Choosing therapy
Does therapy work as well online as in person?
Yes, for most people and most common problems. Trials comparing live video sessions with sessions in the same room find results at least as good online, and some studies find online ahead. Here is what the research shows, what it means for hypnosis, and how to decide what suits you.
By Mark R. Davis, Principal and founder of Hypno-CBT® · Last reviewed October 2026
The short answer
- Live video therapy with a trained therapist works at least as well as meeting in person, particularly for anxiety, depression and PTSD.1–3 Some studies find it does better.4
- The relationship with your therapist is as strong over video, and in some studies stronger.5,6
- Research on hypnosis by video is younger and smaller, but points the same way, including for chronic pain.7–9
- In person is still the better choice for some people and some problems. See when to choose in person.
On this page
What the research shows
Since the pandemic, researchers have run many trials that randomly assign people to have therapy either by video or face to face, then compare how they get on.
Reviews that pool these trials now cover thousands of patients. The largest, published in 2024, combined 54 trials and more than 5,400 people having cognitive behavioural therapy (CBT) for a wide range of problems. Remote treatment did as well as in-person treatment, and the reviewers rated that conclusion as moderately certain.1 Reviews focused on depression, anxiety, PTSD and less common conditions reached the same result.2,3,10–13
| Review | What it covered | Result |
|---|---|---|
| Zandieh et al., 20241 | 54 trials, 5,463 people having CBT for many conditions, by video, phone or other remote formats | As good as in person |
| Shaker et al., 20232 | 20 trials in PTSD, mood and anxiety disorders | As good, same drop-out |
| Scott et al., 20223 | 9 trials, 1,268 people with depression, by video or phone | As good; online ahead at 9 months |
| Luo et al., 20204 | 17 trials of CBT for depression delivered online, by phone or by video | Online more effective |
| Andersson et al., 201414 | 13 trials comparing guided internet CBT with face-to-face CBT | Equivalent |
| Greenwood et al., 202211 | 12 trials, 931 people with less common conditions such as eating disorders and addiction | As good |
“Remote” covers video and, in some reviews, telephone sessions or guided online programmes. Full details are in the notes.
At least as good, and sometimes better
The weight of evidence shows online therapy is not second best, and several studies find it ahead on particular measures. A 2020 review of depression trials concluded that CBT delivered online or by phone was more effective than face-to-face CBT, though the trials varied widely.4 In a Swiss trial, people who had internet-based CBT for depression kept their gains three months later, while the face-to-face group’s symptoms had partly returned.15 In a trial in which the same therapist saw clients both ways, stress improved more often by video.16 Across certified dialectical behaviour therapy (DBT) programmes, clients seen by video missed fewer sessions and were less likely to drop out.17
Where the evidence runs out
Most trials tested CBT for common problems. Very few looked at severe mental illness such as psychosis or bipolar disorder, so nobody yet knows whether video works as well there.11,18 Results also vary from trial to trial, and several reviews combine video with telephone sessions.
Does the relationship with your therapist survive a screen?
Many therapists expected a screen to weaken the working relationship, but clients rate their bond with the therapist as highly over video as in person.6,20,21 Some studies find it stronger. In a randomised trial of CBT for generalised anxiety in Canada, clients rated the working alliance more strongly by video than in the room, and they were more comfortable with video than their therapists were.5
Therapists sometimes find eye contact, posture and small changes in expression harder to read through a camera. Clients, on the other hand, have not had to travel, they are in familiar surroundings, and they are not sitting in a room with someone they have only just met. Researchers have long noted that some people open up more readily online.
When I saw new clients in the evening in a therapy room in Camden, there were other people coming and going in the building. Online, they’re at home. They feel more relaxed, and they’re less guarded.
Mark R. Davis, Principal and founder of Hypno-CBT®
What about hypnosis online?
Fewer studies exist here than for talking therapies, and most are small, but they point the same way.
people, Sweden
51
51 people with irritable bowel syndrome (IBS) had group hypnotherapy by live video. 53% improved, close to the 55% in the same team’s groups held in person, and the gains lasted at six months. Many preferred the online format.8
people, UK
20
In Manchester, 20 people with IBS had hypnotherapy by Skype after a first session in person. 65% improved, against 76% of 1,000 earlier patients treated face to face. 7 in 10 said they could not otherwise have had treatment.7
people, USA
127
A 2026 randomised trial gave people with chronic pain after spinal cord injury hypnosis combined with cognitive therapy, by Zoom or phone. Their pain fell more than with usual care.9
Studies of how strongly people respond to hypnosis find scores online that are similar to, or only slightly lower than, scores taken in a room.23,24 A 2023 review of hypnosis by video concluded that patients accept it and that it opens treatment to people who could not otherwise get it.25,26
Worth knowing
A live therapist is not the same as an app
On this page, online therapy means a real-time session with a therapist. Self-guided hypnosis apps are a different thing. A 2026 trial of 230 people with IBS compared an app with hypnotherapy from a therapist in person. 33% of app users had a meaningful drop in pain, against 48% of those who saw a therapist.27
“What if I get stuck in a trance?”
Some people worry that hypnosis needs the therapist in the room in case something goes wrong, or in case they cannot come out of it. These worries come from an old idea of hypnosis as a trance that someone else puts you into. A review of registered clinical trials using hypnosis found no serious problems likely to have been caused by it, and a rate of minor side effects under 0.5%.28
How Hypno-CBT® works online
The studies above tested other forms of hypnosis and CBT, not Hypno-CBT® itself. Here is how Hypno-CBT® approaches online work.
Hypno-CBT® does not use the idea of trance. Hypnosis is understood as self-hypnosis: focused attention, absorption in your imagination, and expectation, much like getting absorbed in a good film. You learn self-hypnosis from the first session. The therapist guides and coaches you, and you stay in control throughout. If the connection drops in the middle of hypnosis, you naturally come out of it in your own time. Recordings and worksheets can be sent to you straight after each session.
What the room adds
In the same room, a therapist can watch your breathing and small movements more closely and pick up more from being physically present, though clear video and sound give a surprisingly good read. The technique that does need you together is hypnotic touch: for example, a light touch on the arm while suggesting that it feels heavy, used to focus attention or deepen the experience.
Very few therapists and hypnotherapists use physical touch, partly because of permission and boundaries.
Mark R. Davis, Principal and founder of Hypno-CBT®
Chronic pain online
From our community
Anne Glennie is a Hypno-CBT® therapist based on the Isle of Lewis in the Outer Hebrides, and teaches on the College’s Diploma. She works with clients by Zoom and specialises in chronic pain.
Chronic pain is one of the harder problems a therapist works with, and the research supports working with it remotely. In a trial of acceptance and commitment therapy for chronic pain, video sessions matched in-person sessions on the main outcome, how much pain interfered with daily life.29 A trial of 302 people with chronic low back pain found that group therapy by video reduced pain interference substantially, and the gains lasted six months.30 Reviews of psychological treatment for chronic pain delivered over the internet, most of it with less therapist contact than a live session, find it reduces pain, disability and low mood.31,32 For hypnosis, Zoom-delivered treatment for pain after spinal cord injury did as well as an earlier in-person group,33 and the 2026 trial above found it beat usual care.9
If your pain is new, changing or has not been looked into, please see your GP first.
Read more about pain and Hypno-CBT® →
Why people choose each option
Online
- No travel, so sessions fit around work and family
- You can choose a therapist who suits you, wherever they are based
- Many people feel more relaxed at home
- You are already home when the session ends
- Recordings and worksheets arrive straight away
In person
- A private space set apart from home life
- Easier for the therapist to watch breathing and body language
- Hypnotic touch is possible, with your agreement
- Some techniques, such as practising in real situations together, need you in the same place
- No dependence on a camera or an internet connection
- Some people simply prefer it
Many therapists offer both, and you can mix them: for example, meeting in person first and continuing online.
When in person is the better choice
UK professional guidelines ask therapists to check whether online work suits each person before they begin, and to point people elsewhere when it does not. Consider in-person sessions if:
- you have nowhere at home to talk privately without being overheard or interrupted
- you do not feel safe to speak freely where you live
- you have a severe mental illness, where online therapy has been studied least18
- the therapy is for a child or young person, who may say less with family nearby
- your plan includes facing situations together with your therapist, for example on a train or in a shop
- you would rather be in the room
If you are in crisis
Neither online nor in-person therapy is an emergency service. If you are thinking about harming yourself, call NHS 111 and choose the mental health option, call Samaritans free on 116 123, or call 999 in an emergency.
Getting ready for an online session
A few simple steps make online sessions private, comfortable and reliable.
A private room
Somewhere you won’t be overheard or interrupted. Let others in the house know you are unavailable.
Headphones
They keep the session private and your therapist’s voice clear, which helps during hypnosis.
A steady connection
A laptop or computer is better than a phone. A cable is more reliable than Wi-Fi if you can use one.
Smart speakers off
Switch off voice assistants in the room.
A plan if the call drops
Agree at the start whether you will rejoin, or whether your therapist will phone you.
Your location and a safety contact
Your therapist should ask where you are and who to contact in an emergency.
A comfortable chair
For hypnosis, sit supported in a chair rather than lying in bed, with your phone on silent.
Ten minutes afterwards
Give yourself time before your next call or the school run.
Questions to ask a therapist before you book
- Do you offer online sessions, in-person sessions, or both?
- Which video platform do you use, and how do you keep sessions private?
- What happens if we lose the connection?
- Are you insured to work with clients where I live?
Questions people ask
Can hypnosis really work through a screen?
Yes. People respond to hypnosis online at similar levels to in a room, and studies of hypnotherapy by video, including a 2026 randomised trial for chronic pain, have found good results.8,9,23,24 The evidence base is smaller than for talking therapies such as CBT.
What happens if the connection drops during hypnosis?
You naturally come out of it and open your eyes. You stay in control throughout, and your therapist will agree with you at the start how you will reconnect.
Is phone therapy the same as video?
Some of the reviews above included telephone sessions and found similar results.1,3 For hypnosis, most therapists prefer video so they can see how you are responding.
Is online therapy cheaper?
Each therapist sets their own fees. Online sessions save you travel time and costs.
Can I see a UK therapist if I live abroad?
Often, yes. The therapist needs to check that their insurance covers clients in your country, and some countries restrict who can offer therapy. Ask before you book.
What if I try online and don’t like it?
Tell your therapist. Many offer both formats, and some people move between them as therapy goes on.
Find a Hypno-CBT® therapist
Search the directory for therapists who work online, in person, or both.
The Hypno-CBT® College trains therapists online, so working by video is part of how they learn.
Notes and sources
A “systematic review” or “meta-analysis” pools the results of many trials to give a more reliable answer than any single study. Figures below are from the published abstracts.
- Zandieh S, Abdollahzadeh SM, Sadeghirad B, et al. Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ 2024;196(10):E327–E340. doi:10.1503/cmaj.230274. 54 RCTs, 5,463 patients; SMD −0.02 (95% CI −0.12 to 0.07); moderate certainty.
- Shaker AA, Austin SF, Storebø OJ, et al. Psychiatric treatment conducted via telemedicine versus in-person modality in posttraumatic stress disorder, mood disorders, and anxiety disorders: systematic review and meta-analysis. JMIR Mental Health 2023;10:e44790. doi:10.2196/44790. Efficacy SMD −0.01 (17 trials, n=1,814); attrition RR 1.07 (0.94–1.21).
- Scott AM, Clark J, Greenwood H, et al. Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis. Psychological Medicine 2022;52(14):2852–2860. doi:10.1017/S0033291722002331. 9 RCTs, 1,268 patients; video and phone pooled; one 9-month time point favoured telehealth (SMD −0.39).
- Luo C, Sanger N, Singhal N, Pattrick K, et al. A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: a systematic review and meta-analysis. EClinicalMedicine 2020;24:100442. doi:10.1016/j.eclinm.2020.100442. Corrigendum: EClinicalMedicine 2021;41:101182. 17 RCTs; electronic CBT (internet, phone, video, CD-ROM, all with therapist contact) more effective than face-to-face on depression severity; high heterogeneity. The authors conclude it is “at least as effective”.
- Watts S, Marchand A, Bouchard S, et al. Telepsychotherapy for generalized anxiety disorder: impact on the working alliance. Journal of Psychotherapy Integration 2020;30(2):208–225. doi:10.1037/int0000223. RCT, N=115 (50 video, 65 in person); stronger client-rated working alliance by video.
- Seuling PD, Fendel JC, Spille L, et al. Therapeutic alliance in videoconferencing psychotherapy compared to psychotherapy in person: a systematic review and meta-analysis. Journal of Telemedicine and Telecare 2024;30(10):1521–1531. doi:10.1177/1357633X231161774. 18 publications; no significant difference in patient- or therapist-rated alliance.
- Hasan SS, Pearson JS, Morris J, Whorwell PJ. Skype hypnotherapy for irritable bowel syndrome: effectiveness and comparison with face-to-face treatment. International Journal of Clinical and Experimental Hypnosis 2019;67(1):69–80. doi:10.1080/00207144.2019.1553766. Uncontrolled cohort compared with a historical audit; not randomised.
- Lövdahl J, Törnblom H, Ringström G, Palsson OS, Simrén M. Online group hypnotherapy for irritable bowel syndrome: a pilot study. Neurogastroenterology & Motility 2026;38(5):e70328. doi:10.1111/nmo.70328. Uncontrolled pilot, n=51; comparison with an earlier on-site cohort.
- Bombardier CH, Mendoza ME, Thomas PA, Barber JK, Jensen MP. Hypnotic cognitive therapy for chronic pain in spinal cord injury: a randomized controlled trial. Neurology 2026;106(8):e214836. doi:10.1212/WNL.0000000000214836. N=127; six sessions by Zoom or phone plus self-hypnosis recordings; greater pain reduction than usual care at 6 and 12 weeks.
- Krzyzaniak N, Greenwood H, Scott AM, et al. The effectiveness of telehealth versus face-to-face interventions for anxiety disorders: a systematic review and meta-analysis. Journal of Telemedicine and Telecare 2024;30(2):250–261. doi:10.1177/1357633X211053738.
- Greenwood H, Krzyzaniak N, Peiris R, et al. Telehealth versus face-to-face psychotherapy for less common mental health conditions: systematic review and meta-analysis of randomized controlled trials. JMIR Mental Health 2022;9(3):e31780. doi:10.2196/31780. No includable trials for schizophrenia or bipolar disorder.
- Fernandez E, Woldgabreal Y, Day A, et al. Live psychotherapy by video versus in-person: a meta-analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy 2021;28(6):1535–1549. doi:10.1002/cpp.2594. Negligible difference between video and in person.
- Batastini AB, Paprzycki P, Jones ACT, MacLean N. Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clinical Psychology Review 2021;83:101944. doi:10.1016/j.cpr.2020.101944. Treatment effects “largely equivalent”.
- Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 2014;13(3):288–295. doi:10.1002/wps.20151. 13 RCTs, N=1,053; Hedges’ g −0.01 (−0.13 to 0.12).
- Wagner B, Horn AB, Maercker A. Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. Journal of Affective Disorders 2014;152–154:113–121. doi:10.1016/j.jad.2013.06.032. N=62; equal results after treatment; at 3 months the face-to-face group had worsened while the online group stayed stable.
- Stubbings DR, Rees CS, Roberts LD, Kane RT. Comparing in-person to videoconference-based cognitive behavioral therapy for mood and anxiety disorders: randomized controlled trial. Journal of Medical Internet Research 2013;15(11):e258. doi:10.2196/jmir.2564. N=26; no differences on most measures; reliable change in stress favoured video.
- Walton CJ, Skerven K, White A, et al. Engagement in dialectical behaviour therapy in LBC-certified DBT programs: comparison of in-person vs telehealth treatment delivery. Behavioural and Cognitive Psychotherapy 2026;54(2):198–210. doi:10.1017/S1352465826101337. Observational; telehealth-only clients had fewer missed sessions and lower non-completion.
- Thomas N, McDonald C, de Boer K, et al. Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychology and Psychotherapy 2021;94(3):854–883. doi:10.1111/papt.12332.
- Meyer-Keirath C, Wallis H, Kaus M, et al. Comparing video-based and face-to-face psychotherapy: systematic review and multilevel meta-analysis across mental disorders. Journal of Medical Internet Research 2026;28:e89177. doi:10.2196/89177. 12 video-only RCTs; no significant difference; wide variation between trials.
- Berger T. The therapeutic alliance in internet interventions: a narrative review and suggestions for future research. Psychotherapy Research 2017;27(5):511–524. doi:10.1080/10503307.2015.1119908.
- Sucala M, Schnur JB, Constantino MJ, et al. The therapeutic relationship in e-therapy for mental health: a systematic review. Journal of Medical Internet Research 2012;14(4):e110. doi:10.2196/jmir.2084.
- Suler J. The online disinhibition effect. CyberPsychology & Behavior 2004;7(3):321–326. doi:10.1089/1094931041291295. Conceptual paper on online behaviour in general, not therapy.
- Palfi B, Moga G, Lush P, Scott RB, Dienes Z. Can hypnotic suggestibility be measured online? Psychological Research 2020;84(5):1460–1471. doi:10.1007/s00426-019-01162-w.
- Rasch B, Cordi MJ. The influence of experience and modality of presentation (online vs. offline) on hypnotizability. Frontiers in Psychology 2024;14:1293070. doi:10.3389/fpsyg.2023.1293070.
- Hasan SS, Vasant DH. The emerging new reality of hypnosis teletherapy. International Journal of Clinical and Experimental Hypnosis 2023;71(2):153–164. doi:10.1080/00207144.2023.2185527.
- Noble H, Hasan SS, Simpson V, Whorwell PJ, Vasant DH. Patient satisfaction after remotely delivered gut-directed hypnotherapy for irritable bowel syndrome during the COVID-19 era. BMJ Open Gastroenterology 2022;9(1):e001039. doi:10.1136/bmjgast-2022-001039. n=52; 90% would recommend remote treatment.
- Snijkers JTW, Bosman MHMA, Winkens B, et al. In-person therapist-delivered hypnotherapy versus smartphone-based self-guided hypnotherapy in IBS: a multicentre three-armed randomised controlled trial. Gut 2026, online ahead of print. doi:10.1136/gutjnl-2026-338385.
- Bollinger JW. The rate of adverse events related to hypnosis during clinical trials. American Journal of Clinical Hypnosis 2018;60(4):357–366. doi:10.1080/00029157.2017.1315927. Trials registered on ClinicalTrials.gov; serious adverse events likely attributable to hypnosis 0%, other adverse events 0.47%; medical rather than psychiatric settings, and several trials did not report adverse events.
- Herbert MS, Afari N, Liu L, et al. Telehealth versus in-person acceptance and commitment therapy for chronic pain: a randomized noninferiority trial. Journal of Pain 2017;18(2):200–211. doi:10.1016/j.jpain.2016.10.014. N=128; video non-inferior on pain interference.
- Day MA, Ciol MA, Mendoza ME, et al. The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial. BMC Medicine 2024;22:156. doi:10.1186/s12916-024-03383-2. N=302; all three video treatments reduced pain interference, maintained at 6 months; no in-person arm.
- Gandy M, Pang STY, Scott AJ, et al. Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Pain 2022;163(10):e1041–e1053. doi:10.1097/j.pain.0000000000002606. 36 RCTs, n=5,778; compared with control conditions, not with face-to-face.
- Buhrman M, Gordh T, Andersson G. Internet interventions for chronic pain including headache: a systematic review. Internet Interventions 2016;4:17–34. doi:10.1016/j.invent.2015.12.001.
- Bombardier CH, Chan JF, Stensland E, Barber J, Jensen MP. Telehealth-delivered hypnotic cognitive therapy for chronic pain in spinal cord injury: a pilot study with historical controls. Journal of Spinal Cord Medicine 2025;48(6):1112–1123. doi:10.1080/10790268.2024.2395080.
- UK Council for Psychotherapy. UKCP Guidelines for Working Online/Remotely. 2021. psychotherapy.org.uk.
- UK Council for Psychotherapy. Online and phone psychotherapy (public guidance). psychotherapy.org.uk.
- American Psychological Association. Guidelines for the Practice of Telepsychology. 2024. apa.org.