Video-conferencing brings therapists to patients with anxiety

(Reuters Health) - Talk therapy for anxiety disorders can be effective even when done via video-conference, a new study confirms.

This finding could be especially helpful for patients in underserved and rural areas, researchers write in Family Practice.

Nearly one in three U.S. adults suffer from an anxiety disorder at some time in their lives, according to the National Institute of Mental Health (NIMH). There are many effective treatments, including medications and different forms of psychotherapy.

But according to the U.S. Department of Health and Human Services, 55 percent of U.S. counties have no psychiatrists. Other barriers to treatment include a lack of other trained mental health providers, distance to care, and difficulty making appointments.

For the new analysis, researchers reviewed 21 earlier studies on delivery of psychological counseling for anxiety disorders via video conference, including six gold-standard randomized trials that compared video therapy to traditional face-to-face therapy. Ten of the studies were conducted in the U.S., five in Canada and six in Australia.

Fourteen of the studies reported statistically significant improvements in anxiety and 11 reported clinically significant improvements, meaning the improvements made a difference in patients’ daily lives. Four of the six gold-standard trials found statistically significant improvements with video therapy, and five of the six found clinically significant improvements.

One limitation of the analysis is that most of the studies focused on middle-aged adults.

“Telemedicine is a burgeoning area for mental illness. I hope this study will move the research forward and hope it will provide more opportunities for individuals to receive mental health services, especially in rural areas and areas of mental health disparities,” lead author M. Blake Berryhill of the University of Alabama in Tuscaloosa told Reuters Health by phone.

“There needs to be more collaboration between physicians’ offices and mental health providers,” Berryhill said. “I think it is important for providers to offer evidence -based practices like this for treating anxiety.”

Michael Schoenbaum, senior advisor for mental health services, epidemiology, and economics at the National Institute of Mental Health in Bethesda, Maryland, told Reuters Health by phone, “The authors point to some really important issues in the world. Anxiety disorders are pretty common. They can be pretty disabling. We have effective treatments for them. Many people who can benefit from them don’t receive the treatment in actual practice. One major reason is because it’s difficult for people to find a therapist.”

More research on the topic would be helpful, but still, “there is evidence that psychotherapy for anxiety via videoconference is a plausible approach for treatment,” said Schoenbaum, who was not involved in the research.

Dr. Ravi N. Shah, a psychiatrist at Columbia University Irving Medical Center in New York City, sees some of his patients via video-conference. “Patients who already know me and work with me find it’s a great addition,” Shah told Reuters Health by phone.

What’s tricky is that therapists have to slightly change their tactics when using video conferencing, said Shah, who was not involved in the new research.

“In psychotherapy sessions in my office I might use silence as an intervention to give patients time to think . . . Silence can’t be used with the same power and efficacy in a telehealth session as in person. If I try the same intervention in the context of telehealth session, patients will think there’s a glitch in things,” he said.

SOURCE: Family Practice, online September 4, 2018.