The Good, the Bad, and the Ugly: Clinical Considerations for Telehealth Delivery of Exposure Therapies for Anxiety Disorders.

Abstract

Telehealth has become a pillar for the delivery of psychotherapy, including exposure-based treatments for anxiety-related disorders. While research broadly supports the efficacy of telehealth-delivered anxiety treatments, clinicians and patients need to weigh the benefits and limitations to make informed decisions. This piece highlights the benefits of supporting continued use of telehealth exposure-based treatments, including access to specialized services, treatment efficiency, facilitation of naturalistic exposures, and family involvement. We also outline challenges related to building rapport, delivering psychoeducation, monitoring safety behaviors, and treating young children or individuals with complex presentations. Strengths and weaknesses are summarized in a checklist that can be used as a preliminary tool for clinicians and patients to assess the suitability of teletherapy. Additionally, we discuss gaps between efficacy and clinician perceptions of feasibility and identify future research directions, including examination of treatment moderators and development of triage frameworks to guide treatment format decisions. Teletherapy holds lasting promise for exposure-based care, but its implementation must be flexible, tailored, and informed by evidence and patient-specific factors.