Preference for In-Person Psychotherapy versus Online Psychotherapy Options for Depression: Survey of Adults in the U.S. (Preprint)
Authors: Renn Brenna Nikole , Lee Heather Sophia , Bauer Amy M. , Areán Patricia A. , Hoeft Theresa J. 
Published: May 2018

BACKGROUND

Several barriers complicate access to psychotherapy for depression, including time commitment, location of services, and stigma. Online mental health treatment is a potentially viable and efficacious delivery route that can overcome these barriers. However, a recent study in Australia found low consumer preference for these modalities, and other studies from the UK and Australia have found poor initial adoption and long-term adherence to online treatment. Given the efficacy of online treatments and the potential for such treatments to address service gaps in mental health, it is important to understand why people do not avail themselves of these treatments so that accommodations can be made to make them more appealing.

OBJECTIVE

The purpose of this study is to document consumer preferences for self-guided online treatment, peer-supported online treatment, expert-guided online treatment, or in-person psychotherapy, and the reasons that drive preferences.

METHODS

This complementarity mixed methods study was based on cross-sectional survey data collected online using Amazon Mechanical Turk (MTurk). Participants were 164 adults living in the United States who had previously considered psychotherapy for depression; half (49.4%) of the respondents had previously undergone individual in-person psychotherapy. Rural-dwelling and select racial/ethnic minority (i.e., Native American, African American, and Spanish-speaking) respondents were purposively sampled. Participants were asked their preferences for four treatment modalities: self-guided online, peer supported online, expert-guided online, or in-person psychotherapy. They were also asked to provide information about concerns about each type of therapy, and what questions they would ask their doctor if offered each type of therapy.

RESULTS

44.5% of participants preferred in-person psychotherapy, 25.6% preferred online self-guided treatment, 19.7% preferred expert-guided treatment, and 8.5% peer-supported online treatment. Principal themes extracted from qualitative analysis were questions and concerns about the efficacy of treatment, skepticism about self-guided therapy, unease with treatment modality, preference for a specific modality, confidentiality and privacy concerns, access barriers, and concerns about peers. Some participants indicated that self-guided online options provided a desirable alternative to traditional psychotherapy (e.g., offset access barriers), but most felt this treatment would be least desirable in the future because of questions about effectiveness and concerns about the lack of accountability and self-efficacy incumbent upon those using self-guided treatment. Participants were also concerned about the efficacy of peer-supported online treatment because of concerns regarding peer training and roles. Online treatment was also seen as less appealing because of concerns regarding data safety and privacy. Finally, in-person psychotherapy was seen was the most desirable treatment, but many participants reported challenges with accessing this care because of transportation, time, and cost of care.

CONCLUSIONS

For online treatments to be more acceptable to U.S. populations, concerns regarding privacy, data security, and methods to enhance motivation to use these treatments must be developed and addressed.