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Remote mental health services have been around for a while, long before the pandemic. So, we've had plenty of time to study how well they work, and there are some encouraging findings.

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If you had to take your mental health care remote during the pandemic, you’re not alone. And therapy with a provider over video call or some other long-distance method might feel like unexplored territory, but remote mental health service has been around for a long time.

We know, for example, that Freud provided treatment by mail, and the Lancet published a letter on diagnosing a patient over the phone in 1879!

So it’s not exactly new, and we’ve had plenty of time to study how well it works, long before the pandemic.

Now, that doesn’t mean we have all the answers, but we do have some encouraging findings that receiving mental health care at a distance can still work well for patients. Which is great news for expanding access for patients who don’t have access to in-person therapy.

Now, there are many forms of remote therapy, but what we’re talking about today will be videoconferencing with a therapist, talking over the phone, or both.

Depending on where you live, this is called teletherapy, e-therapy, or online therapy, though we’re not including other forms of remote therapy, like text services or chatbots.

Overall, the methods and techniques are basically the same as in-person talk therapy: both types of therapy involve creating a supportive, safe environment where patients can talk about their issues, and patient and therapist can develop a solid relationship.

But the experience can still be very different.

One of the perks of in-person therapy is that therapists can use both verbal and non-verbal communication to build a rapport with their patients. Unspoken things like body language and general demeanor can give therapists key insights into a person’s well-being.

Research has shown that the important conversations and connections at the core of talk therapy can and do happen as effectively in teletherapy as they do in person, whether it’s over the phone or through videoconferencing.

For instance, a 2012 study looked at 100,000 patients in the U.S. Department of Veterans’ Affairs who participated in remote therapy using videoconferencing over the course of four years.

And the number of psychiatric hospital admissions decreased by an average of 24% for patients in this group after starting teletherapy.

At the same time, the overall hospitalization rates for people receiving mental health care from the VA actually increased slightly.

Because the people who participated in teletherapy weren't at the hospital, the researchers say they can't account for all variables, but this still seems promising.

And a 2018 paper showed that, in most cases, both phone and video teletherapy were as effective at reducing PTSD symptoms as in-person therapy.

While these studies all used a mix of phone and videoconferencing for therapy sessions, it turns out therapy can be effective when it’s a phone-only situation, too.

For example, a 2014 study found that vocal cues, like how long or intensely someone speaks, are a critical part of the communication that helps strengthen the patient-therapist rapport. And they can be just as noticeable over a good phone connection as they are in person.

And a 2017 study looked at teletherapy sessions for HIV-positive adults living with depression in rural areas to determine the overall effectiveness of therapy over the phone.

The researchers found that those patients were 5 times more likely to have meaningful improvements in their depression symptoms compared to people who only had access to community services like support groups.

So it seems like teletherapy is an effective way for therapists to reach more people, which is especially important for those who wouldn’t have access to therapy otherwise.

But while phone- and video-based teletherapy seem to be successful, there are a few drawbacks to consider, too. Using technology for therapy can create more space for distractions like incoming emails and texts for both patient and therapist––and a therapy session isn’t really the best time for multitasking.

In addition, researchers aren’t clear on whether teletherapy is equally effective for different conditions.

For example, there is very little data on how effective teletherapy is for treating patients in the early stages of psychosis. Increased research interest as a result of the pandemic may help us learn the answers to these questions, but it will take more time.

And researchers are also looking for better ways to make sure that patients in online therapy are getting the quality treatment they deserve. That’s because teletherapy can also come with a learning curve for therapists.

In some regions, for example, therapists may be required to get extra certifications to offer teletherapy services.

So, there are definitely some challenges left to overcome. But in the end, teletherapy creates more opportunities for patients and providers. And I think that we can all agree that giving more people better access to effective mental health care is a good thing.

We live in a connected world. It’s not just therapy that can connect you with someone far away––you can chat with your friends in Poland or South Africa in an instant now, which is amazing and lovely, and it also means that more of us might want to pick up new languages.

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