Online psychological treatment according to CBT (cognitive behavioural therapy) has become increasingly common, and many studies have shown that this form of treatment is as effective as meeting face-to-face. So what is it like working with CBT in a digital meeting, and how do the clients feel about it? We have spoken to Christer Andemark, who is a licensed psychologist at PBM Executive, a psychology practice that not only offers treatment via video but also conducts research in this field.
How come you started working digitally?
PBM started using digital tools early on, such as self-evaluation forms, etc. Working digitally with these tools is convenient and saves time; the digital forms also provide a good basis for evaluations and research regarding our activities.
I personally became involved at an early stage in projects aiming to explore the digital possibilities of increasing the accessibility of our services to our clients and corporate customers. It’s a good fit since I myself had worked for many years before that as an engineer within IT and digitalisation, and I have always been interested in the possibilities of digital technology. The result was PBM Online, where the keywords are flexibility and accessibility. We have practices in both larger and smaller cities, but many of our clients who have been referred to us, for example through public health insurance channels, can be located anywhere. We thought about how we could offer our services nationwide without having to train and assure the quality of a bunch of subcontractors, and that’s when we realised that the best option was to ensure that our own staff could meet the clients remotely, online. Already in 2015, we initiated a preliminary study regarding suitable solutions for video consultations, and in the long run, we realised that our needs required our own branded app. We looked at a few different solutions and came to the conclusion that Visiba Care was offering the best alternative for us.
“The main advantage is actually choice – our clients can choose to meet with us physically or digitally.”
What types of problems can you handle through your digital practice?
I would say that we can handle most assigned cases digitally – but primarily mild to moderate problems. Acute cases, like an acute crisis or cases that lead to an increased risk of suicide are less suitable as there is both an increased health risk and the patient may also feel fragmented and find it difficult to handle the technology.
I personally meet with a lot of clients with workplace problems via video. They often come to us via company agreements or insurance companies, and they often have stress-related diagnoses, which often entail other problems such as insomnia, depression, and anxiety.
It is important to catch these individuals early on so that their problems can be dealt with in time, otherwise there is a risk of exhaustion. Our video consultations increase our chances of being able to discover the care needs of a client at an earlier stage, regardless of where that client is located.
In addition to treating diagnoses, we also work with coaching and leadership development, which are also effective via video.
What treatment forms do you work with?
Our treatments are based on CBT, which in turn includes a number of subcategories, including ACT and cognitive therapy. We primarily work with conversational therapy but also use other methods, such as virtual reality treatment. At the moment, we are conducting a clinical study on the treatment of speech anxiety, where the client is exposed to a virtual audience in order to practice handling various receptions and situations.
Is CBT as effective via the internet as IRL?
We have looked at this in a pilot study, where we compared the results between those who met our psychologists face to face and those who met with us digitally. The results were roughly the same, regardless of whether the treatment was provided in person or via video. By coding linked treatments and working with scales that measure stress, anxiety, sleep and other measures of life quality, we have excellent chances to continuously measure and compare the results and verify that the quality remains high.
What are the greatest advantages to digital consultations for you at PBM?
The main advantages for our business are that we have a completely different range and we are able to reach many more patients. Using PBM Online, we can cover all of Sweden, or the whole of the EU for that matter, and many of our clients work abroad.
We distribute the client flow more evenly across PBM and increase accessibility, while creating and broadening our flexibility at the same time, which all in all contributes to creating economic value.
For our staff, flexibility is the most important aspect. Today, most of them are in the practice working with online sessions, but there is really nothing to prevent the staff from working at home from time to time. Many people also argue that digital consultations are more focused and effective than physical ones.
What are the advantages for your clients?
The thresholds for seeking help are lowered and it is easier to get in touch, which means that more people can get help in time. It’s time-efficient and convenient not having to travel and take time off from work.
The clients that participated in the pilot test I mentioned even felt that the digital sessions were their only option for seeing a psychologist. Some lived far away from a practice, others were travelling and did not have time for regular contact with a psychologist at a physical practice.
We have also heard many people comment that they find it easier to talk about difficult things remotely than face-to-face. Being able to talk in the safety of their own home environment is a comfort. It’s almost like a home visit.
However, the main advantage is actually choice. Our clients can choose to meet with us physically or digitally. After all, not everyone has the same needs and wishes.
What are your long-term plans?
I know that there are many exciting new features coming in the Visiba Care platform which can make it even easier to work digitally. Multi-party calls will provide new possibilities, for example, for employer sessions where both the client and the manager can participate via link. Couples therapy and teamwork within PBM will also be facilitated through digital collaboration. Care provider-initiated messages allow us to easily send digital assignments for the clients to do at home. But above all, I think that the digital aspect will become even more natural and easily accessible once the booking of both physical and digital visits is integrated in the app. In the long term, I think the digital platform can be the point of departure that is supplemented by the physical, rather than the other way around, as is the case today.