Quotes of the Day

In the ash wednesday bushfires of 1983, Ann Fogarty was so badly burned doctors feared she would die. After many operations and with hardly an inch of her body unscarred, she left hospital and slowly put her life back together. But on a baking-hot day two years ago, Fogarty, who lives in rural Victoria, smelled smoke on the wind — and started falling apart. "It just awakened all my memories," she says. "It was almost like reliving the fire all the time." Telling herself that after so many years "I ought to be over this," she struggled to cope alone. But soon she was so anxious she could barely leave the house.

"I knew I needed help," says Fogarty, 58. "But going and sharing it all seemed too confronting," and as a pensioner, she worried what counseling would cost. Quietly desperate, she combed the Internet for help — and found ptsd-online.org, set up by psychologist Britt Klein, of Swinburne University of Technology, to trial Web-based clinical treatment for people with post-traumatic stress disorder. After a phone interview to confirm her diagnosis, Fogarty was accepted into the e-therapy program. "I had a real gut feeling, Oh, this is just the right thing," she says. "It just seemed like, here is something I can do without having to go out."

E-therapy has been around almost as long as the Internet. It's closely allied to cognitive behavioral therapy, which replaces months or years on the couch with focused programs to help people change unwanted feelings and reactions by challenging the beliefs that underlie them. In the 1990s, some CBT practitioners began to wonder if the structured, learning-based treatment would also work online. At first the idea was widely seen as "wacky," says Klein. "Some people said, 'How can you establish a therapeutic relationship with someone when you don't even see them?' "

Dozens of randomized controlled trials later, the wacky factor is fading. E-therapy programs are being offered or tested by reputable institutions worldwide. In Australia, Swinburne's panic-online and ptsd-online have been joined by e-Couch, for mood disorders, and MoodGYM, for depression, from the Australian National University's Centre for Mental Health Research, and by the Climate suite of programs from the Anxiety Disorders Research Unit at St. Vincent's Hospital, Sydney. The Australian Department of Health is now funding Swinburne's National e-Therapy Centre for Anxiety Disorders, which will soon offer CBT treatment via anxietyonline.org.au.

Mental-health professionals "are fascinated with what we're doing and excited to see the change in patients," says Dr. Gavin Andrews, who heads the St. Vincent's clinic. About 500 people have taken part in its trials of e-therapy for panic disorder, mild depression and social phobia, and "we are amazed by the results," he says. "Over the Web, we can produce exactly the same benefit as in our clinic, with a quarter of the staff time. We are curing people we never see." Andrews, who's also Professor of Psychiatry at the University of New South Wales, says his message to colleagues these days is: "The time has come, guys, to realize that this is another sensible way of delivering therapy."

It's estimated that 1 in 5 Westerners has a mental disorder in any given year. Most never seek treatment, deterred by cost, distance, lack of time, or fear of what others might say. With e-therapy, Andrews says, "people don't have to take time off work, they can do it at night, when it's convenient, at home." It doesn't appeal to everyone, or help all conditions: people with mental illnesses that can't be treated by an e-therapy program are referred to appropriate services during screening. But it adds a new tool to the clinical kit, says Swinburne's Klein: "It's about giving people greater choice and increasing accessibility."

For Fogarty, e-therapy was "a very non-threatening way" to get help. As she went through the 10 weeks of lessons on techniques for tackling her fears and activities to practice what she'd learned, "I felt more confident," she says, "like there was something I could do to manage the way I was feeling." She was guided by a psychologist who emailed her once a week (e-therapy may also include text messaging and access to private online forums). "Even though I never met her," Fogarty says, "I found her very understanding, perfectly accepting of how I felt." Though she sometimes longed for more frequent emails, in her own notes to the therapist, "I was able to write exactly what I wanted to say, rather than speaking to someone and it not coming out quite the way you meant."

Near the end of the program, Fogarty was asked to write about the fires, a task that brought both relief and anxiety. "I thought, it's so nice to begin to be honest about this," she says. But as she started reliving the trauma, "I felt I needed someone alongside me to help me do it." At her online guide's suggestion, she now sees a counselor once a month; the cost is covered by Medicare. "E-therapy was a really positive first step," she says. "It brought me to where I needed to be."

• Elizabeth Keenan