Research supports online therapy, too. A 2018 analysis of 20 studies compared the effectiveness of online and face-to-face cognitive behavior therapy. This type of therapy helps patients change their negative thoughts and feelings. The study concluded that online cognitive therapy was just as effective as the in-person version for treating anxiety and depression.

There may be even more value in online therapy during the COVID-19 pandemic because you don’t have to take precautions such as wearing a mask during sessions, says Judson Brewer, MD, PhD, director of research and innovation at the Mindfulness Center at the Brown University School of Public Health in Providence, RI.

“You can see one another face-to-face, which is really important for therapists since 70-80% of all communication happens nonverbally,” he says. “I can see a patient’s facial expressions, which helps me better gauge their feelings.”

The bigger concern with online therapy is whether it can provide enough support for people going through moderate to severe depression, Bufka says. “If someone is going through a mental health crisis, my concern is that an online therapist won’t be able to intervene and get them to local resources that can provide emergency help,” she says.

Experts are more lukewarm about online text therapy, where you message your therapist in a secure chat window on your phone and they respond. “Emojis are a very weak substitute for body language and facial expression,” says Brewer, who notes that there’s very little research on this type of communication. This format may be good for someone with very mild depression, or suffering from a temporary bout of stress or anxiety, to test the waters, says Ashley Zucker, MD, chief of psychiatry, Kaiser Permanente in San Bernardino County, Southern California.

Nussbaum feels the same way about the automated app that she used. While she feels that right now it’s enough to get her through the stresses of the pandemic, she cautions that it’s not for everyone. 

“I view the … app as a stopgap for someone with depression and anxiety until they’re able to get into therapy, or as an adjunct for someone currently in therapy,” she says. “If you have something specific that is upsetting you, ultimately you want to talk to a person, not a robot.”

Find the Right App for You

If you are considering an online therapy or a mental health app, Bufka says, ask the following questions:

Is the therapist licensed in your state? “This does a few things: it demonstrates that the provider has met the minimum level of training, is in good standing, and gives you protection to file a grievance if things don’t get well,” Bufka explains.

Is the platform HIPPA compliant? All licensed therapists need to abide by patient confidentiality rules, whether therapy happens in person or online, Bufka says. Their site should say, under the privacy notice, that they use encrypted web-based platforms that are compatible with the Health Insurance Portability and Accountability Act. Some sites also have a “Shred” button next to each text message so you can delete your message history.

Is there research behind it? This is especially important for mental health apps, since “anyone can put one up on the app store,” Brewer says. Check the app’s website to see whether it has any published research behind it or was developed by someone at a major university. 

Ultimately, online therapy and apps can be a part of your overall self-care. “One of the best things about the app I used was that it required my full attention — I couldn’t look at it while I made dinner or was on my exercise bike,” Nussbaum says. “Just the act of sitting down to focus on it helped my mind stop racing. It encouraged me to relax, take some deep breaths, and cultivate mindfulness — all of which are so important.”