In recent years, the advent of digital technology has ushered in transformative changes across numerous sectors, with mental health care standing prominently among them. Cognitive behavioural therapy (CBT), a widely recognized and effective psychological treatment for disorders such as anxiety and depression, is experiencing a significant evolution through its digital counterpart, internet-based or virtual CBT (eCBT). This transition reflects a broader shift towards client-centred care, emphasizing personalized treatments that adapt to individual needs and preferences. As the world recovers from the disruptions of the COVID-19 pandemic, the exploration of eCBT’s real-world application and effectiveness has gained unprecedented urgency and relevance.
Until very recently, CBT was predominantly delivered in in-person sessions, requiring both therapists and clients to meet physically in clinical settings. However, the onset of the pandemic created a pressing demand for accessible mental health solutions that transcended geographic and logistical barriers. Virtual CBT emerged not merely as a stopgap but as a potentially revolutionary method capable of extending the reach of mental health services. The digital format ostensibly offers greater flexibility and convenience, enabling clients to engage in therapy from their own homes or other comfortable environments. Nevertheless, despite promising outcomes in controlled experimental environments, the lived experiences of clients navigating between traditional in-person and virtual CBT have remained underexplored until now.
The study reported in BMC Psychiatry undertakes a thorough investigation into this very dichotomy, focusing on clients who have experienced both therapy formats. Conducted at Ontario Shores Centre for Mental Health Sciences, this research uses in-depth interviews with a carefully selected cohort of clients to dissect the nuances of therapeutic engagement in virtual versus face-to-face scenarios. Employing Braun and Clarke’s rigorous six-step thematic analysis method, the study illuminates the multi-dimensional aspects of therapy delivery and reception, extending well beyond efficacy to encompass relationship-building, client satisfaction, and empowerment.
One of the paramount themes that emerged from the research is the concept of accessing therapy in novel ways. Many participants found virtual CBT significantly more accessible due to its elimination of travel time, reduced scheduling conflicts, and enhanced privacy. These features collectively demystify mental health treatment, lowering barriers for individuals who might otherwise hesitate to seek help. This innovation aligns precisely with the evolving demands of modern healthcare ecosystems where flexibility is not a luxury but a necessity.
Building a foundational client-provider relationship remains central to therapeutic success, irrespective of the delivery mode. Interestingly, the findings underscore that while both virtual and in-person therapy can foster strong alliances, the nuances differ markedly. eCBT demands a recalibration of communication techniques to overcome the absence of physical presence. Therapists must cultivate digital rapport-building skills, utilizing verbal and non-verbal cues within a constrained technological medium. Clients who are comfortable with digital interactions often adapt well, yet for others, this shift can introduce a sense of detachment or decreased emotional immediacy.
Satisfaction with care emerges as a multifaceted construct deeply contingent on both the modality and individual client preferences. The study reveals that many participants report high satisfaction rates with eCBT, appreciating its flexible scheduling and the control it affords over the therapy environment. However, these positives are tempered by technical challenges such as connectivity issues, software usability problems, and occasional disruptions that can interrupt therapeutic flow. These obstacles not only affect session quality but may also interfere with the subtle dynamics of therapeutic communication, potentially undermining treatment outcomes.
Moreover, the environment in which clients engage therapy plays a crucial role in meeting their therapeutic needs. For in-person CBT, the clinical setting provides a distinct, neutral space conducive to focusing on mental health. Conversely, eCBT brings therapy into clients’ personal spaces, which can be both an advantage and a limitation. Familiar surroundings may encourage openness and comfort, yet domestic distractions or privacy concerns might compromise session effectiveness. This duality highlights the need for enhanced strategies to support clients in optimizing their virtual therapy environments.
Empowerment stands out as a significant and promising theme tied to digital therapy experiences. Clients often feel a heightened sense of autonomy when managing their therapy through eCBT platforms, including scheduling appointments and engaging with digital resources at their own pace. This empowerment is aligned closely with client-centred care principles, emphasizing collaborative decision-making and respect for client preferences. Importantly, empowerment acquired through virtual modalities can translate into sustained motivation and engagement, fundamental components of successful therapeutic trajectories.
The study’s findings resonate with larger systemic considerations facing mental health services globally in the post-pandemic era. As health systems increasingly integrate digital technologies, provider training assumes critical importance. Developing competencies in digital rapport-building and troubleshooting technical issues is indispensable for optimizing therapeutic alliances in virtual settings. Equally essential is addressing digital equity—ensuring all clients, regardless of socioeconomic status or technological literacy, can benefit from eCBT without encountering prohibitive barriers.
Crucially, the strengths and challenges identified in eCBT mirror those found in face-to-face therapy, demonstrating that neither modality is inherently superior but rather complementary. Clients’ comfort with digital platforms emerges as a key determinant in their therapy experiences, suggesting that personalized treatment plans incorporating client preferences could enhance engagement and outcomes. Hybrid models blending in-person and virtual sessions might also offer balanced approaches, maximizing accessibility without sacrificing therapeutic depth.
From a technological perspective, continuous innovation will be vital to refining eCBT delivery. Developments in secure platforms, user-friendly interfaces, and integration of multimedia therapeutic tools could further enhance efficacy and client satisfaction. Meanwhile, researchers and clinicians must remain vigilant to evolving client needs and emerging challenges, maintaining an adaptable stance towards virtual mental health care.
In sum, this groundbreaking study offers invaluable insights into the rapidly evolving landscape of cognitive behavioural therapy delivery. It challenges preconceived notions about virtual therapy and counters skepticism with empirical evidence of its viability and benefits in real-world settings. As mental health care moves decisively into the digital age, embracing client-centred approaches that recognize the unique merits and limitations of both in-person and virtual CBT will be paramount to effective, inclusive, and compassionate treatment.
By illuminating the interplay between technology, therapeutic relationships, and client empowerment, the research paves the way for future innovations and policy directives that will shape mental health service delivery for years to come. For practitioners, clients, and policymakers alike, these findings underscore an essential truth: the future of therapy is not exclusively digital or physical but integrative, personalized, and responsive to the diverse realities of those it aims to serve.
Subject of Research: Client experiences and perspectives on in-person and virtual cognitive behavioural therapy (CBT) modalities.
Article Title: Therapy in the digital age: exploring in-person and virtual cognitive behavioural therapy.
Article References:
Vizza, J., Riahi, S., Jackson, O. et al. Therapy in the digital age: exploring in-person and virtual cognitive behavioural therapy. BMC Psychiatry 25, 615 (2025). https://doi.org/10.1186/s12888-025-07063-0
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