Online therapy matches the patchwork of in-person care, even during a crisis
The rapid shift to online therapy during the COVID-19 pandemic was a global experiment in mental health care. In Sweden, researchers tracked 2,300 patients over six years – three years before and three years during the pandemic – to see whether treatment outcomes held steady when visits moved online. The result: online care did not undercut effectiveness. For common conditions like depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD), outcomes remained stable even as nearly half of all visits were conducted virtually during the crisis (up from 4% before the pandemic).
What the study measured and what stayed the same
The researchers followed patients in Sweden’s public mental health system, comparing pre-pandemic and pandemic-era data to assess whether the delivery format influenced recovery. The findings suggest that the core elements of good therapy – a strong therapeutic alliance, evidence-based interventions, and consistent follow-up – can be preserved in a remote setting. In other words, the essential ingredients of effective treatment aren’t confined to face-to-face meetings.
Key conditions studied
Across depression, anxiety, PTSD, and OCD, the study monitored symptom trajectories and engagement with care. Even with a rapid scale-up of telehealth, outcomes did not deteriorate. This aligns with broader questions about whether the modality of delivery matters as much as the quality of care itself.
Why online care can work—and for whom
One possible reason online therapy performed as well as in-person care is that online formats can lower barriers to attendance. Video meetings can be more convenient for people who live far away, have mobility challenges, or juggle demanding schedules. During a health emergency, telehealth also helps people stay connected to treatment without exposing themselves to risk.
Another factor is that clinics in the study adhered to proven therapies and maintained careful monitoring of patient progress. The evidence-based backbone of care remained intact regardless of whether the patient and therapist sat in the same room or connected via a screen. When implemented well, online therapy can replicate the structure, accountability, and supportive environment that patients need to recover.
Limitations and caveats
It’s important to note what the study did not include. Children, individuals in acute psychiatric crises, and those with severe psychotic disorders were not part of the analysis, and they may still require in-person care. Access to private space, stable internet, and the ability to engage through video are also prerequisites for effective remote care, which isn’t available to everyone. These factors underscore that online therapy isn’t a universal substitute for all patients or all situations.
Implications for practice: a flexible, quality-driven model
The study’s takeaway isn’t a call to abandon in-person therapy. Rather, it emphasizes flexibility: patients should have a choice, and healthcare systems should maintain high standards of care no matter the delivery method. Online therapy, when integrated with robust clinical practices, offers a resilient option that can sustain continuity of care during crises and improve access for many people in routine times.
A new normal for mental health care
Prior to the pandemic, online therapy was growing but often viewed as supplementary. The Swedish findings suggest that remote care can be a central component of mental health services going forward. The goal is clear: ensure that every patient receives evidence-based treatment, regular follow-up, and a strong therapeutic relationship—whether in a clinic, at home, or somewhere in between.
In the end, what matters most is not where therapy happens, but that it happens and that it works.
