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- A systematic review found that online therapy produces small-to-moderate improvements in teen depression symptoms.
- Internet-based CBT techniques are particularly effective when combined with therapist guidance.
- Adolescents benefit more from online therapy than younger children due to developmental readiness and digital fluency.
- Unguided programs may lead to higher dropout rates, lowering effectiveness in treating teen depression.
- Platforms with parent involvement and therapist interaction show higher engagement and better outcomes.
As more kids and teens deal with mental health problems, online therapy has become a helpful—and at times, needed—treatment. 1 in 5 children have a mental health disorder (CDC, 2023). The pandemic sped up the need for ways to get help from far away. This makes the question pressing: can internet-based therapy truly help kids and teens well? Let’s see what the research shows, what works now, and where things are going.
The Rise of Online Therapy for Kids and Teens
Online therapy became much more common during the COVID-19 pandemic, but it started before that. Mental health services were already trying out digital ways to get help to young people who didn’t have easy access or felt judged. The pandemic pushed systems to quickly use internet-based therapy platforms. This happened because rates of anxiety, loneliness, burnout, and depression in young people were going up.
The U.S. Centers for Disease Control and Prevention (CDC) said that mental health emergencies among teens went up sharply during the pandemic. ER visits for suspected suicide attempts among girls aged 12 to 17 went up a lot in 2020 and 2021. This made it more urgent to use treatments like online therapy for kids that were easy to get to and didn’t have many hurdles.
Digital tools like Talkspace, Brightline, MY3, BetterHelp Teen, and many mindfulness apps became helpful for families who suddenly couldn’t get in-person help. For teenagers especially, who were already online a lot for social life, using these tools felt like a normal part of their digital lives moving into therapy.
How Internet-Based Therapy Works
Online therapy for kids usually comes in two main types. Each one is made to fit different needs and what people like:
- Live therapy – Means planned video calls, phone talks, or online chat with a trained helper. It’s a lot like regular therapy, but you do it on a screen.
- Anytime therapy – Has parts you can use on your own like tracking your mood, watching videos, and writing in a journal. You can get to these things whenever you want.
Some newer tools mix the two types. This gives you a blend of both. For example, a teen might do an iCBT lesson on an app in the morning. Then, they might have a 30-minute talk with their therapist later that week to go over it and think about it. Some tools also have computer-made ideas or messages that tell therapists if someone’s mental health seems to be getting worse.
The types of therapy used most often include:
- Internet-based Cognitive Behavioral Therapy (iCBT) – Uses set parts to help young people see bad ways of thinking and change how they think.
- Mindfulness help – Teaches being aware and breathing methods to handle feelings better and focus.
- Learning about feelings – Helps children get a basic grasp of feelings, thoughts, and signs of mental health problems.
- Tools for parents – Teach parents how to help with therapy goals in everyday life.
A lot of kids and teens are online for a good part of their day. So, using a way they know well can make them more willing to start therapy.
Effectiveness in Treating Teen Depression
Online therapy works in treating teen depression. This is one of the most serious and common mental health issues for young people. It’s not right for everyone, but facts show it helps. This is especially true when a therapist is involved.
🧪 A big study called a meta-analysis by Torous et al. (2021) found that digital mental health help can make depression signs less bad for young people. The changes were small to medium. These changes might not be as big as those from intense in-person therapy, but they are big enough to be important for health.
🧠 A study where people were put into groups by chance, done by Calear et al. (2021), looked at an iCBT program for children aged 8 to 13. It found clear improvements after only eight weeks. Those in the study said they got better at handling feelings, using skills to cope, and had fewer signs of depression.
It’s important to note that the best results were seen on tools that had help from a person. This helped teens feel responsible and build a working connection with the therapist. Programs with therapist guidance worked much better than those without it. This was true for both how well they worked and how many people finished them.
To sum up, internet therapy looks like it can help treat teenage depression well. This is especially true when it’s made for the person and watched over by a professional.
Comparing Online vs. In-Person Therapy Outcomes
Parents and people who work in mental health often ask, “Does online therapy work as well as meeting in person?”
Many studies show that for some problems and groups of people, it can. A study by Ebert et al. (2020) found that internet treatments for mild to medium depression and anxiety in young people often worked about the same as regular therapy. This means digital therapy can be as good as meeting in person for making symptoms better. This is especially true when it uses set, proven methods like iCBT.
Other good things found include:
- Teens sticking with treatment better. They might otherwise miss in-office visits because they feel judged, can’t get there, or can’t fit it into their schedule.
- Better focus when using parts that involve doing things. This lessens the worry some teens feel when talking face-to-face.
- A chance for therapists to give help that is more steady and in small bits. This can be based on what’s happening right now.
But online therapy by itself might not be enough for young people dealing with big, complicated past hurts, thinking about suicide, or having very bad depression. These situations may need deep checks or therapy from many different types of helpers. These often work best in regular clinics or using a mix of online and in-person care.
Age and Developmental Considerations
Age is very important when figuring out if any mental health help works, including internet therapy. Being ready in how they have grown affects how well a child can make sense of feelings, talk with a therapist, and use skills to cope in their daily life.
- Children under 12 might find it hard to grasp big ideas like twisted thinking or mindfulness if they only see them online. So, parents getting involved is key to success. This is especially true for finishing therapy homework and showing good ways to act.
- Tweens (ages 10 to 13) do better when programs look interesting, tell a story, or feel like games. Things like cartoons or charts that give rewards work well for this age group. This is especially true when parents are involved at the same time.
- Teenagers (13 to19) are usually more on their own and good with tech. They often like texting or chatting for help more than phone calls or video talks. Many digital therapy tools for teens also let them write in a journal or track their mood. This fits with skills they are learning about thinking about themselves and figuring out who they are.
How the brain is growing also counts. Teens’ brains are still growing, especially the part that helps with making choices and not acting without thinking. This means they might make mistakes or not stick with therapy all the time. This can happen even more without help from an adult or things to keep them going.
Engagement and Challenges
Online therapy for kids looks promising, but keeping people using it is a main challenge. People often think kids who grew up with computers will love using these tools. But facts show many stop without the right push or help.
Programs you use on your own have especially high rates of people stopping. In a review by Baumel et al. (2019), mental health apps used alone had much fewer people sticking with them than programs with a therapist or a mix of methods.
To help people keep using the tools, platforms have started adding:
- Making it like a game – Things like points, badges, and winning streaks make sessions more fun and active.
- Personal pages – Let users see how they are doing and set goals.
- Characters and cartoons you can relate to – These work very well for kids under 13 who like stories.
- People checking in – Automatic reminders and messages from therapists help people feel more responsible for using the tool.
Having things that fit with different cultures also helps people use the tools more. Programs with characters or examples from different backgrounds can help users feel seen and understood. This is very important for young people who are often left out.
Benefits of Online Therapy for Youth
Why do so many families start using online therapy for kids? Besides being needed quickly and being easy to get to, digital therapy gives many good points that are different:
- Easy to use – No time spent traveling. Sessions can fit around school or after-school activities.
- Easy to get to – Parents in areas far away or without many doctors can make sure their child gets help.
- Private – Teens often feel safer sharing how they feel by text or video instead of walking into a therapist’s office.
- Feels less shameful – This helps a lot for LGBTQ+ young people or those worried about what friends might think.
- Can go at your own pace – Kids can look at lessons or journal entries again when they want. This helps young people whose brains work differently and who might take more time to understand things.
Rideout & Fox (2018) found that almost 70% of teens they asked said digital health tools made them feel more in charge of how they felt. That feeling of being able to do things for themselves can be the start of changing how they act over a long time.
Limitations and Concerns
Even with the good points, digital therapy has things that aren’t so good. Families and helpers should know about what it can’t do:
- Not everyone has access – Not all kids have phones, fast internet, or a private place. These things are important for sessions to work well.
- Keeping info safe – It’s very important to keep information safe. Parents should check that the tools follow privacy rules like HIPAA and are clear about how they use private info.
- Too general – Some tools might use the same lessons for everyone. These lessons might not fit a child’s background, how their brain works, or what they’ve been through.
- Risk of not finding problems fast – Small signs that hide bigger issues might not be dealt with quickly enough when using methods that don’t involve live talks.
In the end, online therapy should help, not take the place of, what a professional thinks is best. It’s a good tool to have among many ways to help with mental health.
Best Practices for Parents and Providers
To make sure digital therapy works well, being involved from the start is key. This is extra important for kids under 12. Here are some good ways to do things:
- Parents checking in – Make sure your child logs in regularly and talks about how they feel openly.
- Therapist’s skills – Always check their license, training, and if they have worked with teens.
- Tools that keep kids using them – Pick tools that feel like a game, let kids track their mood, or have stories that fit the child’s age.
- Therapist help – Choose tools that offer live talks or weekly check-ins with a therapist.
- See how things are going – Use the tools the platform has or work with the helper to see results and change plans if needed.
Parents should also talk about what is expected with their children before they start. They should make clear how important it is to be honest, stick with it, and set goals for therapy.
Ethical and Clinical Considerations
Just like meeting in person, digital mental health care must meet strict rules for what is right. These include:
- Agreeing and saying yes – The child (if they are old enough) and parent must agree to the rules, what they hope to achieve, how private info is kept, and any risks.
- Rules for emergencies – Tools must show how they will handle it if there is a risk of suicide, harm, or abuse. This is extra important if talking to a therapist is limited or doesn’t happen live.
- Rules about who can help – Therapists must work where they are allowed to. Or they must have special licenses if they are helping people in a different state.
- Making tools usable for everyone – Make sure tools work for young people with different ways of learning, who react strongly to things they sense, and who speak different languages.
Good tools should have things to help parents get started, rules for safety, and ways to step in if things get serious. This is to keep young users safe.
Future of Internet-Based Therapy for Kids
The next steps for mental health technology look like they will be even more specific and engaging. New features include:
- Smart computer programs – Computer programs that look at what someone does and change the help they get right away.
- Fake worlds (VR) – Used in therapies where you face fears, like dealing with being afraid of people or remembering upsetting past events.
- Tracking body signs – Things you wear that watch heart rate, sleep, or signs of stress. These can make the app start helping you.
- Friends helping friends safely – Safe places online for teens to share what they are going through, with a therapist watching over it.
- Studies that feel like games – Let kids be part of studies while they use the tool’s games and features.
But keeping help from people and good plans for treatment will be key. As this new area of mental health grows, making sure things are fair, good, and clear must stay very important. This is true especially for young people who need extra care.
Conclusion
Online therapy for kids and teens is not just a quick fix. It’s a type of care that is getting better and is based on proof, and it will stay. Studies and bigger reviews show more and more that internet therapy works well for signs of depression in teens. It’s easy to change, easy to get to, and fits with how young people use computers. This makes it a helpful tool. This is extra true when a therapist helps and the family is involved. To use all it can do, families should check tools carefully, think about what kids need as they grow, and plan to stick with it for a long time.
References
- Baumel, A., Fleming, T., & Schueller, S. M. (2019). Digital mental health interventions for children and adolescents: A systematic review of the literature. JMIR Mental Health, 6(9), e13873.
- Calear, A. L., et al. (2021). Implementing an internet cognitive behavioral therapy (iCBT) program for youth depression: Outcomes from a randomized trial. Journal of Affective Disorders, 290, 178–185.
- Ebert, D. D., Zarski, A. C., Christensen, H., et al. (2020). Internet and mobile-based psychological interventions for depressive symptoms in children and adolescents: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 29(5), 559–576.
- Rideout, V., & Fox, S. (2018). Digital health practices, social media use, and mental well-being among teens and young adults in the U.S. Hopelab and Well Being Trust. https://hopelab.org/report/a-national-survey-by-hopelab-and-well-being-trust-2018/
- Torous J, Jän Myrick K, Rauseo-Ricupero N, Firth J. Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow. JMIR Ment Health. 2020 Mar 26;7(3):e18848. doi: 10.2196/18848. PMID: 32213476; PMCID: PMC7101061.
- World Health Organization. (2021). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
