Preference for in-person psychotherapy versus digital psychotherapy options for depression: survey of adults in the U.S

Brenna N Renn,Patricia A Areán,Theresa J Hoeft,Heather Sophia Lee,Amy M Bauer

doi:10.1038/s41746-019-0077-1

Abstract

Several barriers complicate access to psychotherapy for depression, including time commitment, location of services, and stigma. Digital treatment has the potential to address these barriers, yet long term use of digital psychotherapy is poor. This paper presents data from a mixed-methods, online survey to document concerns patients with depression face when given the choice of in-person psychotherapy and digital psychotherapy. Participants were 164 adults living in the United States who had previously used or considered psychotherapy for depression. Rural-dwelling and racial/ethnic minority (Native American, African American, and Spanish-speaking) respondents were purposively sampled. Participants were asked their preferences for and opinions about four treatment modalities: self-guided digital, peer-supported digital, expert-guided digital, or in-person psychotherapy. Less than half (44.5%) of participants preferred in-person psychotherapy, 25.6% preferred self-guided digital treatment, 19.7% preferred expert-guided digital treatment, and 8.5% peer-supported digital treatment. Principal themes extracted from qualitative analysis centered on the efficacy of digital treatment, access to digital treatment, concerns about peer-supported care, confidentiality and privacy concerns, preference for in-person treatment, skepticism about self-guided therapy, and the impact of social anxiety on the use of video-chat based care. Future development of digital psychotherapy will need to address concerns regarding efficacy, privacy, data security, and methods to enhance motivation to use these treatments.

Highlights

Depressive disorders are prevalent and are a leading cause of disability, lost productivity, and health care expenditure.[1]
Despite the effectiveness and preferences for these treatments, most people who seek psychotherapy for depression only attend one session,[8,9,10] and in the US overall utilization by people with depression has declined from 15% in 1997 to 10% in 2007.11–13 At fault for poor utilization are transportation, time commitment, and supply-side barriers, with too few professionals living in rural areas
Of the 238 individuals who psychotherapy with a licensed clinician were more likely to reconsider this treatment in the future, compared to 64.4% of those without previous in-person psychotherapy experience (t(160) = −3.56, p ≤ 0.001)

Summary

Introduction

Depressive disorders are prevalent and are a leading cause of disability, lost productivity, and health care expenditure.[1]. The stigma that many cultural groups have related to seeking care is noted as an important utilization barrier.[14,15,16,17] A potential solution to overcome these barriers is providing treatment via digital means, such as on-line tools and mobile applications (apps). Digital psychotherapy consists of self-guided digital treatment, in which consumers use web-based and app-based care to apply therapeutic principles without any additional support; peerguided digital treatment, in which consumers use digital devices with access to trained peer support specialists who support and guide their use of the treatment program; and expert-guided digital treatment, in which consumers use digital devices with help from a professional. Healthcare organizations around the globe offer digital tools to their depressed patients and a new healthcare industry based on feefor-service, subscription based digital treatment has emerged in the US.[22]

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