Does online therapy work for anxiety?
Online CBT matches in-person outcomes for anxiety. For some kinds of anxiety it works better, because the work happens where the problem lives.
It is a fair question, and people ask it in a particular tone, as though they expect the honest answer to be no. Surely sitting in a room with someone is the real thing, and a video call is the compromise. I understand the instinct. The evidence does not support it, and for anxiety in particular, the picture is more interesting than a straight comparison.
What the research says
For the problems I treat, online CBT matches in-person outcomes for anxiety disorders. That is why online delivery is a standard option rather than a fallback.
The reason is that CBT does not depend on the room. It depends on the map we build of what keeps your anxiety going, on the experiments you run in your own week, and on reviewing what happened. None of that needs us to be in the same building. What it needs is a clear connection, a private space, and the work between sessions, which was always going to happen at home anyway.
Where online is easier
For a lot of people, the hardest part of therapy is starting, and online removes several of the barriers at once. There is no waiting room, which for social anxiety and health anxiety is often exactly the place where the fear is loudest. There is no journey, which matters if travel or public places are part of what you avoid. You are in your own space, which many people find makes it easier to say difficult things.
You can also have the camera off if that helps, and for some people, particularly autistic adults, that removes most of the load before we have even started.
Where online is better
For some kinds of anxiety, online is better, because the work can happen in the place where the problem lives.
Anxiety is specific to situations. The panic happens in your kitchen at night. The contamination fear is about your own bathroom. The worry starts in your bed. When we work online, you are in those places, and the experiments we design can happen there, sometimes during the session itself, with me alongside you on the call. In a therapy room, we would be talking about your kitchen. Online, we are in it.
For health anxiety, practising in your own environment is part of the work. For contamination OCD, the exposures happen at home rather than in a consulting room. For panic, the sensations can be brought on and tested in the place you usually fear them.
What you need
A private space where you will not be overheard for fifty minutes, a stable connection, and a device with a camera, though the camera is optional. Sessions run over a secure, private video link, notes are kept to the minimum, and data handling is ICO-registered.
The honest limits
Online is not for everyone. Some people simply prefer to be in a room, and that is a perfectly good reason to choose it. Some situations, a particular phobia exposure that has to happen somewhere specific, need planning around, though usually the planning happens online and the step happens in your own week. And if privacy at home is genuinely impossible, that has to be solved first.
I work online across the UK and worldwide, and see a small number of clients in person at Sanctuary Therapy Centre in Prestwich and Hebden Bridge. The fee is the same either way, and sessions can be in English or Spanish. For regulatory reasons I am not able to take on clients based in the United States.
If the idea of a screen has been the thing putting you off, there is more on how I treat anxiety, and the first call is a good place to ask about the practicalities.