For people living in conservative countries like the UAE, where therapy has a stigma attached to it, e-Therapy could be a life saver. Image Credit: Getty Images

Getting help for something - be it anxiety or an addiction - from someone you never meet may seem like a strange idea, but virtual counselling, known as e-Therapy, is becoming increasingly popular. In a world where we have little time yet increasing issues, e-Therapy - online counselling at the click of a button 24/7 - seems like a smart solution. And, though it's been around for a while, in recent years eTherapy programmes have been set up by reputable institutions worldwide - even governments are endorsing it.

The Australian National University's Centre for Mental Health Research offers e-Couch for mood disorders, while in the UK, FearFighter Treatment, an online cognitive behavioural therapy (CBT) programme for anxiety, and Beating The Blues, a CBT treatment for depression, have both been endorsed and proven to be clinically effective by the National Institute of Clinical Excellence, the latter the most widely used within the UK National Health Service. While most focus on anxiety, fears and depression, there are also ones for eating disorders, addictions and marital issues. 

A private affair

There are numerous reasons why e-Therapy is growing and why it's effective - it's cheaper than face-to-face therapy, accessible and convenient and totally private. And with depression now the second leading contributor to poor health and a shorter lifespan among people aged 15-44, according to the World Health Organisation, convenient and appropriate methods for delivering treatment for both this and anxiety is clearly necessary. So, could e-Therapy fill that gap?

For people living in conservative countries like the UAE, where therapy has a stigma attached to it, e-Therapy could be a life saver. Dr Saliha Afridi, clinical psychologist at The LightHouse Arabia, was a speaker at the recent Obs-Gyne Exhibition & Congress that discussed depression among women in the Middle East and she explains that ‘social stigma' associated with going to see a mental health professional still acts as a strong deterrent for women seeking treatment for their emotional issues. "The Arab/Asian world is very private with religion playing a strong mediating role in coping with mental-health issues. It is much easier and more socially acceptable to admit that there is something wrong with the body than it is to admit that they need help coping," says Dr Afridi.

Would people be more likely to seek help knowing they can do so privately, in the comfort of their own home? According to the Consumer Guide to Online Counselling, yes… it states that of those demanding online therapy, 68 per cent had never been to a face-to-face therapy session, while in one study, 92 per cent of the 452 online therapy clients surveyed found e-Therapy helpful in alleviating their issues. 

Is it effective?

In fact, in some cases, e-therapy can be more effective than traditional therapy. According to a Dutch study published in The Lancet Journal, 63 per cent of teenagers suffering from chronic fatigue given psychotherapy online reported making a recovery, almost eight times better than those given standard care. "This study has added to an increasing evidence base that shows that therapist-aided, internet-based CBT is an effective treatment for many similar disorders," says professor Peter White of The London School of Medicine.

Similarly, another Lancet study of online CBT, which compared real-time online therapy sessions with normal GP care, discovered that those receiving online treatment were2.4 times more likely to have recovered eight months later. "Real-time online cognitive behavioural therapy offers the flexibility and responsiveness of face-to-face cognitive behavioural therapy and is appropriate for people with severe symptoms," said leader of the study, Dr David Kessler.

And it's not just suitable for depression. A study at the University of Amsterdam* tested internet-based cognitive therapy to prove its effectiveness in treating 105 bulimia patients, with the senior author on the study, Alfred Lange, concluding that the study "identifies online cognitive behavioural therapy as a viable alternative in the treatment of bulimic symptoms." One of the main reasons behind its success, explain the study authors, is that bulimic patients are often reticent about face-to-face contact and online interaction provides a healthy alternative, allowing them to seek help in privacy.

This seems to be a common thread amongst those advocating online platforms for therapy… the fact that this platform can provide results in the comfort of your own home. And say therapists, ‘comfort' for the patient is a prerequisite when it comes to treating them and getting results, as the patient is often more transparent and open. Sharing deep emotions can be easier via an exchange of emails, thereby helping therapists get to the root of the psychological problem more easily.

Another one of eTherapy's distinct advantages is its flexibility - it fits into your lifestyle and you decide how and when. Setting up face-to-face therapy involves travel and waiting time, reminder calls and missed appointments. With e-Therapy, however, you don't have to take time off work, you can do it at night or when it's convenient, and in the privacy of your own home. 

Online issues

Of course, e-Therapy doesn't suit everyone and it may not be the right therapy for every issue, as many healthcare professionals concede, including Dr Afridi. "I think e-Therapy may be an option for individuals in rural communities without access to those resources, but for others with access, especially those who are depressed, face-to-face therapy is important," she explains. "Being organised enough to set up an appointment, getting dressed, showing up and then facing another person is all part of the recovery process for a depressed person," explains Dr Afridi. She, like many others, also believes that in face-to-face counselling, so much can be revealed non-verbally. "So much of what we do as counsellors is about ‘being' with another person - to be able to read micro non-verbals and feel their energy in order to arrive at our analysis, and this cannot be done on the phone or via emails," warns Dr Afridi.

Also, for serious conditions or severe mental health problems, supervised psychiatric care is essential. There's also the issue of trust and confidentiality. "A cornerstone of effective therapy is to be able to create safety and to protect the clients' confidentiality so they can explore difficult and dark issues and I question how safe the internet is," says Dr Afridi. Guidelines from the British Association for Counselling and Psychotherapy advise patients considering e-Therapy to "ensure that the therapist is suitably trained and supervised". The most internationally reputable ones have several things in common: they all provide detailed information about their counsellors, including educational backgrounds, experiences and area of speciality; and they state the fees, method of payment, method of interaction (email, web, chat rooms and so on) and offer a step-by-step guide to getting started.

Where to find help

There are a number of different therapy tiers, depending upon the issue or severity of it. There's the option to follow a recognised and endorsed programme - usually CBT - through online instruction; to exchange emails with a trained counsellor; or to talk one-on-one in a chat room in real time, the last allows for greater interaction and more specific feedback. Most programmes screen and determine the severity of your anxiety, depression, eating disorder or addiction, and with a click of the mouse, then provide you with recommendations for appropriate treatment options.
The FearFighter CBT programme teaches you how to cope with anxiety by tackling your thoughts and challenging avoidance behaviours. During this 12-week structured online course, you undertake activities from worksheets, monitor your own progress, receive emails with extra tips. It's recommended you do one session a week, each lasts around 30 minutes. You also get phone support. The cost is £197 (Dh1,160).
This Australian site provides screening for 21 psychological disorders and you are clinically diagnosed after completing psychiatric reviews by answering online questions. You then enrol on a self-help 12-week CBT treatment programme, with the option of eTherapist interaction. The self-help programme is free, but you have to pay for any e-Therapist interaction.
Based out of Germany, this provides appointment-based and group therapy via webcam or email in English. Individual therapy sessions start from €60 (Dh288) per hour. There are also several free online support groups, including one for improving self-esteem, and you can join in via phone or webcam - they run weekly for 60 minutes and places are limited.
This US-based e-Therapy site features a list of therapists with specialities, which you can select from, before purchasing an email session or web chat, $40 (Dh147) for an email session and $95 (Dh350) for a webchat. You fill in a form, providing the therapist with information about yourself and your needs. The therapist will then get back to you within two days.
Founded by Carl Benedict, a US-based licensed counsellor and therapist with expertise in grief, loss, anger, anxiety and depression, this service provides chat and/or email therapy. You fill out a questionnaire, purchase the first chat therapy session, and within 48 hours you receive your first chat therapy appointment. Only available on Saturdays and Sundays, starting from $50 (Dh185) for a 60-minute session.
Founded by Australian psychologist Timothy Sharp, this follows a 10-step programme to overcome depression using CBT. It identifies and replaces negative thoughts with positive, constructive ones, while teaching a range of practical strategies to help you overcome depression. From $49 (Dh180) for a two-month programme.