Chronic conditions like cancer, cardiovascular disease and diabetes carry more than a biological burden; there are powerful and debilitating psychological consequences of receiving such a diagnosis and living with long-lasting, often fatiguing and painful symptoms. For this reason, psychological counselling is often recommended alongside physiological treatments—but many people lack access, means or time for therapy.
Online therapy is an attractive, low-cost, highly accessible option in such cases, but the evidence regarding its efficacy is scattered. To gain a clearer picture of the effectiveness of online therapy in treating chronic disease-related mental health problems, a team of Australian research conducted a metastudy of 70 studies across 17 health conditions. Their paper, published in Psychological Medicine, sheds light on the current state of empirical affairs.
The study included papers involving populations with cancer, chronic pain, arthritis, multiple sclerosis, HIV, tinnitus and other hearing problems, epilepsy, psoriasis, chronic fatigue and spinal cord injury (in order of decreasing frequency).
Their findings demonstrate a grand diversity in the approaches taken, including goal setting, mindfulness, journaling, and discussion boards, although a majority of the studies (66%) were based on CBT principles. However, a few common threads appear from the data.
First, the presence of a facilitator increased effectiveness in treating depression, but not anxiety or psychological distress. Second, studies using CBT-based interventions were significantly more effective at treating anxiety and psychological distress, but not depression. These findings underscore the importance of adapting approaches to whatever symptoms are most severe in subjects.
Moreover, though, the metastudy highlighted some gaps in the literature. Certain health conditions, like cancer and chronic pain, benefited from population sizes able to yield statistically significant results. Others, however, like arthritis and heart disease, are underrepresented in the literature and will require additional testing.
In all domains, additional, high-quality randomized control trials (RCTs) are required to evaluate the efficacy of online and self-guided therapy for treating chronic disease-related health conditions. Additionally, a majority of the studies reported fewer than 70% completion of intervention, emphasizing the importance of crafting simple and, most of all, engaging programs.
Online therapies have great potential for enabling a larger portion of those living with chronic diseases to access psychological support and lead happier lives, but more research is needed to understand the particularities and design truly effective programs.
