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. 2025 Jul 1;25(1):615.
doi: 10.1186/s12888-025-07063-0.

Therapy in the digital age: exploring in-person and virtual cognitive behavioural therapy

Julie Vizza  1 , Sanaz Riahi  2   3 , Olivia Jackson  4 , Christen Potvin  5 , David Rudoler  6   7
Affiliations

Therapy in the digital age: exploring in-person and virtual cognitive behavioural therapy

Julie Vizza et al. BMC Psychiatry. .

Abstract

Introduction: The adoption of client-centred care has become a foundational principle in mental health treatment, prioritising interventions tailored to the unique needs and preferences of clients across settings. Virtual or internet-based cognitive behavioural therapy (eCBT) has emerged as an effective, cost-efficient alternative to traditional, in-person CBT for a variety of mental health conditions, including anxiety and depression. Initially explored in experimental settings, eCBT gained substantial use during COVID-19, when the demand for accessible, remote mental health services were needed. Despite its broad implementation, limited research exists on the real-world experiences of clients who have participated in eCBT, particularly regarding its strengths and challenges compared to in-person therapy.

Objectives: This study aimed to (1) explore the experiences of clients who have participated in both in-person CBT and eCBT, and (2) identify strengths and challenges associated with each modality from the client's perspective.

Methods: Clients were recruited from three outpatient clinics at Ontario Shores Centre for Mental Health Sciences in Whitby, Ontario. In-depth interviews were conducted with twelve clients between June and December 2023. Transcripts were analysed using Braun and Clarke's six-step approach to thematic analysis.

Results: Five main themes emerged from the data: (1) accessing therapy in a new way; (2) building a foundation for care: the client-provider relationship; (3) satisfaction with care; (4) addressing clients' needs in the environment; and (5) client empowerment. Many clients expressed high satisfaction with eCBT, citing factors such as ease of access, flexibility, and the perceived effectiveness of virtual sessions in fostering mental health support. However, clients also noted challenges with technology, which could impact therapeutic engagement and the quality of the client-provider relationship.

Discussion: The strengths and challenges identified in eCBT parallel those encountered in in-person settings, though eCBT was particularly appreciated by clients comfortable with digital environments. These findings emphasise the importance of client-centred care in virtual contexts, including the need for provider training in digital rapport-building and consideration of technological barriers. Ultimately, insights from this study can inform the refinement of eCBT delivery and support tailored approaches that align with the diverse needs of mental health service users in post-pandemic healthcare landscapes.

Keywords: Client-centred care; Cognitive behavioural therapy; Internet-based therapy; Mental health; Mental health services; Qualitative research; Thematic analysis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study adhered to ethical principles outlined by the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS-2) and was conducted in accordance with the ethical standards set forth in the Declaration of Helsinki. Ethical approval was obtained from a joint jurisdiction Research Ethics Board Committee at Ontario Shores Centre for Mental Health Sciences and Ontario Tech University (JREB #22-032-D). As this study was not a clinical trial, no registration was required (Clinical trial number: not applicable). A member of the research team (JV) provided both oral and written information about the study to eligible clients with mental health conditions and obtained their written informed consent, providing them a copy of their consent for their records. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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