-to-face treatment offers superior results in these specific cases.