New evidence supports online therapy as a viable alternative to in-person care
The transition to online mental health care during the COVID-19 pandemic was abrupt and uncertain. A large Swedish study tracked 2,300 patients treated in public mental health services over six years—three years before and three years during the pandemic—to evaluate whether remote care could match traditional, face-to-face therapy.
The researchers focused on common conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). They found that nearly half of all visits shifted online during the pandemic (up from 4% before the crisis). Importantly, treatment outcomes remained stable despite the rapid switch to digital formats.
Why online care worked, and what this means for patients
Although the exact reasons aren’t fully understood, the study suggests that the core elements of effective therapy—building trust between patient and therapist, applying evidence-based treatments, and regular follow-ups—can still be delivered successfully through video or telehealth platforms. In some cases, video meetings may even reduce barriers to attendance, making it easier for people to engage with care from the comfort of their own homes.
The findings indicate that quality care matters more than the delivery method. When treatment is implemented with proven methods and ongoing monitoring, online therapy can achieve outcomes comparable to in-person sessions.
Practical benefits beyond the therapy room
Remote care offers practical advantages for daily life. It can be especially beneficial for people who live far from clinics, have mobility challenges, or juggle demanding schedules. During a health crisis, maintaining continuity of treatment through online sessions likely helped many individuals stay on track and avoid lapses in care.
These advantages need to be weighed against limitations. The Swedish study did not include children, individuals in acute psychiatric crisis, or those with severe psychotic disorders—groups that may still require in-person care. Access to privacy, stable internet connectivity, and the ability to engage via a screen are also prerequisites for effective online therapy, and such conditions aren’t guaranteed for every patient.
What clinicians did to ensure success online
Turning on a webcam alone does not guarantee good outcomes. The clinics involved in the study adhered to established treatment protocols and closely monitored patient progress. This combination of rigorous clinical practice and careful follow-up is likely a key factor behind the success of remote care during the study period.
Implications for mental health systems
The results support a broader view of online mental health services as a permanent component of care—not merely a stopgap during emergencies. When well implemented, remote care can match in-person treatment in effectiveness, even amid challenges like a global pandemic.
There is no universal model that fits everyone. Some patients may thrive with online therapy, others may prefer or require in-person sessions. The overarching lesson is clear: offer choice and maintain high standards of care regardless of delivery method. The aim is to ensure that care happens, and that it works, no matter where it occurs.
Fabian Lenhard, a researcher in the Department of Clinical Neuroscience at Karolinska Institutet, emphasizes that the study’s takeaways point to a future where online therapy is an integral, enduring option in mental health care.
