A therapist running a session over video can't hand a client a worksheet across the table, point to a whiteboard, or read body language the way they would in a room together. Virtual therapy activities exist to close that gap: structured exercises, adapted for screens, that keep telehealth sessions as engaging and clinically useful as in-person sessions. Done well, they're not a workaround. Done poorly, they're the difference between a client who stays engaged and one who quietly drops off after a few sessions.
Quick Answer: Best Practices for Virtual Therapy Activities
- Choose activities built for the screen, not in-person exercises ported over without adjustment.
- Use the platform's built-in tools (screen sharing, shared documents, chat) instead of asking clients to juggle multiple apps.
- Front-load technical setup so a session's time goes to the activity, not troubleshooting.
- Match the activity to the modality, since exposure therapy, CBT worksheets, and mindfulness exercises each translate differently to video.
- Build in homework that carries over outside the session, since clients can't take a whiteboard home.
- Watch engagement cues differently than you would in person, since body language reads differently on a small video window.
- Keep data and notes inside a compliant system, not scattered across personal apps or unsecured documents.
Why Virtual Therapy Activities Need Their Own Approach
The Research Backs Real Engagement, Not Just Convenience
It's tempting to assume virtual therapy activities are simply a lesser substitute for in-person ones. The evidence doesn't support that framing. The National Institute of Mental Health's own overview of technology and the future of mental health treatment points to internet-based cognitive behavioral therapy performing comparably to conventional, in-person CBT for conditions including depression, anxiety, social anxiety disorder, and panic disorder. The format isn't inherently the limiting factor. How the activity is adapted to it is.
What Changes When an Activity Moves to a Screen
A whiteboard exercise becomes a shared digital document. A role-play becomes something that has to work through a video lag. A grounding exercise that relied on a quiet, controlled room now has to account for the client's environment, which the therapist can't fully see or control. None of this makes virtual therapy activities worse. It just means they need to be deliberately redesigned rather than copied over unchanged.
Choosing the Right Activities for Telehealth
Cognitive Behavioral Therapy (CBT) Worksheets and Thought Records
CBT translates to telehealth relatively cleanly, since much of its structure is already worksheet-based. Shared digital documents, screen-shared thought-record templates, and structured questionnaires completed between sessions all work well, and several platforms now let clients fill these out asynchronously ahead of a session so the live time goes toward discussion rather than data entry.
Mindfulness and Grounding Exercises
These rely heavily on tone, pacing, and presence, which can feel different over video. Shorter, more structured guided exercises tend to translate better to telehealth than long, free-form ones, since they're less dependent on the in-room atmosphere that a screen can't fully replicate.
Exposure Therapy and Role-Play
This is where adaptation matters most. A qualitative study of telemental health therapists found that the vast majority described telehealth as reducing access barriers and enhancing exposure-based therapy in some respects, while also reporting real challenges with technology and less-controllable client environments. The same research base has also begun exploring telehealth-delivered virtual reality exposure therapy to recreate controlled exposure scenarios remotely, with early studies showing interest from both clients and therapists, alongside real questions about cost and access that are still being worked out.
Group and Family Activities
Icebreakers, structured discussion prompts, and shared creative exercises adapt reasonably well to group video formats. However, they typically need more explicit facilitation than an in-person group would, since the usual cues for "who speaks next" don't translate naturally to a grid of video tiles.
Setting Up Sessions for Activities to Actually Work
Front-Load the Technical Setup
Every minute spent troubleshooting a screen-share permission or a document that won't load is a minute not spent on the actual activity. Confirming that a client can access any tool an activity requires before the session starts, not during it, protects the limited time a session has.
Use Fewer Tools, Not More
A session that bounces a client among the video platform, a separate worksheet app, and a third messaging tool adds friction unrelated to the therapeutic content. Activities that live inside the same platform as the visit itself, through screen share, built-in document tools, or structured intake forms a client already knows how to use, tend to hold engagement better than ones requiring a new app each time.
Build Homework That Survives Outside the Session
An activity that only exists on a therapist's screen during the live session doesn't help a client between appointments. Worksheets, journals, or structured prompts that a client can revisit on their own device, ideally through the same secure portal they already use for intake and messaging, extend the value of an activity well beyond the 50 minutes during which it was introduced.
Reading Engagement Differently Over Video
Body Language Reads Differently on a Small Screen
A client's hands, posture, and broader physical presence are largely invisible in a typical video frame, so therapists often have to rely more heavily on vocal tone, pacing, and explicit check-ins than they would in person. This isn't a workaround so much as a different, equally valid set of clinical skills.
Watch for Disengagement Signs Specific to Telehealth
Camera avoidance, delayed responses that might be lag or might be hesitation, and a client multitasking just out of frame are telehealth-specific signals worth watching for directly, since they don't always map onto the disengagement cues a therapist would recognize in a physical room.
Compliance Considerations Specific to Virtual Therapy Activities
Keep Activity Data Inside a Secure System
Any worksheet, journal entry, or assessment a client completes as part of a virtual therapy activity is protected health information the moment it's linked to their record, which means it needs to reside within a HIPAA-compliant platform under a signed Business Associate Agreement, not in a personal note-taking app or an unsecured shared document.
Document Activities the Same Way You'd Document an In-Person Exercise
Whatever activity is used in a session still needs to be reflected in clinical documentation, as with any other therapeutic intervention. A platform that connects intake, session notes, and clinical records in one place makes this far less of an afterthought than juggling separate systems for the activity and the chart.
How Bask Health Supports Behavioral Health and Telehealth Practices
Behavioral health and telepsychiatry practices that build virtual therapy activities into their workflow need the same underlying infrastructure as any other telehealth specialty: secure intake that captures relevant history before a session, documentation that keeps pace with clinical work, and a platform that treats compliance as the default rather than an afterthought. Bask Health's patient management tools help practices track client progress and follow-ups between sessions. At the same time, our virtual clinic infrastructure provides a behavioral health brand with the same connected foundation that other telehealth specialties run on.
Conclusion
Virtual therapy activities work best when they're built for the screen rather than squeezed onto it, matched deliberately to the modality being used, and supported by a platform that keeps engagement, documentation, and compliance connected rather than scattered. The research suggests the format itself isn't the limiting factor. Thoughtful adaptation is.
If you're running a behavioral health or telepsychiatry practice and want the infrastructure behind your sessions to match the care happening inside them, you can explore Bask Health's plans or talk to our team about what that looks like for your practice.
References
- Authors. (2023). Article available via PubMed Central. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC10371164/
- National Institute of Mental Health (NIMH). (n.d.). Technology and the future of mental health treatment. https://www.nimh.nih.gov/health/topics/technology-and-the-future-of-mental-health-treatment
