This has made CBT-by-website extremely popular in Europe and Australia, where health systems are more nationalized, says Stephen Schueller, an assistant professor of preventative medicine at Northwestern University. Schueller works in what he says is the largest team in the U.S. researching “technologies for behavioral change.” (Projects from that team include a social network meant to help depressive people.)

In the U.K., there is a version of online CBT for depression called Beating the Blues, which became popular despite only being available by prescription. “They would write you out a prescription with a web address and access code, and you’d be able to access that,” Schueller told me.

In the U.S., big managed-care consortiums like Kaiser Permanente have shown the most interest in CBT delivered through the Internet. (Kaiser has even licensed a version of Beating the Blues.) But when online CBT isn’t supported by large providers, Schueller says, it struggles to make money.

“I’ve seen a lot of people try this, and no one has been very successful at getting one to stick around,” he says. The main thing, it seems, preventing effective Internet therapy from entering the American market is … the market.

Joyable costs $99 per month or $239 for three months. It assigns every client—the site never calls them patients—a coach, who has a 30-minute-long telephone call with the patient at the beginning of their treatment. After that, the coach is available by text, email, or scheduled phone call, and they’re supposed to reach out once a week.

The coaches aren’t licensed therapists, though they are trained in CBT and motivational methods by Joyable. (They’re also all salaried, for now: “Today all of our coaches are full-time Joyable team members and they sit with us in our headquarters,” Shalek told me.)

“Imagine you wanted to get in shape and you went to the gym and had a personal trainer. They’ll tell you what to do, you do exercises, and you’d get in shape. But if you went to the gym by yourself and did those same exercises, you’d also get in shape,” says Shalek. (Or you might hurt yourself doing dead lifts—less of a liability with home CBT, though its fair to surmise that many would welcome the supervision of a trained professional.)

With the coach assigned, Joyable has three phases. First, it educates clients about how CBT approaches social anxiety with readings and interactive videos. Then, it teaches clients to recognize anxious thoughts and break them down: This, says Shalek, is the “cognitive” part of “cognitive behavioral therapy.” Finally, there’s the behavioral section, when the website guides users through small, offline activities.

“You do things that make you a little bit anxious, and in doing so you realize that the thing you’re afraid of is less likely to happen—and if it does happen, then you can cope with it,” he says. Typical activities in this phase might include getting coffee with a friend, making a phone call, or speaking up at a meeting.