Quick answer: For mild to moderate anxiety or low mood, guided online CBT worked about as well as face-to-face therapy in trials, so starting online is reasonable. See a GP or primary-care clinician first if you might need medication, a fit note or tests for a physical cause, or if you're dealing with an eating disorder, psychosis or alcohol or drugs. In a crisis, call 988, 9-8-8 or Samaritans.
In this guide
Who this is for — and when to get help today
This guide is for adults who are struggling with worry, stress or low mood and are wondering whether to sign up for online therapy or book a doctor's appointment first. It applies whether your doctor is a GP in the UK, a family doctor or walk-in clinic in Canada, or a primary-care clinician in the US.
If you're thinking about suicide or feel unsafe, don't wait for either. Call or text 988 in the US or 9-8-8 in Canada, call Samaritans on 116 123 in the UK, or call 911 or 999 in an emergency.
Does online therapy work as well?
For common problems, the research says it can. A 2023 review of 31 randomised trials found that guided internet-based CBT — structured online lessons with regular support from a therapist — produced results equivalent to face-to-face CBT for conditions such as depression, anxiety and panic. A separate analysis of video therapy for depression found no meaningful difference from in-person sessions, and no difference in how many people dropped out.
The evidence is less reassuring for post-traumatic stress: Scotland's health technology advisers found video therapy for PTSD did worse at three to six months' follow-up. And most trials exclude people with severe illness or high risk, so the results don't tell you much about those situations.
When to see your doctor first
Online therapy services can't do several things a doctor can. See your GP, family doctor or primary-care clinician first if:
- You might need medication. BetterHelp and Online-Therapy.com therapists can't prescribe. Talkspace has prescribers, but only for adults in the US, and not for controlled medicines.
- A physical cause is possible. Tiredness, low mood and anxiety can come from an underactive or overactive thyroid, anaemia or medicine side effects. The NHS notes a GP may arrange blood or urine tests; our guide to the five blood tests worth asking for when you're always tired explains which.
- You need time off work. In the UK you can self-certify for seven days; after that you need a fit note from a healthcare professional who has assessed you.
- Your problem needs a specialist referral. The NHS routes eating disorders, bipolar disorder, psychosis, personality disorders and drug or alcohol problems through a GP.
- Symptoms have lasted more than two weeks, are getting worse, or include thoughts of self-harm. That's the NHS's own threshold for seeing a GP.
When starting online makes sense
Starting online is reasonable if your symptoms are mild to moderate, you're managing day to day, you don't think you need medication, and you'd find it easier to talk from home or outside working hours. It's also a sensible bridge while you're on a waiting list for free therapy.
Some online therapy is free. In England, NHS Talking Therapies often starts with guided online programmes. Scotland's Living Life offers free phone CBT, and Wales offers SilverCloud online CBT by self-referral. In Ontario, Ontario Structured Psychotherapy and BounceBack are free.
If you pay, subscription services cost roughly £35–75 a week in the UK, and about $60–120 a week in the US without insurance.
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What's free in the US, Canada and UK
United States
Many insurance plans cover telehealth therapy; check your plan's network before paying yourself. Without insurance, federally funded health centres offer counselling on a sliding scale, and many employers offer free sessions through an assistance programme.
Canada
A family doctor, nurse practitioner or walk-in clinic is free, and can refer you to provincial programmes. In Ontario, Ontario Structured Psychotherapy offers free CBT to adults, with self-referral in some areas; BounceBack coaching is part of it. Other provinces run BounceBack and similar programmes.
United Kingdom
NHS Talking Therapies in England takes self-referrals without a GP; Scotland and Wales have the free phone and online CBT services above. A GP appointment is free everywhere in the UK.
Compare your options
| Option | Cost | Can prescribe or refer? | Best for |
|---|---|---|---|
| GP, family doctor or primary-care clinician | Free (UK, Canada); insurance or sliding scale (US) | Yes | Medication, physical checks, fit notes, specialist referral |
| Free public therapy (NHS Talking Therapies, Living Life, SilverCloud, Ontario Structured Psychotherapy) | Free | Can signpost; no prescribing | Depression, anxiety and related problems |
| Online therapy subscription | About £35–75 or $60–120 a week | Talkspace psychiatry (US adults) only | Mild to moderate problems, flexible timing, bridging a wait |
| Crisis lines (988, 9-8-8, Samaritans) | Free, 24 hours | Can connect you to urgent care | Thoughts of suicide or feeling unsafe |
What to do next
- In crisis, call a crisis line now.
- If any "doctor first" point applies, book your GP or primary-care appointment.
- Refer yourself to the free programme for your country — it costs nothing to join the list.
- If you start online therapy, review after a month. No improvement, or feeling worse, is a reason to see your doctor.
- Tell your doctor what you're doing so your care joins up.
The mental-health support finder asks how much this is affecting you and suggests self-help, online therapy, your doctor or crisis support, with free routes first.
Find my supportCommon questions
Is online therapy as good as seeing someone in person?
For many people, yes. A 2023 review of 31 trials found guided internet CBT worked about as well as face-to-face CBT for common problems such as anxiety and depression, and video therapy for depression shows similar results. Evidence is thinner for post-traumatic stress and severe illness, where in-person care may work better.
Can an online therapist give me a sick note?
Not usually. In the UK you can self-certify for the first seven days off work; after that you need a fit note from a doctor, nurse, pharmacist, occupational therapist or physiotherapist who has assessed you. Therapy subscriptions don't issue them, and in Canada and the US sick-leave paperwork normally comes from your doctor.
Should I tell my GP if I start online therapy?
It's a good idea, especially if you take medication, have a long-term condition or your symptoms change. Your GP can check for physical causes, prescribe if needed and refer you to free services. Telling them means everyone involved in your care has the full picture, and it makes a later referral quicker.
What if I can't afford online therapy?
Start with the free routes: NHS Talking Therapies in England, NHS 24's Living Life line in Scotland and SilverCloud in Wales; Ontario Structured Psychotherapy and BounceBack in Canada; and sliding-scale community health centres in the US. Many employers also offer a few free counselling sessions through an assistance programme.
Related guides
Sources
- Hedman-Lagerlöf E, et al. Therapist-supported internet-based CBT vs face-to-face CBT: systematic review and meta-analysis of 31 trials. World Psychiatry, 2023.
- Meta-analysis of video-delivered psychotherapy vs in-person therapy for depression. 2022.
- Scottish Health Technologies Group. Remote real-time psychotherapy compared with face-to-face therapy for depression, anxiety and PTSD.
- NHS. Depression in adults — diagnosis and when to see a GP.
- NHS. NHS Talking Therapies — what needs a GP referral. Accessed 18 October 2026.
- GOV.UK. Who can issue fit notes.
- BetterHelp. FAQ — prescribing and diagnosis. Accessed 18 October 2026.
- Talkspace. Psychiatry — medications prescribed.
- NHS 24. Living Life — free phone-based CBT in Scotland.
- Powys Teaching Health Board (NHS Wales). SilverCloud self-referral guide.
- Government of Ontario. Mental health services — Ontario Structured Psychotherapy.
- BounceBack Ontario. BounceBack coaching as part of Ontario Structured Psychotherapy.
- Health Resources and Services Administration. Find a health center.
- BetterHelp. Online therapy in the UK — prices. Accessed 18 October 2026.
- Online-Therapy.com. Pricing and plans. Accessed 18 October 2026.
- 988 Suicide & Crisis Lifeline (US).
- 9-8-8 Suicide Crisis Helpline (Canada).
- Samaritans. Contact a Samaritan.
General information, not medical advice — see our medical disclaimer. Written to the WhereToStart editorial policy. Next scheduled review: .