By Dr. Lane Pederson

It is one of the most reasonable questions people ask about online mental health treatment:

Is it really as effective as being there in person?

The question matters even more with Dialectical Behavior Therapy (DBT). DBT is active treatment. It requires engagement, structure, skills practice, accountability, and a strong connection between clients and their treatment team. Moving DBT online involves much more than putting a therapist and client on a video call.

At Mental Health Systems (MHS), we wanted to know whether our online DBT services were actually producing the same kinds of clinical outcomes as our in-person services.

So we measured them.

We didn’t want to assume online DBT worked

When the pandemic forced mental health providers to move rapidly into telehealth, the question for us was never simply whether DBT could be delivered online. Clearly, it could.

The more important question was whether we could deliver it online without compromising the quality of treatment.

That distinction remains important today.

Telehealth is now commonplace. But the availability of online therapy does not necessarily tell you anything about its quality. Programs can differ substantially in their structure, expectations, clinician expertise, client engagement, safety procedures, and attention to outcomes.

At MHS, we approached virtual treatment as a clinical program that needed to be deliberately designed, not simply as a different way to connect to an appointment.

We maintained the structure of our DBT programs, established specific expectations for participating remotely, developed procedures for engagement and safety, adapted how clinicians teach and interact with clients online, and continued measuring clinical outcomes.

Then we compared the results.

What we studied

We examined clinical outcome data from clients participating in MHS intensive outpatient DBT either in person or remotely.

Clients received intensive DBT programming three days per week. Outcomes were measured at the beginning of treatment and again at approximately 3, 6, and 9 months.

We focused on four particularly important areas:

• Depression
• Suicidality
• Panic
• Quality of life

We then analyzed the data using a mixed-effects statistical model. This allowed us to look beyond whether one group happened to score better than another at a particular point in treatment.

Instead, we could ask a more important question:

Did clients receiving online DBT improve differently over time than clients receiving DBT in person?

The answer was no.

Online and in-person clients showed comparable improvement

Clients in both treatment formats improved significantly over the course of treatment.

More importantly, there were no statistically significant differences in the trajectories of improvement between online and in-person DBT for any of the four clinical outcomes we examined.

That was true for depression, quality of life, panic, and suicidality.

By nine months, clients in both formats had demonstrated substantial clinical improvement.

The finding is important because we are not simply saying that clients receiving online DBT got better.

We found no evidence that receiving MHS intensive DBT remotely resulted in poorer clinical outcomes than receiving the treatment in person.

That is an important distinction.

Clients also really liked online treatment

Clinical effectiveness is the first question. Client experience matters too.

Among clients responding to our telehealth satisfaction survey, 93.9% reported being either very satisfied or extremely satisfied with MHS telehealth services. The average satisfaction rating was 4.43 out of 5.

Perhaps even more telling was what happened when clients were asked whether they wanted to return to in-person treatment.

85.1% said they preferred to remain in telehealth.

Only 7% indicated that they wanted to switch to in-person services.

For many clients, remote treatment was not a second-best alternative to being in the clinic. It was the treatment format they preferred.

Not all online therapy is the same

There is a temptation to take findings like these and conclude that online therapy is simply as effective as in-person therapy.

We would not go that far.

Our data tell us something more specific, and more useful:

High-quality DBT can be delivered remotely without sacrificing clinical outcomes.

The words high-quality matter.

Putting an existing treatment program on a video platform does not automatically make it an effective telehealth program.

MHS online services were intentionally designed around the same principles that guide our in-person care. We maintain clear treatment expectations. We actively manage engagement. We have procedures for responding to safety concerns remotely. Our clinicians are trained to use the virtual environment effectively. And we collect outcome data so we can determine whether the treatment we provide is actually helping.

That last piece is especially important.

Many mental health programs offer telehealth. Far fewer have practice-based outcome data that allow them to compare how their clients actually do online versus in person.

At MHS, we believe specialized care carries a responsibility to do more than provide an evidence-based treatment. We also need to know whether our delivery of that treatment is producing the outcomes we expect.

Online DBT can also remove barriers to specialized care

Minnesota is a big state, and specialized DBT programs are not evenly distributed across it.

Virtual treatment allows people who live far from one of our clinics to participate in specialized DBT without repeatedly traveling long distances. It can improve access for people with transportation or mobility barriers, families managing complicated schedules, and parents who need to participate in adolescent skills training.

It also gives clients a meaningful choice.

If clinical outcomes were substantially worse online, convenience alone would not justify recommending remote treatment.

But that is not what we found.

Our clients improved. Their clinical trajectories were comparable to those of clients receiving treatment in person. They reported very high satisfaction. And when given the choice, the large majority wanted to continue online.

The question isn’t simply online or in person

The better question may be:

Where can I receive high-quality treatment that is designed around my needs and delivered with enough structure and expertise to work?

For some clients, the answer will be in person. For others, it will be online.

At MHS, we offer both.

What matters to us is that whichever way you receive treatment, you are receiving DBT that has been thoughtfully designed, delivered by specialists, and evaluated based on actual clinical outcomes.

Our online DBT is effective because we designed it to be effective. And we collected the data to make sure.