Online therapy helps – not just in the Corona crisis
24.06.2020 12:50
Like all doctors, psychotherapists cannot and do not want to leave their patients alone during the corona pandemic. At the same time, however, personal contact should be minimized in order to protect patients and practitioners from infection with SARS-CoV-2. The solution to this dilemma is video consultations, for which the therapist and patient are connected via an online video service. The German Society for Psychosomatic Medicine and Medical Psychotherapy (DGPM) reports that previous, mostly international, experiences with this mode of therapy have been positive. A German feasibility study now shows that the majority of patients and therapists are satisfied with the video consultation.
The PROVIDE project (funded by the Federal Ministry of Education and Research (BMBF)https://www.provide-project.de/) was initiated in 2016, long before the Corona outbreak. “At that time, the question arose as to whether video consultations could help to improve the widespread care of patients with mental illnesses,” says Dr. med. M.Sc. Psych. Markus Haun from the Clinic for General Internal Medicine and Psychosomatics at Heidelberg University Hospital, who leads the PROVIDE project. As part of the project, patients who visit their family doctor because of depression or anxiety disorders are offered the opportunity to receive psychotherapeutic treatment in their familiar family doctor's practice - through the involvement of a therapist who cooperates with the practice. The aim is to create a low-threshold offer that saves the patient additional journeys and the need to move to unfamiliar premises.
In interviews during the study, all 20 patients surveyed stated that the therapeutic relationship was positive and helpful. Only five of them rated the lack of personal interaction as a disadvantage, while others even found it easier or more pleasant to open up in a video conversation. The therapists also viewed the video consultations as practical and easy to carry out, but also more strenuous than face-to-face contact. “Despite initial skepticism, the three study therapists ultimately had no problems establishing a sustainable therapeutic relationship with their patients,” sums up Haun. For many patients, the spatial distance no longer played a role after a short time and a feeling of presence even emerged.
The PROVIDE study itself does not allow any conclusions to be drawn about the effectiveness of video-based therapy. “However, in other studies that compare psychotherapy conducted via video with traditional face-to-face therapy, no statistically significant differences could be found,” says Haun, referring to current reviews on the topic. Therapy success and symptom reduction are quite comparable here.
The biggest difficulty with online therapy seems to be of a technical nature: patients and therapists alike found disruptions in image and sound transmission to be a significant disadvantage; The stability of the Internet connection was therefore also the subject of most suggestions for improvement.
“Overall, high image quality with comparatively stable connectivity is already possible,” says Haun - and it can be assumed that the connection quality will continue to increase due to broadband expansion and advancing technological development. The Heidelberg doctor is therefore convinced that video consultations will remain an important alternative to face-to-face therapy even after the corona pandemic. Especially in the routine care of patients with limited mobility or people in rural areas, the new technology can be used outside of times of crisis.
Also Professor Dr. med. Harald Gündel, media spokesman for the DGPM from Ulm, sees advantages of video therapy: “Especially under special conditions and with special treatment constellations, the digital consultation gives us the opportunity to care for patients even over longer distances - be it because the relevant expert is not at home of the patient or because the patient has problems leaving the house.” The direct encounter between doctor and patient is still of central importance for psychotherapy, but video consultations could be used more frequently in the future to ensure comprehensive psychotherapeutic care. A large effectiveness study is currently underway in the PROVIDE project, which is testing whether multimorbid, severely physically ill patients who present directly to their family doctor's office with depression and/or anxiety can have better access to psychotherapy through video consultations with psychotherapists in usual care.
Source: Haun, MW, Hoffmann, M., Tönnies, J., Dinger, U., Hartmann, M., & Friederich, H.-C. (2020). Video consultations by psychotherapists in times of the COVID-19 pandemic: effectiveness, design of the setting and initial experiences from a feasibility study as well as with routine services in the hospital. Psychotherapist. https://doi.org/10.1007/s00278-020-00438-6