Is online therapy effective? What the evidence says

If you’re considering online therapy, you probably want to know whether it actually works. It’s a fair question. Sitting in front of a screen feels different from being in a room with someone, and you might wonder whether the therapeutic value holds up.

The short answer is that, for many people, it works well. There is now a large body of research on online therapy, involving thousands of participants and a range of difficulties. Below, we walk through what the research shows, what it means for specific difficulties, and how online delivery compares to traditional face-to-face therapy.

The research base

Online therapy has been studied for over two decades. Early research focused mainly on internet-based cognitive behavioural therapy (CBT), and more recent studies have looked at therapy by video and at other approaches.

Two large reviews are worth highlighting.

Zandieh and colleagues (2024)

This review, published in the Canadian Medical Association Journal, analysed 54 randomised controlled trials with over 5,400 patients. It found little or no difference in outcomes between therapist-guided remote CBT and face-to-face CBT across a range of difficulties, including anxiety, depression and insomnia.

Carlbring and colleagues (2018)

This earlier review of 20 randomised controlled trials, with 1,418 participants in total, found that guided internet-based CBT and face-to-face CBT produced equivalent results for a range of psychological and physical health conditions.

Research since the pandemic

The move to remote therapy during the COVID-19 pandemic led to many more studies of therapy by video. Many of these are still being published, and so far the findings have generally been encouraging.

Effectiveness by difficulty

The evidence isn’t uniform across every difficulty, so here’s what we know about the areas we work with most at The Online Psychologists.

Depression

Online CBT for depression is one of the most researched areas in digital mental health. Many randomised controlled trials have found that guided online CBT reduces symptoms of depression compared with being on a waiting list, and the reviews above found similar results for remote and face-to-face CBT.

For more severe presentations, online therapy can still play an important role, often as part of a broader treatment plan. The key factor is the quality of the therapeutic relationship and the clinical expertise of the therapist, not the medium of delivery.

Anxiety disorders

There is also good research evidence for online CBT for anxiety, including generalised anxiety disorder, social anxiety disorder and panic disorder. Online delivery can actually offer a practical advantage for anxiety treatment, as clients can begin practising exposure-based techniques in their own environment from the outset.

PTSD

The research on online treatment for PTSD is growing. Studies of internet-delivered trauma-focused CBT, and early studies of EMDR by video, are encouraging, although there are fewer of them than for online CBT for anxiety and depression. For people with PTSD, having therapy from a safe, familiar space can make it easier to start, because avoidance is often part of the condition itself.

OCD

CBT with exposure and response prevention (ERP) is the first-line psychological treatment recommended by NICE for OCD, and controlled trials of online CBT with ERP have been encouraging. Having therapy at home also means you practise techniques in the places where OCD symptoms tend to show up.

How online therapy compares to in-person

This is the question most people really want answered: is online therapy as good as being in the room?

For many common mental health difficulties, the research so far suggests online therapy produces similar outcomes to face-to-face therapy. The strongest evidence is for CBT for anxiety and depression.

A few nuances are worth noting:

• Therapist-guided online therapy tends to do better than unguided self-help programmes. The human element matters.
• Treatment completion rates for online therapy seem broadly similar to in-person therapy.
• Client satisfaction is generally good, and some people prefer online sessions once they have tried them.
• Therapeutic alliance, the quality of the relationship between therapist and client, has been shown to develop effectively online. We’ll cover this in more detail below.

Where studies have found differences, they have tended to be small.

Advantages of online therapy

Online therapy also has several practical advantages.

Accessibility

Geography is no longer a barrier. If you live in a rural area, have limited local options, or need a specialist who isn’t available nearby, online therapy opens up access. At The Online Psychologists, we work with clients across the UK regardless of location.

Convenience

No travel time, no waiting rooms, no need to rearrange your entire day. You can attend sessions from home, from work, or from wherever you feel comfortable. This matters practically, but it also reduces the mental load of fitting therapy into a busy life.

Comfort and safety

Many people find it easier to open up from their own space. This is particularly true for individuals dealing with social anxiety, agoraphobia, PTSD, or difficulties where leaving the house can feel overwhelming. Being in a familiar environment can lower defences and support more honest, productive sessions.

Reduced stigma

For some, the fear of being seen entering a therapy clinic remains a real concern. Online therapy removes that worry entirely, which can make the difference between someone seeking help and continuing to struggle alone.

Continuity of care

If you travel for work, move house, or face disruptions like illness, online therapy can make it easier to keep going. Your therapy doesn’t have to pause because your circumstances change.

Addressing common concerns

It’s reasonable to have questions about whether online therapy will work for you. Here are the concerns we hear most often.

Can a strong therapeutic relationship develop online?

Yes. This is one of the most studied aspects of online therapy. Studies have found that the therapeutic alliance, the trust and collaboration between therapist and client, can develop well in video-based therapy, and some have found no significant difference in alliance ratings between online and in-person therapy. The quality of the relationship depends a great deal on the skill and attentiveness of the therapist.

What about crisis situations?

This is an important consideration, and one that responsible online therapists plan for carefully. At The Online Psychologists, every enquiry is screened for risk before we offer an appointment, and your psychologist will talk with you about safety at the start of therapy, including what to do and who to contact if you are ever in crisis. Online therapy is not suitable for everyone, and we will tell you honestly if we don’t think it is right for you.

If you are having thoughts of harming yourself or ending your life, please don’t wait for a therapy appointment. We are not a crisis service. If you need urgent help, call NHS 111 (option 2), contact your GP, or call Samaritans free on 116 123, any time. In an emergency, call 999. In Scotland, call NHS 24 on 111. In Northern Ireland, call Lifeline on 0808 808 8000.

What if I’m not confident with technology?

You don’t need to be. If you can manage a video call, you can do online therapy. The platforms we use are straightforward, and we provide clear instructions and support before your first session. Most clients who feel anxious about the technology find it becomes second nature within minutes.

Is it private and confidential?

Online therapy is subject to the same strict confidentiality requirements as in-person therapy. We use encrypted, secure video platforms designed for clinical use. Your sessions are private, and no recordings are made without explicit consent.

Frequently asked questions

Is online therapy as effective as face-to-face therapy?

For many common difficulties, especially anxiety and depression, research suggests online therapy produces similar outcomes to in-person treatment (Zandieh et al., 2024; Carlbring et al., 2018). The key factor is working with a qualified, experienced therapist rather than the delivery format itself.

What types of therapy work well online?

CBT has the strongest evidence base for online delivery, but other approaches including EMDR, acceptance and commitment therapy, and compassion-focused therapy have also been delivered effectively online. The suitability of a particular approach depends on your individual needs, which your psychologist will talk through with you at the start.

Who is online therapy suitable for?

Online therapy is suitable for most adults experiencing common mental health difficulties such as anxiety, depression, PTSD, OCD, stress, and adjustment difficulties. It may not be the best fit for individuals in acute crisis, those with severe and complex mental illness requiring multi-agency input, or those without access to a private space and stable internet connection.

How do I know if online therapy is right for me?

The best way to find out is to talk to a qualified therapist who can assess your needs and discuss whether online delivery is appropriate. Tell us what’s bringing you here and we will let you know whether we think online therapy with us is a good fit. If online therapy isn’t the right fit, we’ll tell you honestly and help you find a more suitable option.

Will my therapist be properly qualified?

At The Online Psychologists, all therapy is delivered by HCPC-registered clinical psychologists with a Doctorate in Clinical Psychology. The practice is led by Dr Rachel Whatmough (HCPC PYL25125). Online delivery does not change the qualifications, training, or professional standards that apply to your treatment.

Can online therapy help with severe symptoms?

Online therapy can help with moderate to severe symptoms for many people. The determining factors are the nature and complexity of your difficulties, your current level of risk, and whether online delivery can meet your needs safely. We look at this individually when you get in touch and at the start of therapy.

The bottom line

The research so far is encouraging. For many common difficulties, especially anxiety and depression, online therapy produces similar outcomes to in-person therapy, and it is easier to fit into your life.

What matters most is that your therapist is properly qualified, experienced and able to build a genuine therapeutic relationship with you.

If you’re considering online therapy and would like to discuss whether it’s the right fit for your situation, get in touch with us. We’re happy to have an honest conversation about what we can offer and whether it meets your needs.