Cognitive behavioral therapy delivered electronically to treat people with depression is more effective than face to face, suggests an evidence review led by McMaster University.

Based on randomized control trials, the systematic review and analysis revealed that cognitive behavioral therapy that connected therapists and patients through such modes as web-based applications, video-conferencing, email and texting, improved patients' symptoms better than face to face when measured using standardized mood symptoms scales. As well, there was no difference in the level of satisfaction or function between the two methods of delivery.

The details were published in EClinicalMedicine, published by The Lancet.

"Although this study started before the current COVID-19 pandemic, it is timely and assuring that treatment delivered electronically works as well if not better than face to face and there is no compromise on the quality of care that patients are receiving during this stressful time," said corresponding author Zena Samaan, associate professor of psychiatry and behavioral neurosciences at McMaster and a psychiatrist at St. Joseph's Healthcare Hamilton.

Cognitive behavioral therapy is a type of psychotherapy widely used to treat depression. However, limited resource availability poses several barriers to patients seeking access to care, including lengthy wait times and geographical limitations.

In this evidence review, researchers identified 17 randomized control trials comparing therapist-supported cognitive behavioral therapy delivered electronically to face to face cognitive behavioral therapy. The studies were conducted between 2003 and 2018 in the United States, Australia, Netherlands, Switzerland, Sweden and the United Kingdom.

Samaan said the findings of the meta-analysis debunk widely-held perceptions about psychotherapy.

"The common understanding was that face to face psychotherapy has the advantage of the connection with the therapist and this connection is in part what makes the difference in treatment," she said.

"However, it is not surprising that electronic interventions are helpful in that they offer flexibility, privacy and no travel time, time off work, transport or parking costs. It makes sense that people access care, especially mental health care, when they need it from their own comfort space."

Samaan noted that the findings support advocacy and widespread implementation of electronic cognitive behavioral therapy.

"Electronic options should be considered to be implemented for delivering therapy to patients," she said. "This can potentially vastly improve access for patients, especially those in rural or underserved areas, and during pandemics."