Text Therapy Really Can Work, Especially During a Pandemic
A new study looked at text-based interventions as a safe and promising tool to help people with mental illness.
How long has it been since you sent your last text? A few hours, or maybe even a few minutes? Most of us are texting nonstop these days, especially if we’re cooped up indoors and separated from the people we love. And while you’re likely super comfortable texting your friends, odds are, you haven’t given much thought to this idea: What about texting your therapist?
If this sounds crazy to you, buckle up—it may be the way of the future. The mental health care landscape as we once knew it is changing, and quarantine is accelerating that shift. “While the pandemic is, of course, problematic in so many ways, I think it has forced our field to innovate in mental health,” says Bill Hudenko, Ph.D., research assistant professor in the Department of Psychological & Brain Sciences at Dartmouth College in Hanover, NH. Hudenko co-authored a new study in Psychiatric Sciences examining text-message intervention as a tool in conjunction with other forms of mental health treatment.
Researchers found that texting is an effective way for therapy providers to engage with their patients, especially when schedules are disrupted due to COVID-19. Though it may never replace the value of in-person connection, virtual care has perks: it’s accessible, convenient, and totally pandemic-safe.
COVID-19 & Mental Health Care
Depending on where you live, getting in-person therapy may not be an option right now. On the bright side, the pandemic has ushered in a huge new wave of remote working and living. The U.S. Department of Health and Human Services has reported a dramatic increase in the demand for telehealth care and they’ve taken steps to make it more accessible to people across the country, like expanding Medicare coverage to include remote care.
And the science behind telehealth? So far, it appears that it’s working. A 2016 research review in Telemedicine Journal and E-Health found telemedicine (talking to a therapist over phone or video) to be an effective mental health care tool on par with in-person therapy. A 2018 study from the University of Michigan Behavioral Health Workforce Research Center noted that around half of mental health practitioners surveyed were offering telehealth care, and most professionals found it to be a valuable way to connect with patients.
There’s a difference, though, between phone or video conferencing and texting—the modality that Hudenko and his colleagues are examining more closely. For the Psychiatric Sciences study, they added a text-message intervention service to an in-person program of mental health treatment for people with serious mental illness. “What we wanted to demonstrate was that [text-based therapy] works and for whom it really works,” Hudenko says. “The study generally found that messaging-based intervention is a very promising mode.” Specifically, the study found that regular texting with a mental health practitioner can reduce depression and paranoid thinking and improve illness management.
“I think this has tremendous implications nationally for mental health,” Hudenko explains, noting that texting could help improve access to therapy, especially during this era of social distancing. When your significant other is sitting in the next room, it’s difficult to vent to your therapist about them on Zoom. You may feel more comfortable conversing over text where you can have a better sense of privacy.
What Text Therapy Looks Like
Here’s how a text conversation with a mental health care provider might go:
“People now can consistently vent what they need and be talking to someone,” Hudenko says. This is different from shooting off a message to your friend about your frustrations with life in quarantine. Providers can use cognitive behavioral therapy to ask questions, helping patients identify the root causes of their anxiety or depression and figure out how to reframe them. “If you are struggling with depression, and you’re thinking, ‘No one loves me,’ I as a clinician can take that information about your belief, and I can help you think about a challenge of that thought,” Hudenko explains. Rather than waiting a week until your next therapy session rolls around, you’re able to get answers ASAP.
Inspired by the research he’s done on text-based therapy intervention, Hudenko and some colleagues have started a therapy platform called Trusst, which connects patients to therapists through an app-based messaging service. Providers are available five days per week to respond to concerns within 24 hours. BetterHelp and Talkspace are two other online services that offer video, phone, and text therapy, or some combination of those three.
It’s Not for Everyone
While there are definite upsides to text therapy (privacy, ease of access, immediate responses), it’s not a perfect solution for everyone. Lynn Bufka, Ph.D., senior director for Practice Transformation for the American Psychological Association in Washington, D.C., cautions that text therapy is probably best used in addition to another form of therapy. The reason? In case of a crisis, you have access to a real person who can help you through that tough moment, either over the phone or in person.
“Texting can be useful to support some of the behavior changes that you’re trying to do and engage in, but it’s not necessarily going to be the medium in which you have that discussion to identify what the issues are,” she says. It can be difficult to facilitate lengthy conversations over text.
Though texting has shown to be helpful in addition to in-person care, Bufka notes that there’s not a lot of research to show that it works well on its own. It's also tough to know who you’re really talking to behind that text interaction. “If a person is considering a text-only service, they really should pay attention to what the fine print says,” Bufka suggests. “Who’s on the other end of it? What’s the level of service?” You want to make sure your provider is licensed as a registered social worker, psychologist, or psychiatrist associated with a legitimate company that requires proper credentials. Do your research before you commit.
Bufka notes that choosing a therapist is a personal decision based on your needs. “I think an individual really needs to think about, what’s the level of care that I need?” she says. If you’re okay with checking in quickly a few times throughout the week, text therapy might be a good model for you. If you’re more comfortable with an hour-long video conversation, that works too. Hudenko agrees that there’s no one-size-fits-all approach. “I think messaging-based care can work as a stand-alone treatment for many people, but for some people, they’ll either need something else or need texting in addition to what they’re already doing,” he says. Ask your provider if they have a texting option alongside their regular therapy service.
The Future of Therapy
It’s unclear how the pandemic will change mental health care, but Bufka expects that this is only the tip of the iceberg for virtual services. “I suspect that when the public health emergency is over, many people will be doing more of a hybrid model of in-person and telehealth in their practices, because we’ve demonstrated that it can be done and it can work,” she says. Spending an hour on video chat or having a 10-minute text conversation removes the need to spend 30 minutes in the car going to and from your appointment.
Hudenko hopes that virtual providers will continue to change the way people think about therapy. “Not only does it represent a change in the model of what’s possible, but I think there’s going to be a national change in mindset around the kind of care that is the most helpful to us,” he says. This unprecedented time may lead to a more approachable, more convenient model of mental health services.
Telehealth Demand: U.S. Department of Health and Human Services. (2020.) “Telehealth: Delivering Care Safely During COVID-19.” hhs.gov/coronavirus/telehealth/index.html
Text Therapy Study: Psychiatric Services. (2020.) “Augmenting Evidence-Based Care With a Texting Mobile Interventionist: A Pilot Randomized Controlled Trial.” ps.psychiatryonline.org/doi/10.1176/appi.ps.202000239
Telehealth Study: Telemedicine Journal and E-Health. (2020.) “The Empirical Evidence for Telemedicine Interventions in Mental Disorders.” ncbi.nlm.nih.gov/pmc/articles/PMC4744872/
Telehealth Study: University of Michigan Behavioral Health Workforce Research Center. (2018.) “The Use of Telehealth Within Behavioral Health Settings: Utilization, Opportunities, and Challenges.” behavioralhealthworkforce.org/wp-content/uploads/2018/05/Telehealth-Full-Paper_5.17.18-clean.pdf