Mental health: Text therapy to ease depression; study finds evidence

One of the biggest mental health innovations of the past decade is therapy via text message — treatment you can access in snippets throughout your day. If you wake up anxious about a presentation, you might text your therapist first thing in the morning. Hours later, she replies, helping you reframe your thoughts and calm your nerves.

Text-based therapy has expanded rapidly through digital platforms like BetterHelp and Talkspace, which connect users with licensed therapists for both live chat and on-demand messaging. A new study published Thursday in JAMA Network Open provides early evidence that this approach can effectively treat mild to moderate depression, with results comparable to traditional video therapy.

In the clinical trial, 850 adults with mild to moderate depression were randomly assigned to two groups. One received weekly video sessions, while the other had unlimited messaging or email exchanges with a therapist. After 12 weeks, both groups reported similar improvements in depression symptoms.

“We were pleasantly surprised to see that it was as good as weekly video therapy,” said Patricia A. Areán, a former professor at the University of Washington School of Medicine and co-author of the study. “We didn’t really find any differences in the outcomes.”

The study wasn’t designed to prove the two methods are equivalent, but rather to see if one outperformed the other. It offered limited details about participants, such as how long they’d been depressed or whether they were taking antidepressants.

According to Dr Areán, Talkspace initiated the study partly because insurers rarely reimburse for text-based therapy, despite its growing popularity. “They knew that they needed data,” she said. The findings, she added, suggest insurers should consider covering it, potentially improving access for people who can’t easily attend video appointments.

Dr Jane M. Zhu, a health policy researcher at Oregon Health & Science University who was not involved in the study, called the results “encouraging” but said more data is needed before insurers change policies. The trial excluded higher-risk patients, such as those with suicidal thoughts, and didn’t analyse differences in therapist response times or message frequency.

The demand for therapy has surged since the pandemic, when virtual sessions became the norm. Historically, about 3–4% of Americans received psychotherapy; by 2021, that number had more than doubled to 8.5%. Meanwhile, roughly 17.5% of Americans take psychotropic medication — a figure that has remained stable for years.

Dr Zhu said text therapy could eventually serve as part of a “stepped-care model,” where patients start with low-intensity treatments and move to more specialised care if needed. Dr Mark Olfson, a psychiatry professor at Columbia University, agreed, saying patients with milder depression “might reasonably be offered a choice” between text- and video-based psychotherapy.

Although some therapists worry that text exchanges may miss subtle emotional cues, no adverse events occurred during the study. Interestingly, participants were more likely to drop out of video therapy than text-based treatment, though video sessions appeared to foster stronger emotional bonds. When some participants later switched to video sessions, their connection with therapists deepened significantly.

Dr Areán said this difference deserves further study. “How do you build an alliance when you can’t see the person?” she asked. “How do you deal with silences when you can’t see them? Are they crying? Are they happy?”

@The New York Times