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Cognitive-Behavioral Therapy Online: Does It Work?

One of the most popular forms of psychotherapy is cognitive-behavioral therapy (CBT). It also happens to be one of the most researched and evidence-based treatments available to treat many psychological conditions. However, CBT’s beauty is that it focuses on fostering a deeper relationship between the patient and the therapist. With the rise of lockdowns and restrictions during the COVID-19 outbreak, many addiction centers turned to cognitive-behavioral therapy online. Can this be as effective as the face-to-face therapy setting?

What is Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy is a form of psychotherapy guided by a therapist to address negative thinking and emotional and behavioral patterns. CBT can help people prepare better to manage stressful life situations that often lead to unfavorable outcomes, like an addiction.

When Is It Used?

CBT is used to treat a wide range of issues. It’s usually the preferred psychotherapy method because it quickly shows individuals how to identify their triggers and provides the tools for coping with these challenges. When done in a structured way, it often requires fewer sessions than other forms of therapy. 

Cognitive-behavioral therapy is used to treat a myriad of mental health disorders, including:

  • Anxiety disorders
  • Bipolar disorder 
  • Depression
  • Eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Phobias
  • PTSD
  • Sexual disorders
  • Schizophrenia 
  • Substance use disorders 

In addition, CBT can also help those struggling with behavioral disorders. In most cases, CBT is most effective when combined with other treatments, including group therapy and medication. 

How is Cognitive-Behavioral Therapy Conducted Online?

An online CBT session will look very similar to an in-person one, at least in structure. First, your online therapist will ask you a set of questions designed to help them understand the context of your struggles and your goals. This form of therapy is heavily focused on an equal relationship, so even as your therapist asks questions, they’ll expect some level of feedback from your end. Because of this setup, therapists can pinpoint cues that they can use to recognize triggers, past traumas, and so forth.

What’s the Difference Between CBT Online and In-Person CBT?

In essence, online and in-person cognitive-behavioral therapy sessions are very similar. An online therapist will replicate this therapy’s core concepts, including CBT techniques, homework or reading material, and feedback. The most significant difference between online treatment are:

  • Convenience. Online therapy is available almost 24/7 if you use text-message therapy services. However, even still, video therapy is widely available throughout the day.
  • Lower costs. On average, telehealth sessions are more affordable than traditional therapy. 
  • More comfortable. At first, not everyone feels comfortable talking about their struggles in a face-to-face setting. Online therapy gives those individuals a different type of outlet where they can still get the help they need.

What does Research Say About eCBT?

Although relatively new, some researchers are starting to analyze the impact offering online cognitive-behavioral therapy can have. A systematic review of 17 studies found that electronically-delivered CBT (eCBT) was more effective than face-to-face CBT at reducing the severity of depression symptoms.

Another systematic review of studies also found that eCBT helped reduce depression or anxiety symptoms similar to traditional face-to-face therapy. In yet another systematic review of studies, looking at a treatment length of eight to fifteen weeks, eCBT led to a 50% improvement rate in symptoms of panic disorder, social anxiety disorder, generalized anxiety disorder, depression, obsessive-compulsive disorder, compulsive gambling disorder, stress, and chronic fatigue.

eCBT Criticism

Even with promising studies, there’s still some criticism of this form of therapy from both patients and therapists. However, most of the criticism is directed to automated programs that use automated bots instead of a certified therapist. Other criticism relates to some of the risks of online therapy, mainly when it uses text-based messaging:

  • Confidentiality risks. Not online databases have protection, and they’re prone to security breaches that can put your personal information and discussions with your therapist at risk.
  • Worsening of symptoms. In some CBT sessions, patients have to face their triggers directly. Without the supervision of an experienced therapist, someone might experience worsening symptoms.

What to Expect from Your First Session

The first session is always a bit intimidating. Nonetheless, online CBT might make the experience feel more comfortable. One of the benefits of cognitive-behavioral therapy is that instead of feeling like an interview, it feels more conversational. 

During your first session, your therapist will most likely ask questions about current and past emotional health and physical health to understand your situation better. At this point, they might discuss the possibility of other treatments, like group therapy or medications. 

Each session feels entirely different; CBT works in different steps or stages that help you make progress at a comfortable pace. Here’s a quick breakdown of what this means. 

Identify triggering situations. Remember that CBT is problem-focused, so your therapist wants to identify the conditions in your life that cause triggers, like a divorce, grief, or mental illness. You’ll start working on each of these problems at a time.

Bring awareness to thoughts, emotions, and beliefs about these triggers. Then, your therapist will encourage you to share your thoughts about these triggering situations. They’ll observe your self-talk about these issues to recognize any negative thought patterns. Your interpretation of these issues, other people, and events can be quite telling. 

Identify inaccurate thinking. We often tell ourselves different stories about what happened. We create our unique reality, and sometimes we don’t recognize the negative thoughts we build around our story. 

Reshape inaccurate thinking. At this stage, your therapist will ask you to confront your version of reality to analyze if you’re holding on to an erroneous perception of reality. It can be challenging to see our cognitive distortions, but with practice, you’ll be able to see it for yourself. Your therapist will then show you the tools to reshape your thinking and learn problem-solving skills to manage these triggers and behavioral patterns. 

How to Find Cognitive-Behavioral Therapy Online?

A psychotherapist is a general term that means psychiatrists, psychologists, licensed professional counselors, licensed social workers, and other licensed mental health professionals with mental health training can do psychotherapists. 

If you choose to attend addiction treatment, odds are they’ll have several psychotherapists on staff. Even still, to find a CBT therapist, you want to make sure that they:

  • Have the right education. Most psychotherapists have a master’s or doctoral degree with training in psychological counseling. 
  • Are certified and licensed. Make sure they meet the state certification and licensing requirements for their discipline. 
  • Have the right area of expertise. While all psychotherapists can treat a myriad of mental health conditions, you should look for one with experience treating your symptoms or area of concern. 

Who Can Do It?

A psychiatrist, psychologist, social worker, counselor, and other therapists can provide CBT services in a nutshell. However, if you’re looking to address a specific concern such as anxiety disorders, depression, post-traumatic stress disorder, or substance abuse, you need a specialist. Make sure you ask about their previous experience and find someone who aligns with your needs.


The average cost of cognitive-behavioral therapy online ranges between $20 to $250 per session, making it a cost-effective solution for many people. Nowadays, many telehealth providers offer monthly or yearly subscription packages for a set amount of access.

Unlike in-person sessions, online CBT can occur over the phone, via text messages, or through a video call. Because of this, there are many different payment structures available. Unfortunately, not all insurance companies will cover the costs of online therapy. 

Getting Help

Whether you choose to try it online or in-person, remember that CBT isn’t a magic cure for addiction, but it can give people the tools to cope with challenging situations healthily. Psychotherapy is a powerful treatment and a critical portion of addiction recovery. Besides, it gives people the right tools to achieve long-term recovery.

If you or someone you know is struggling with addiction, please seek help today. At Lighthouse Recovery Institute, our licensed and certified psychotherapists can help you navigate the ups and downs of addiction. Combined with other resources, including group counseling, family therapy, life skills development, and more, we can help you move away from addiction and start walking toward recovery. Don’t let addiction tell the story of your life. Take control of your story by seeking help today. 

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