Virtual Cognitive Behavioral Therapy For Mental Health Concerns
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Whether you’ve previously received therapy or are starting to research treatment options, you may have read about virtual cognitive behavioral therapy, a form of cognitive-behavioral therapy (CBT) delivered via video, phone calls, or chat, rather than in-person.
In recent years, virtual CBT therapy has gained attention for its potential to address various mental health concerns, including depression, anxiety, bipolar disorder, schizophrenia, and others. Since 2021, four out of 10 Americans have used online therapy. To understand whether you might join this statistic, looking at how CBT online is practiced and how it might benefit your life can be helpful.
What is virtual cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy is a form of talk therapy designed to help an individual better understand how thought patterns and beliefs are connected to emotions and behaviors. A CBT therapist, such as a clinical psychologist, counselor, or social worker, may start by helping clients identify unhelpful or destructive thought patterns in their life.
These might be catastrophizing, assigning blame, jumping to conclusions, confusing emotions with facts, or partaking in other cognitive distortions.
Once these patterns have been identified, the focus can shift to reframing and restructuring an individual’s thoughts, feelings, and behaviors, replacing them with more helpful or positive ways of thinking. According to the American Psychological Association, “the focus [of CBT] is primarily on moving forward in time to develop more effective ways of coping with life.”
Virtual CBT, online CBT therapy sessions, and self-guided CBT
While the word "virtual" may imply similar things, there are key distinctions between virtual CBT, online CBT, and self-guided CBT. Virtual reality CBT refers to therapist-guided CBT using technology to simulate environments and create interactive experiences tailored to address specific therapeutic goals, such as overcoming a phobia. Self-guided CBT refers to structured self-help CBT techniques, often delivered through video lessons.
In this article, online CBT therapy sessions (virtual CBT) refer to standard therapy sessions provided by a licensed therapist. The only distinction is that, rather than having sessions in-person, therapy is provided online, by phone, or via chat options.
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What mental illnesses can CBT treat?
Cognitive-behavioral therapies are widely supported as safe and effective treatments for various mental health conditions. These may include but are not limited to:
- Anxiety disorders
- Depressive disorders
- Phobias
- Eating disorders
- Substance use disorders
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
Cognitive-behavioral therapy is unique because it focuses on learning to recognize unhelpful ways of thinking, gain control over them, and reframe them more positively and constructively. For this reason, CBT can equip patients with the tools to address challenges in their lives as they arise.
According to the American Psychological Association, “CBT emphasizes helping individuals learn to be their own therapists.” This process can benefit their mental well-being in the short and long term.
What happens during online cognitive behavioral therapy?
Regardless of whether talk therapy sessions are conducted in person or via an online platform, the focus remains the same: identifying and restructuring unhelpful thought patterns and behaviors in daily life.
One of the differences between online cognitive-behavioral therapy and in-person CBT is the format. While in-person sessions are often conducted in an office setting, CBT online can be administered via a video call, instant messaging, or a voice call, depending on your preferences.
What to expect in your first session?
Your mental health services provider may choose to start with an initial talk therapy session designed to get to know you better. After outlining goals, they can begin helping you address your life circumstances, current challenges, and mental well-being concerns.
Therapists might also inquire about your point of view, thoughts, feelings, and beliefs. These mental health professionals can then teach you how to question, control, and reframe the thoughts that are causing you distress. Like in-person cognitive behavioral therapies, CBT online providers may use various other techniques to help you improve your relationship with your thoughts. These may include:
- Role-playing exercises
- Journaling
- Stress-reduction techniques
- Mindfulness and mediation
- Combining (VR) exposure therapy with CBT
Your therapist may also provide you with additional exercises or “homework” assignments designed to help you put the strategies you’ve discussed into practice in your everyday life. Depending on your situation, they may recommend complementary practices like self-care or group counseling designed to maximize the benefits you receive from your therapy sessions.
How about medication?
CBT therapy involves psychotherapy provided by a therapist. Usually, a therapist cannot prescribe medication. However, a therapist may collaborate with a prescribing doctor, such as a psychiatrist, to create a holistic treatment plan and coordinate care for the individual taking medication.
Paying for online therapy
The cost of online therapy is usually more affordable than what you pay for in-person therapy. Virtual CBT therapy costs and insurance coverage vary by insurance provider, plan, and location. Depending on the state, online therapy costs may be covered by insurance, and some insurance providers may offer reimbursement for out-of-network providers, especially for individual therapy for a mental health condition. Additionally, online therapy platforms may also offer financial aid to those who qualify.
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Supporting a loved one between online CBT therapy sessions
It can be challenging to change entrenched patterns of thinking and behaving. If your loved one is attending online CBT therapy sessions, they will likely be doing "homework". Homework may include:
- Journaling
- Cognitive restructuring exercises
- Relaxation exercises
- Practicing mindfulness .
It can be helpful to support their process by respecting their boundaries, practicing active listening, and managing your own expectations during their therapeutic journey.
Bringing a loved one into therapy
In some cases, bringing a loved one into therapy can enhance the therapeutic process. If this is something you wish to explore, you can discuss it with your therapist. Often, bringing a loved one into therapy will require consent from a therapist and establishing new expectations for the process.
Getting support through online therapy
Despite the difference in setting, online cognitive-behavioral therapy has gained widespread attention for its affordability, convenience, and effectiveness. For those with a limited number of local resources, busy schedules, or mental health conditions that may make it difficult to leave the house, like depression and anxiety disorders, the ability to attend therapy sessions from the comfort of home and virtual environment may be beneficial. Having the ability to message a therapist at any time of day may also be helpful for those who need additional guidance and support. For instance, you can use in-app messaging to ask your therapist how to implement the strategies from your CBT sessions in your everyday life.
A 2017 systematic review and meta-analysis, which included a randomized controlled trial, found that internet-based CBT is an effective and cost-efficient treatment for conditions like depression, panic disorder, specific phobias, bipolar disorder, and generalized anxiety disorder. A separate original publication from 2020, which included data collection and a randomized controlled trial, found that electronically-delivered CBT was at least as effective at reducing symptoms of depression as in-person CBT.
Many researchers are continuously evaluating the efficacy of CBT online work compared to traditional therapy.
If you are interested in exploring virtual cognitive-behavioral therapy, you can connect with a licensed therapist through an online platform like BetterHelp, which offers access to over 30,000 licensed therapists, with many specializing in CBT. Regardless of whether you choose to start therapy in person, online, or in a virtual reality (VR) environment,cognitive-behavioral therapy could be the first step toward building a healthier relationship with your thoughts and behaviors.
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Takeaway
What is virtual cognitive behavioral therapy (CBT)? Can therapists conduct these sessions?
Virtual cognitive behavioral therapy (CBT) is a form of talk therapy conducted in a virtual reality (VR) environment to treat a wide range of mental health issues listed in the DSM-5 diagnostic criteria, including panic disorder, phobias, bipolar disorder, posttraumatic stress disorder, generalized anxiety disorder, depression, and other psychiatric symptoms. Therapists can conduct sessions with their clients through video calls or messaging, offering flexible guidance and support.
Can you do CBT via Zoom?
Patients can do cognitive-behavioral therapy (CBT) with a therapist via Zoom; however, Zoom isn’t always guaranteed to stay unpublicized. Online therapy platforms like BetterHelp use their own video platforms more tailored for talk therapy sessions.
Can online CBT work?
The effectiveness of CBT online work has been demonstrated in numerous research and data analyses that suggest online or virtual CBT is as effective as CBT delivered in person for a variety of mental health conditions. For example, researchers from Queens University and the University of Toronto found comparable significant improvements in depressive symptoms and quality of life between patients treated for major depressive disorder online and in person. They also determined that participant patients in the virtual CBT group had higher adherence to treatment than patients in the in-person group.
What is the main focus of virtual cognitive behavioral therapy?
The primary focus of virtual cognitive behavior therapy is to help patients learn to identify problematic, negative patterns of thinking that contribute to emotional stress. Main CBT goals involve reframing them through skills practice to reflect more realistic, positive ones in a virtual environment. CBT treatment is an evidence-based approach operating on the premise that our thoughts, feelings, and behaviors are interconnected, and by altering unhealthy thoughts (cognitions) and behaviors, we can improve mental well-being and problem-solving skills. Below are the primary focuses of virtual CBT.
Identifying faulty thinking
CBT treatment is an evidence-based approach in which a therapist helps clients recognize cognitive distortions and negative patterns of thinking that contribute to emotional and psychological distress. For example, one might tend to expect the worst possible outcome (catastrophizing), even if there’s no reason to think that’s what will happen.
Challenging and reframing faulty thoughts
Once negative patterns of thinking are identified, cognitive-behavioral therapy (CBT) guides clients in questioning their accuracy and validity. Then, the client can follow up on this process by reframing or reimagining them as more realistic, balanced, and constructive.
Changing behavioral patterns
In cognitive-behavioral therapy (CBT), a therapist helps individuals identify unhealthy or maladaptive behaviors and replace them with healthier, more productive alternatives. For example, avoiding social situations due to anxiety might be replaced with gradual exposure to those situations.
Developing coping skills
In CBT treatment, a therapist teaches practical techniques and strategies to help clients cope more effectively with daily challenges. For example, the client might learn stress management techniques like deep breathing or body mindfulness. Part of this process also includes building communication and problem-solving skills.
Improving emotional regulation
Clients can gain better control over their emotional responses by changing destructive thoughts, feelings, and behavioral patterns. This can help reduce severe anxiety and alleviate depressive symptoms, anger, or fear.
What is virtual cognitive behavioral therapy?: What is an example of a CBT treatment?
There are several techniques that a therapist can combine to create a cognitive-behavioral therapy (CBT) treatment plan tailored to the individual. Treatment follows a structured approach, combining cognitive restructuring with behavioral interventions. Here’s an example of how counselors might use cognitive-behavioral therapy (CBT) and exposure therapy techniques to help a person with social anxiety:
- The CBT therapist first helps the individual identify the negative thoughts and feelings contributing to the issue. For example, the person might think, "If I speak in public, people will laugh at me," or "I’ll embarrass myself, and everyone will think I’m incompetent."
- The CBT therapist then guides the individual in challenging the accuracy of those thoughts. The client may be asked follow-up questions like, "What evidence do you have that people will laugh at you?" or "Is it really true that everyone will think poorly of you if you make a small mistake?"
- Once the individual understands that their negative thoughts may not be accurate, they work with the CBT therapist to control and reframe them. For example, they might develop alternative, more realistic thoughts such as, "Most people won’t even notice if I make a small mistake," or "Even if someone disagrees with my point, that doesn’t mean I’m incompetent."
- Once the individual understands how to control and reframe their distressing thoughts and feelings, they are gradually exposed to the situations they fear, beginning with less anxiety-provoking scenarios and slowly working their way up to more difficult ones. For example, they might start by speaking up in a small, supportive group of friends. Then, once they feel more comfortable, they might practice giving a short presentation in front of a few colleagues. Finally, they gradually build up to larger social situations, like giving a public speech or attending a large social gathering.
The CBT therapist may assign "homework" to practice these skills in real-life situations between sessions. For example, they may ask the person to start a conversation with a stranger or speak up during a meeting. The CBT therapist and individual regularly review progress throughout the therapy process, noting improvements in managing anxiety and building complete confidence in social situations.
CBT treatments may also include guided meditations or visualizations to recall events causing emotional distress. This allows the individual to understand better their effects on thoughts, emotions, behaviors, and mental well-being. Then, the CBT therapist and client work together to find practical solutions and productive ways to cope with them.
Is virtual CBT free?
Virtual CBT or online cognitive behavioral therapy sessions are not usually offered for free, but there are free online CBT resources. For example, UK-based ThinkCBT offers free downloadable worksheets and exercises. The Cognitive Behavioral Therapy Blog, courtesy of Dr. Albert Bonfil and CBTLA, also provides a wealth of information on CBT and an open-access article distributed and free CBT course and workbook.
Moreover, there are many low-cost CBT teletherapy options, and some people receive insurance coverage for telehealth. What usually affects costs for telehealth include:
- Therapist location
- Session frequency
- Therapy platform
- Therapist credentials
- Type of insurance (if any)
Can you do cognitive behavioral therapy virtually?
Yes, cognitive behavioral therapy may be conducted virtually by a licensed therapist. Many therapists now offer online therapy, enabling individuals to receive therapy via phone, video, or chat.
What are the 5 steps of CBT?
The five steps of cognitive behavioral therapy can refer to cognitive restructuring, an essential technique used in CBT to examine your thoughts when you feel distress about a situation. Step one involves writing down the upsetting situation in one sentence or two. Step two involves identifying a strong feeling that the situation triggered, such as anger or sadness. Step three asks you to identify the underlying thoughts that accompany the feeling, and identify one main thought that brings distress. Step four asks you to evaluate the accuracy of those thoughts, making you logically question evidence that supports the thought, and consider the evidence that doesn't support it, such as asking yourself, "Is there another way to see this situation? Another explanation?" Step five invites you to determine the accuracy of the thought based on the evidence you listed in step four. Often, this last step allows a person to see how their thoughts about the situation might be interpreted or reframed in a different light.
Is online CBT as effective as in-person?
Findings indicate that online therapy can be equally effective as in-person therapy sessions for addressing many mental health concerns, such as anxiety and depression. For example, one recent study suggests that online therapy can be an "empowering alternative" to in-person therapy. However, CBT may not be suitable for every person and mental health condition.
What should I expect at my first session?
Often, your first therapy session offers an opportunity to establish rapport with your therapist and get a sense of who they are. During this session, your therapist will go over expectations, confidentiality, and boundaries. Then, they'll likely ask you what brings you to therapy and help set goals for therapy. Often, Most likely, your therapist will also cover the basics of their approach and modality used, such as the principles of cognitive behavioral therapy, and answer questions you may have.
Does insurance cover online CBT and how do I check coverage with my insurance provider?
Many insurance companies cover online therapy, but the level of insurance coverage can vary greatly. For example, you may have a smaller co-pay with an in-network provider and higher out-of-pocket costs with an out-of-network provider, even if you receive a reimbursement. Employee assistance programs (EAPs) also often cover insured members seeking mental health services online. To check your plan, you may need to review what they cover. Some ways to check your coverage include contacting the customer service number on the back of your card, reviewing your insurer's site, or the your provider’s brochure/documents received by mail.
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