Survey: Consumers open to digital psychotherapy treatment, but lean toward in-person care

Cost was highlighted as a major barrier to in-person care, while efficacy, access and confidentiality were cited as arguments against digital.
By Dave Muoio
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A survey of 164 US adults published last week in npj Digital Medicine suggests that while many individuals seeking psychotherapy for depression would consider a digital treatment with or without supplementary support, a one-on-one in-person visit is still the most popular option due to concerns of efficacy, access and confidentiality.

Topline data

Forty-nine percent of the survey’s eligible responders identified as a minority and 48 percent as living in a rural area. When asked to cite barriers they had previously faced when considering in-person psychotherapy, the participants cited cost (48.2 percent), insurance limitations (26.8 percent) and stigma (26.2 percent) as the most prevalent.

Seventy-two percent of the respondents said they would likely try a digital psychotherapy session in the future, a response rate similar to that regarding in-person care (73 percent).

However, when asked to pick a single care modality, respondents most frequently said that they would choose an in-person visit (44.5 percent) over a self-guided digital treatment (25.6 percent), a digital treatment with peer support (8.5 percent) or a digital treatment with expert support (19.7 percent). The researchers highlighted these individual response rates in their interpretation of the data, which crowned the in-person option as most popular among respondents; however, it is worth noting that, when taken together, the preference for care modalities that include any digital component did outweigh that of purely non-digital care.

Accompanying the survey was a qualitative, open-ended question regarding any concerns a respondent would have when choosing one of the four options. These responses fell within seven major categories: effectiveness of digital treatments compared to in-person care, access barriers, skepticism on self-guided therapy, social anxiety, confidentiality and privacy, concerns specific to peer support strategies and a general preference for in-person treatment.

How it was done

Researchers identified potential participants from Amazon’s Mechanical Turk participant pool for online consumer opinion surveys. Those considered were aged 18 years and older, and reported previously considering either psychotherapy or use of a self-guided treatment for depression.

Recruitment into the study occurred between November 2016 and April 2017, and consisted of two rounds. The survey’s questions were developed by the principal investigators and an advisory board survey, and consisted of structured questions for quantitative analysis as well as free text for qualitative analysis. The later was conducted by two response coders, with any identified themes verified by a third.

What’s the history

A fair number of digital depression therapy services and general telehealth offerings have sprung up over the past few years, with consumers and patients also becoming increasingly more aware of these options. That being said, there’s also plenty of published evidence suggesting that these technology-based services have yet to make a substantial impact on the mainstream.

In conclusion

“Concerns raised by respondents can be addressed through more rigorous research and dissemination of the efficacy of digital treatments and through better management of data security and privacy,” the researchers wrote. “We suggest transparency and proactive attempts to address potential concerns about treatment effectiveness, privacy and confidentiality concerns, and the specific training and professionalism of any peers used to supplement treatment. In clinical settings, this is best accomplished using shared decision making, a collaborative process whereby clinicians present patients with information regarding the medical condition and its treatment options, and patients inform clinicians about their values, goals, experiences, and preferences regarding treatment.”