Today you can talk with a therapist by video from your kitchen table. You can also work through a therapy program on a website, or tap through lessons on a phone app. For many people, this makes help easier to reach, cheaper, and less awkward to start.

But "online" covers a lot of very different things. Some are tested treatments delivered by licensed professionals. Others are wellness apps with no research behind them, and some share your private data. This page helps you tell them apart.

Key points

Live video therapy with a licensed therapist is real therapy. It is the same care as an office visit, just delivered over a screen.
Internet CBT (a structured, online version of cognitive behavioral therapy) works about as well as in-person CBT when a therapist guides it.² Strong evidence
Most mental health apps have not been tested in good studies.¹ The FDA does not review most of them.⁵
Rejoyn, cleared by the FDA in 2024, is a prescription app for depression. It is an add-on to antidepressant medicine and care from a clinician, not a replacement.^3,4
Many apps are not covered by HIPAA, the federal health privacy law. Read the privacy policy before you share anything personal.⁷

Four kinds of online mental health care

It helps to sort online options into four groups. They differ a lot in how much proof stands behind them.

Type	What it is	Who is involved	How much evidence
Video or phone therapy (telehealth)	Regular sessions with a therapist or psychiatrist, by video or phone	A licensed professional	The same therapy as in person
Guided internet CBT	Weekly online lessons and homework, with a therapist checking in by message or short calls	A trained guide or therapist	Strong for depression, anxiety and several other conditions²
Prescription digital therapeutics	Apps cleared by the FDA to help treat a condition. A clinician must prescribe them	Your prescriber stays in charge	Tested in at least one trial reviewed by the FDA^3,4
Self-help and wellness apps	Mood trackers, meditation, sleep sounds, chatbots	Usually no one	Ranges from some to none. Most have no published research¹

Video and phone therapy

A video visit with your own therapist is not a lesser kind of care. You talk, the therapist listens and guides, and you work on the same skills as in an office. The main differences are practical: no driving, no waiting room, and fewer missed visits in bad weather.

For people with Medicare. As of October 2026, Medicare covers telehealth for mental health care, including talk therapy, and you can get it from your home. The Medicare.gov page says this applies through December 31, 2027. You usually pay the same 20% share as an in-person visit after the Part B deductible.⁹ Audio-only phone visits are allowed for people at home who cannot use video or do not want to.¹⁰ Rules can change, so ask your provider's office before your first visit. See what Medicare covers for mental health.

Check the license. A therapist must be licensed to practice. In Virginia, you can look up any counselor, psychologist, social worker or other licensed health professional for free on the Department of Health Professions License Lookup.¹³ Other states have similar tools. For more on choosing someone, see how to find a therapist.

Internet CBT: the best-studied online treatment

Cognitive behavioral therapy, or CBT, teaches you to notice how thoughts, feelings and actions feed each other. You then practice small changes. You can read more on our CBT page.

Internet CBT puts those lessons online. You usually log in once a week for several weeks, read or watch a short lesson, and do practice tasks between lessons. In "guided" programs, a therapist or trained coach reads your work and writes back.

The research is encouraging. A 2023 review pooled 31 trials with about 3,000 adults in nine countries. It compared therapist-guided internet CBT with face-to-face CBT. On average, the two worked about the same.² About half the trials were for depression or anxiety. Others covered problems such as insomnia, panic, tinnitus (ringing in the ears) and chronic pain conditions.² The U.S. National Institute of Mental Health (NIMH) also describes internet CBT as about as effective as regular CBT for depression and anxiety.¹

Two limits are worth knowing. Most conditions in that review had only one or two trials. And the people in trials agreed to try an online program, so the results may not fit everyone.²

Why guidance matters. The strongest research is on programs where a therapist checks in along the way.² If you choose a fully self-guided program, set a regular time each week, or ask a friend to check on your progress.

CBT for insomnia also comes in online and app versions. The VA's free CBT-i Coach and Insomnia Coach apps are examples.¹² See insomnia for the in-person and online choices.

Prescription apps cleared by the FDA

A small number of apps are treated as medical devices. The FDA reviews them before they can be sold for a medical use. The FDA has a special category for computerized behavioral therapy devices for depression.³

Rejoyn for depression

On March 30, 2024, the FDA cleared Rejoyn, a prescription app for depression made by Otsuka.³ Here is what to know:⁴

Who it is for. Adults age 22 and older with major depression who are already taking an antidepressant.
How it is used. It is added to care from a clinician. It does not replace medicine or therapy.
What it does. Over 6 weeks, the app gives short CBT lessons and a memory game with pictures of emotional faces. The game is meant to train the brain to manage emotions. Text messages remind you of lessons. You can still see the lessons for 4 more weeks.
What it does not do. It does not track your symptoms or alert your doctor if you get worse.

What the study showed. In the main trial, 386 adults on antidepressants used either Rejoyn or a look-alike app with a plain shapes game. After 6 weeks, both groups felt better. The Rejoyn group improved by about 2 points more on a doctor-rated depression scale.⁴ That is a small difference. In the main planned analysis, it was not quite large enough to rule out chance. A second analysis that counted everyone did reach that bar.⁴ Promising

No side effects were judged to be caused by the app.⁴ Everyone in the trial was between 22 and 64, so there is no data yet on people 65 and older.⁴

Will insurance pay for prescription apps?

Coverage is still new and patchy. Since 2025, Medicare has payment codes for FDA-cleared digital mental health devices. To qualify, the device must be used as part of ongoing care under a treatment plan with your clinician.¹⁰ Ask your clinician and your plan before you start. See paying for therapy.

Self-help apps and chatbots

There are thousands of mental health apps. Some teach breathing, mindfulness or sleep habits. Some track mood. Some offer a chatbot that "talks" with you.

These apps can help you practice skills, and some people find them a gentle first step.¹ But NIMH warns that most apps have no peer-reviewed research behind them. Some also promise too much and may steer people away from treatments that work.¹ There are no national quality standards for these apps.¹

The FDA focuses on apps that diagnose or treat. For low-risk apps that help people manage their own health without giving specific treatment advice, the FDA generally does not require review.⁵ So a "clinically proven" claim in an app store has usually not been reviewed by the FDA.

About AI chatbots. Chatbots built on generative AI (the kind that writes back in full sentences) are new. In November 2025, an FDA advisory committee met to discuss how mental health devices that use this kind of AI should be judged.⁶ A chatbot is not a therapist. It does not know your history, and it cannot call for help if you are in danger. If you use one, treat it like a self-help book, not a counselor.

An app is not crisis care. If you have thoughts of suicide or feel unsafe, call or text 988, the Suicide and Crisis Lifeline. If someone is in immediate danger, call 911. You can also make a safety plan ahead of time. A good app should tell you clearly what to do in an emergency.¹

Free, tested options from the VA

The U.S. Department of Veterans Affairs makes a set of mental health apps. Examples include PTSD Coach, Mindfulness Coach, CBT-i Coach, Insomnia Coach and a Safety Plan app.¹² PTSD Coach is free and open to anyone, including family members. It is meant to be used along with treatment, not instead of it.¹¹ The VA says its apps do not send your name or personal entries to the VA or anyone else.¹²

Your privacy: what to watch for

Many people assume their health information is always protected by law. Online, that is often not true.

HIPAA, the federal health privacy law, covers doctors, hospitals, health plans and the companies that work for them. It generally does not cover an app you download and fill in on your own, unless your doctor or health plan gave it to you.⁷ An app company may be able to use your data for ads or sell it.⁷

This has happened with mental health services. In 2023, the Federal Trade Commission (FTC) said the online counseling company BetterHelp shared people's emails and answers to health questions with Facebook and other companies for advertising. This was after promising to keep that information private. BetterHelp agreed to pay $7.8 million for refunds and to stop sharing health data for ads.⁸

Simple privacy steps⁷

Download fewer apps, and be most careful with free ones.
Say no to location tracking unless the app truly needs it.
Turn off ad tracking and personalized ads in your phone settings.
Look for a way to delete your data in the app's settings or help pages.
Do not enter more personal detail than you need to.

How to choose an app or online program safely

The American Psychiatric Association made a model to help clinicians judge apps. In April 2025 it added questions about AI use. It does not rate or endorse specific apps.¹⁴ You can use the same kind of thinking:

Ask your doctor or therapist. They may know a program that fits your needs, or one your health plan covers.¹
Check who made it. Look for a named team with health credentials. Be wary of borrowed logos. NIMH says some apps have used its logo without permission.¹
Look for research. Is the app based on a tested treatment such as CBT? Has the app itself been studied? You can search its name on PubMed.¹
Read the privacy policy. Does it sell or share data? Can you delete your account and data?⁷
Look for a safety plan. The app should say what to do if you feel worse or are in crisis.¹
Decide if you want a person involved. Some programs are fully automatic. Others include a therapist or coach.¹
Try it for a few days. If it is confusing or boring, you are unlikely to keep using it.¹

Signs of a better choice

Licensed therapists you can look up
Based on CBT or another tested therapy
Clear privacy policy; no ads based on your health
Says what to do in a crisis
Clear about what it can and cannot do

Warning signs

Promises to cure depression or anxiety fast
No named experts or company address
Asks for lots of personal data up front
Hard to cancel or delete your account
Pushes you to stop medicine or skip your doctor

Tips for older adults and caregivers

Online care can be a good fit in later life. It saves trips, works for people who no longer drive, and can be easier for people with mobility problems. Some things help:

Practice once before the first visit. A family member or library staff can help you set up the video app and test sound and camera.
Use a bigger screen such as a tablet or laptop, and headphones if hearing is an issue. Ask whether captions are available.
Phone visits are an option. Medicare allows audio-only visits at home if video does not work for you.¹⁰
Remember the age gap in research. The Rejoyn trial included no one over 64.⁴ Ask your clinician how well a program has been tested in people your age.
Caregivers can join with permission. If you help a parent or spouse, ask the therapist how you can be involved in a way that respects their privacy. See supporting someone in treatment.

Online programs are not a good fit for everyone. Someone with memory problems, severe depression, or thoughts of suicide usually needs closer, in-person care. If you are unsure, start with your primary care doctor.

Is online therapy as good as seeing someone in person?

For live video therapy with a licensed therapist, it is the same treatment. For guided internet CBT, a large review found results similar to face-to-face CBT on average.² Self-help apps without a person involved have much less proof.¹

Can an app replace my antidepressant?

No. Rejoyn, the FDA-cleared depression app, is meant to be used alongside antidepressant medicine and a clinician's care.⁴ Talk with your doctor or pharmacist before changing any medicine.

Where to go next

Sources

National Institute of Mental Health. Technology and the Future of Mental Health Treatment. NIMH, reviewed 2024. NIMH
Hedman-Lagerlöf E, et al. Therapist-supported Internet-based cognitive behaviour therapy yields similar effects as face-to-face therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. World Psychiatry, 2023. Full text (PDF)
U.S. Food and Drug Administration. 510(k) Premarket Notification K231209: Rejoyn. FDA, 2024. FDA database
U.S. Food and Drug Administration. 510(k) Summary K231209: Rejoyn (CT-152). FDA, 2024. FDA summary (PDF)
U.S. Food and Drug Administration. Device Software Functions Including Mobile Medical Applications. FDA, 2026. FDA
U.S. Food and Drug Administration. November 6, 2025: Digital Health Advisory Committee Meeting Announcement. FDA, 2025. FDA
U.S. Department of Health and Human Services. Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet. HHS. HHS
Federal Trade Commission. FTC to Ban BetterHelp from Revealing Consumers' Data, Including Sensitive Mental Health Information, to Facebook and Others for Targeted Advertising. FTC, 2023. FTC
Medicare.gov. Telehealth. Centers for Medicare & Medicaid Services, accessed 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule (fact sheet). CMS, 2024. CMS
U.S. Department of Veterans Affairs, National Center for PTSD. PTSD Coach. VA. VA
U.S. Department of Veterans Affairs, National Center for PTSD. Mobile Apps. VA. VA
Virginia Department of Health Professions. License Lookup. Commonwealth of Virginia. Virginia DHP
American Psychiatric Association. App Advisor: Mental Health Apps. APA, updated 2025. APA

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.

Online therapy and mental health apps