Unleashed: How Being Different Online Is Redefining Therapy

On social media, we can be ourselves—or pretend to be completely different—much like a nightclub where the lights have gone out. I came across this metaphor in Peter Pomerantsev’s book, „This is Not Propaganda: Adventures in the War Against Reality," which discusses disinformation. And it's true, isn’t it? Filters that enhance dull photos, a heated exchange on X, or a rude discussion in a Reddit forum are all things that occur online. However, there's a strong likelihood that in real life, when we meet face-to-face, we would be more genuine, polite, and restrained. Why is that?

„While online, some people self-disclose or act out more frequently or intensely than they would in person.“ wrote John Suler in 2004 and coined the term online disinhibition effect. Twenty years later, Suler is still correct about an effect that shapes how we behave in the digital world, how we use our smartphones, and why many online discussions quickly veer off track. We all encounter the negative aspects of this effect that ripple through our work, personal lives, and online interactions. But can there also be a positive side to it?

Why is online different from reality?

Let’s explore three of the six factors mentioned by Suler in his article that are particularly significant to mental health and therapy in the digital realm:

• dissociative anonymity

• dissociated imagination

• minimization of status and authority

Notably, two of these factors include the term "dissociative," a psychological concept referring to disconnection or detachment, which relates to the online disinhibition effect.

Dissociative anonymity refers to the idea that our digital persona is not directly tied to our true personality and lifestyle. Instead, because we remain relatively anonymous online, we can compartmentalize our digital self, keeping it separate from our „real“ self. This can lead us to repress our online identity by convincing ourselves that our online behaviors "aren’t me at all." The upside of this? You can learn something about yourself and your true character when you reflect on the ways your behavior changes when you’re anonymous. Where is that anger coming from, and can I channel it somewhere else?

Dissociative imagination, the second factor, refers to the perception that digital life exists in a separate world with its own rules and norms. This world seems disassociated from the real world, but it is not. The user advocating strongly for a zero income tax is, after all, a real person. While it's possible that bots or autonomous AI agents engage in discussions or threads, the main point remains that we envision the digital world as distinct from the real world, even though the two are actually inextricably linked. Without the real world, there is no online presence (at least not yet).

However, when it comes to mental health and therapy, this presents valuable options. We can challenge the rules and norms imposed by society or ourselves that shape our behavior. Albert Ellis proposed in his ABC model that it isn't the events themselves that trigger our emotions and actions; instead, it's our beliefs that influence how we perceive and evaluate a situation.

Cognitive reappraisal allows us to reassess our interpretations. For instance, when you encounter a colleague in the hallway, greet him, but he doesn’t return the greeting—how do you react? The level of disappointment or frustration you experience largely depends on whether you believe a) he’s upset because you requested a favor last week, or b) he’s preoccupied with thoughts related to the impending project deadline.

The final factor is the minimization of status and authority. In the digital realm, when you send a message, no one can tell if you’re dressed in a suit or joggers, whether you’re attractive, or if you’re frowning or smiling. What truly matters are your words, knowledge, the quality of your thoughts, and your technical expertise (just like here on Substack). In the context of digital mental health, this eliminates certain cues that could lead to biased judgments and behaviors. However, it also removes crucial information like body language, which can be beneficial in therapeutic interactions. Unfortunately, there’s no such thing as a free lunch.

The benefits of disinhibition in therapy

I firmly believe that amidst the chaos generated by the online disinhibition effect in Reddit forums, there lies an opportunity for digital therapy. Traditional face-to-face therapy utilizes techniques like cognitive reappraisal and restructuring to challenge our interpretations and alter the thoughts and beliefs we hold about ourselves, the world, and others. In this context, online disinhibition can be beneficial as it aids in this process.

I believe access to therapy is limited for many people today. For a 20-year-old man grappling with obsessive sexual thoughts, it requires considerable courage to meet face-to-face with a professional who is often a stranger, and mainly female. While I wouldn’t claim that professionals favor a specific patient type, like YAVIS—young, attractive, verbal, intelligent, and successful—data from Germany indicates that psychotherapy services are primarily utilized by women, individuals with advanced education, and those residing in large cities (German reference 1). In fact, German women aged 21 to 29 are twice as likely to seek psychotherapy compared to their male counterparts in the same age group (German reference 2).

Isn’t it interesting how we might explore digital ways to deliver therapy that really help break down barriers to access? Imagine if being anonymous allows us to open up and talk about those things we sometimes feel a bit shy or ashamed to share. And what if losing those visual cues about status and authority actually helps patients and therapists build a stronger bond? It may sound a bit paradoxical, but not seeing each other could actually foster that therapeutic connection, especially if we look at the positive experiences of young people using online therapy („I didn’t have to look her in the eyes“),

I find myself experiencing the online disinhibition effect, too! When I write here, I enjoy being much sharper and more focused in my arguments without the usual hedging I might do in face-to-face conversations. After all, that’s part of what crafting an op-ed or opinion piece is all about! It’s interesting how this style allows us to frame our ideas and think about concepts differently compared to chatting with someone at a conference. By the way, has anyone come up with the term „real-world inhibition effect”?