Online therapy as effective as in-person therapy, finds large study

When COVID arrived early in 2020, pandemic restrictions made in-person mental health care difficult or impossible. Both therapists and patients had to adapt almost overnight. For many in the field, it felt like a gamble: could this screen-based format offer the same level of support for people struggling with depression, anxiety or trauma?

Evidence has been growing, but until now few studies have compared treatment outcomes before and during the pandemic. Research my colleagues and I conducted offers new insights into this period.

We followed 2,300 patients treated in Sweden’s public mental health system over six years – three years before and three years during the pandemic – and tracked outcomes for common conditions including depression, anxiety, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).

We found that nearly half of visits shifted online during the pandemic (up from just 4% pre-COVID), yet treatment outcomes did not decline – they remained stable, despite the rapid transition.

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Patients filled out regular questionnaires during treatment to track their progress, using standard mental health assessments that measured depression and anxiety symptoms. We examined the degree of symptom improvement and the number of patients who transitioned from severe to manageable symptoms.

Fully 38% of depressed patients recovered, along with 56% of those with generalised anxiety disorder, 46% with OCD and 59% with PTSD. These recovery rates were almost identical before and during the pandemic.

As long as care is done well

We aren’t certain why remote care works, but one reason might be that the most important aspects of good therapy – things like building trust between patient and therapist, using evidence-based treatments and regular follow-up – can still occur online. In fact, for some people, meeting by video can make it easier to show up and feel comfortable. Our study suggests that, when care is done well, whether it’s in person or online doesn’t make much difference.

Online care also helps with everyday difficulties. It’s often easier for people who live far away, have trouble getting around or have busy schedules to get help from home. And during a health crisis like the pandemic, being able to keep up with treatment probably helped many people stay on track instead of falling behind.

Still, the findings come with limits. The study did not include children, people in acute psychiatric crisis or those with severe psychotic disorders — groups for whom in-person care may still be essential. And while online therapy offers flexibility, it also requires access to a private space, stable internet and the ability to engage through a screen — conditions that aren’t guaranteed for all patients.

Just turning on a webcam isn’t enough. The clinics in this study followed proven treatment methods and kept a close eye on how patients were doing. These steps probably made a big difference and are important for making remote care work.

Rather than being a temporary fix, online mental health care has become a core part of the system. Our study offers strong evidence that remote care, when well implemented, can match in-person treatment in effectiveness, even during something as challenging as a pandemic.

There is no one-size-fits-all model – and not all patients will benefit equally from internet-based treatments. But giving people the choice – and maintaining high standards of care regardless of delivery method – appears to be a key to success.

Because in the end, what matters most isn’t where care happens. It’s that it happens and that it works.

Fabian Lenhard works as the Head of Data & Analytics for WeMind Psychiatry and is affiliated as a researcher at Karolinska Institutet, Stockholm, Sweden.