Online therapy counters the needless stigma around mental health

Have you ever sat in the waiting room of a psychotherapist? Whenever I have, I have felt uneasy, partly from being in unfamiliar surroundings among strangers.

Much of the apprehension, however, is due to the social stigma that can attach itself to mental health issues. All sorts of questions arise: what if someone I know sees me here? What if they spot me entering or leaving, what will they think?

Like in other parts of the world, one of the barriers to accessing psychotherapy in the UAE is stigma. Ill-informed beliefs and unkind attitudes cause some people to ridicule or exclude people experiencing mental health issues.

In close-knit, collectivist societies such stigma can go beyond an individual, affecting the reputation of the entire family.

The fear of stigmatisation – becoming the victim of stigma – keeps many people from seeking professional help. In some cases, such denial and avoidance can have tragic consequences. Problems left untreated frequently get worse. Accessing support, where available, makes far more sense than staying silent. For some, that eventually becomes too much to bear. People can reach a crisis point, and the only option at that stage might be intensive psychiatric care – involuntarily.

The Covid-19 pandemic might inadvertently be helping remedy these long-standing and interconnected issues of mental health stigma and the under-utilisation of mental health services that are available to us. One of the positives slowly emerging from the pandemic is improved access to psychological therapies, in the form of high quality online mental health services. The enhanced privacy and anonymity afforded by online psychotherapy allows us to side-step stigma. The problem of being spotted walking in to the psychotherapist's office is eliminated.

People who out of fear of social stigma don't seek professional help may do well to consider online therapy. Similarly, communities and localities with limited access to traditional face-to-face therapists now have a world of online options.

In at least some forms of psychotherapy, the online version of the intervention can be as useful as its face-to-face equivalent. A review of studies comparing online cognitive therapy with the traditional in-person approach was published in the peer-reviewed journal World Psychiatry in 2014. Both forms of cognitive therapy, online and in person, were found to be equally effective for the range of conditions studied, which included depression and anxiety.

Personally though I much prefer in-person communication for all situations, from meetings to classes to job interviews. There is something about physically being present in a room with a person that gets lost in digitally mediated interactions.

Subtle paraverbal cues, such as body language and tone of voice, can be much more challenging, if not impossible, to detect during our small-screen interactions. Sometimes, though, necessity overrules our preferences, and in-person becomes out of the question.

Measures such as self-isolating, quarantine and physical distancing that we have seen during the pandemic have both increased the demand for psychotherapy and also, in many cases, necessitated the use of digital mental health services. The frequency of people worldwide googling the term “online therapy” shows a massive spike for March 2020, and this increase has yet to return to pre-pandemic levels.

Similarly, US-based Talkspace, one of the more well-known online therapy services, reported rapid growth in its traffic since February. Some of this increase is accounted for by help-seekers from new territories in Asia and Europe. Online therapists can have an international client list from locations across the world.

This increased demand, along with measures to contain the spread of coronavirus, has forced many psychotherapists to use technologies that they once ignored. There are now also numerous courses popping up to help therapists work more effectively online. Covid-19 seems likely to have a lasting impact on how we seek and deliver psychotherapies, with online offerings becoming a far more frequently accessed option.

The increasingly widespread availability of online therapy will indirectly help erode mental health stigma. More people seeking help, even online help, will lead to the further normalisation of psychological complaints in general. Having more accessible, evidence-based psychotherapies – online or otherwise – could help reduce much of the suffering in our societies.

Since 2003, September 10 has been designated World Suicide Prevention Day. Facilitating greater access to psychological therapies is a crucial strategy in the global effort to prevent suicide, a leading cause of death for young people, responsible for an estimated 800,000 lives lost each year.

While online therapy might not always be everyone’s first choice, some help is better than none at all. Just having someone to listen to us is often enough to engender the hope and optimism required to get through a tough time.

Justin Thomas is a professor of psychology at Zayed University