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    Online therapy explained: evidence, rules and privacy in 2026

    Therapist-supported internet CBT produced effects similar to face-to-face CBT in a 2023 meta-analysis of 31 trials.[1] Rules matter as much as evidence. Medicare telehealth flexibilities run through 2027, therapists generally need a license or compact privilege where the client is, and the FTC has taken action against BetterHelp and Cerebral over sharing health data for advertising.[2][3][4][5]

    Editor reviewedStrict sourcingUpdated ExplainerMental health, Health and medicine

    Online therapy means getting mental health care by video, phone, messaging or an internet programme instead of in an office. NIMH notes that phones, the internet and mobile devices have created new ways to reach treatment, including where professionals are scarce.[6] This page explains what the evidence shows, how online care is regulated, and the privacy record of large platforms, as of 11 October 2026.

    This page is not medical advice. Talk to a clinician about what suits you. Online services are not a substitute for emergency help. In a crisis, call or text 988 in the US, call Samaritans on 116 123 in the UK and Ireland, or see findahelpline.com.[7]

    What the evidence shows

    The best evidence is for guided internet CBT: structured online lessons with support from a therapist. Across 31 randomised trials, it worked about as well as CBT in person.[1] CBT delivered as self-help with no therapist also helped with depression, but less.[8] Many apps have not been tested. NIMH says there is very little information on app effectiveness.[9]

    Hedman-Lagerlöf et al. (2023) pooled 31 RCTs comparing therapist-supported internet CBT with face-to-face CBT in adults across 16 conditions, half in depression or anxiety, and found g=0.02 (95% CI −0.09 to 0.14).[1] Unguided self-help CBT for depression gave g=0.45 versus control in Cuijpers et al. (2023), compared with g=0.79 for CBT overall.[8][10] These results do not automatically carry over to subscription messaging services, which deliver therapy in different ways.

    How online care is regulated

    • Licensing. Therapists are licensed by states.[11] The Counseling Compact lets counselors in ten live states apply for privileges to practise in the others, as of 1 October 2026.[3]
    • Medicare. Telehealth is available anywhere in the US through 2027. An in-person visit rule for mental health telehealth at home applies after 31 December 2027, and people who start before then count as established patients.[2][12] Audio-only care at home continues through 2027.[13]
    • Apps and AI. NIMH describes very little industry regulation of mental health apps.[9] As of November 2025, FDA had not authorised any generative-AI device for mental health conditions. Illinois banned AI-delivered therapy in 2025.[14][15] See the AI chatbots analysis.

    Privacy: what regulators found

    • BetterHelp. The FTC said BetterHelp shared email addresses, IP addresses and health questionnaire answers with Facebook, Snapchat, Criteo and Pinterest for advertising, despite promising privacy. Its 2023 order requires a $7.8 million payment and bans sharing health data for advertising.[16][4] Refunds of nearly $5.2 million and then over $2.6 million have been sent.[17]
    • Cerebral. The FTC said Cerebral gave sensitive information of nearly 3.2 million consumers to platforms including LinkedIn, Snapchat and TikTok. It also alleged a multi-step, often multi-day cancellation process.[5][18] Separately, Cerebral stopped prescribing controlled substances in October 2022 and agreed in a 2024 non-prosecution agreement not to prescribe them in future.[19]

    For a service-by-service comparison with dated prices, see the online therapy services guide. For the wider debate on sensitive health data, see the neural data privacy debate.

    Questions to ask an online service

    NIMH’s questions for any therapist apply online too: credentials, approach and evidence, goals, whether they can prescribe, confidentiality, fees and insurance.[20] Given the FTC cases above, it is reasonable to also read how a service uses your data for advertising.[4][5]

    Next in the crash course

    Questions readers ask

    Is online therapy as effective as in-person therapy?

    For therapist-supported internet CBT, a 2023 meta-analysis of 31 randomised trials across 16 conditions found effects similar to face-to-face CBT (pooled g=0.02). That finding is about guided internet CBT, not every online service.[1]

    Do mental health apps work?

    NIMH says there is very little industry regulation of mental health apps and very little information on their effectiveness.[9]

    What did the FTC find about BetterHelp?

    The FTC said BetterHelp disclosed email addresses, IP addresses and health questionnaire information to Facebook, Snapchat, Criteo and Pinterest for advertising, and in 2023 ordered it to pay $7.8 million.[16][4]

    Will Medicare cover video therapy at home in 2027?

    Yes. CMS says beneficiaries can receive Medicare telehealth anywhere in the US through 31 December 2027, and behavioural health keeps home access after that, with an in-person visit requirement applying after 2027.[2][12]

    Sources

    · 20 claims from 14 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      A 2023 meta-analysis of 31 randomised trials across 16 conditions found therapist-supported internet CBT produced effects similar to face-to-face CBT (pooled g=0.02). confirmedas of 2023-06-01

    2. [2]

      CMS says Medicare beneficiaries can receive telehealth anywhere in the US through 31 December 2027; from 1 January 2028, location limits return except for behavioural health services. confirmedas of 2026-10-08

    3. [3]

      As of 1 October 2026 the Counseling Compact was live in ten states (Arizona, Arkansas, Georgia, Indiana, Louisiana, Minnesota, Ohio, Oklahoma, Tennessee and Wyoming), letting eligible licensed counselors who live there apply for a privilege to practise in the other nine. confirmedas of 2026-10-01

    4. [4]

      In July 2023 the FTC finalised an order requiring BetterHelp to pay $7.8 million and banning it from sharing consumers' health data for advertising, resolving allegations that it shared sensitive data with Facebook, Snapchat and others after promising privacy. confirmedas of 2023-07-14

    5. [5]

      In April 2024 Cerebral agreed to an FTC order restricting its use of sensitive data for advertising; the FTC said it had shared sensitive information of nearly 3.2 million consumers with platforms such as LinkedIn, Snapchat and TikTok. confirmedas of 2024-04-15

    6. [6]

      NIMH says phones, the internet and mobile devices have created new ways to get treatment, including where mental health professionals are not physically available; some involve a therapist at a distance, while web programmes and apps work without one. confirmedas of 2026-10-11

      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · What are options for digital health care? (retrieved 2026-10-11)
    7. [7]

      In the US, people in suicidal crisis or emotional distress can call or text 988 to reach the 988 Suicide & Crisis Lifeline; in the UK and Ireland, Samaritans can be called free on 116 123; findahelpline.com lists helplines in other countries. confirmedas of 2026-10-11

    8. [8]

      The 2023 CBT meta-analysis found CBT was also effective as unguided self-help (g=0.45), though with smaller effects than CBT versus control overall. confirmedas of 2023-02-01

    9. [9]

      NIMH says there is very little industry regulation of mental health apps and very little information on their effectiveness. confirmedas of 2026-10-11

    10. [10]

      A 2023 meta-analysis of 409 trials (52,702 patients) found CBT for depression had moderate to large effects versus care as usual or waitlist (g=0.79), was only slightly and not robustly better than other psychotherapies, and matched medication in the short term. confirmedas of 2023-02-01

    11. [11]

      Licensed counselors (such as LPCs) need a master's degree; BLS says all states require counselors in private practice to complete supervised clinical hours, pass an exam and do continuing education, with requirements varying by state. confirmedas of 2026-10-11

    12. [12]

      CMS says Medicare's in-person visit requirement for mental health telehealth at home (a visit within 6 months before the first telehealth service, then every 12 months) takes effect after 31 December 2027, and people who start before then will count as established patients. confirmedas of 2026-10-08

    13. [13]

      CMS says audio-only telehealth at home remains available through 2027, and from 2028 audio-only can still be used for behavioural health at home when the patient cannot use or does not consent to video. confirmedas of 2026-10-08

    14. [14]

      At the November 2025 meeting, CDRH director Michelle Tarver said FDA had authorised more than 1,200 AI-enabled medical devices, but none yet used generative AI for mental health conditions. confirmedas of 2025-11-06

    15. [15]

      Illinois Governor JB Pritzker signed the Wellness and Oversight for Psychological Resources Act on 1 August 2025; it bars using AI to provide mental health and therapeutic decision-making while allowing AI for administrative and supplementary support for licensed professionals. confirmedas of 2025-08-04

    16. [16]

      The FTC said BetterHelp disclosed consumers' email addresses, IP addresses and health questionnaire information to Facebook, Snapchat, Criteo and Pinterest for advertising. confirmedas of 2023-07-14

    17. [17]

      The FTC's refund administrator sent nearly $5.2 million in BetterHelp refunds in June 2024 and a second round of over $2.6 million to more than 534,000 people; eligible customers paid for BetterHelp between 1 August 2017 and 31 December 2020. confirmedas of 2026-10-11

    18. [18]

      The FTC alleged that despite promising "cancel anytime", Cerebral made clients go through a complex, multi-step and often multi-day cancellation process. confirmedas of 2024-04-15

    19. [19]

      In a November 2024 non-prosecution agreement with federal prosecutors in Brooklyn, Cerebral agreed to forfeit $3.652 million over practices that encouraged stimulant prescribing from 2019 to 2022; it stopped prescribing controlled substances on 15 October 2022 and agreed not to prescribe them in future. confirmedas of 2024-11-01

    20. [20]

      NIMH suggests asking a prospective therapist about credentials, approach and its evidence base, goals and expected number of sessions, whether they can prescribe medication, confidentiality, fees, insurance and sliding-scale fees. confirmedas of 2026-10-11

      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · How can I find a therapist? (retrieved 2026-10-11)
      • Psychotherapies · National Institute of Mental Health (NIH) · 2024-02-01 · What should I look for in a therapist? (retrieved 2026-10-11)
    Revision history (1)
    1. Page created.

    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Jan 11, 2027.

    Cite this page

    "Online therapy explained: evidence, rules and privacy in 2026." ContentLora, updated Oct 11, 2026. https://contentlora.com/explain/online-therapy-explained

    Spotted an error? Suggest a correction or emailcorrections@contentlora.com.

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