Acknowledging one's own struggles is difficult; talking about those struggles with others — especially strangers — is even harder. In-person therapy can be intimidating—there’s something about sitting in a room, on a couch or chair, in front of a complete stranger who’s listening to your problems because you’re paying them—that doesn’t always feel authentic.
It makes me nervous and anxious, feeling their eyes on me as I recount past struggles that still impact me today, silently analysing while expressing concern and sympathy. Perhaps it would be so much easier and less stressful to share everything over text with someone — or something.
I might even feel a little less depressed.
A new study published in JAMA Network Open provides evidence that message-based psychotherapy (MBP) — therapy conducted through text messaging or chat interfaces — can be just as effective in easing depression and its symptoms as video-based psychotherapy (VBP), though further research is needed. This opens the door for text-based therapy to become a viable treatment option alongside in-person and video sessions.
The study involved an 850-participant, randomized clinical trial. The researchers found that the asynchronous nature of MBP allows for accessible and flexible interaction during times when support is most needed. It also facilitates more frequent contact, which is associated with steeper recovery curves, and creates a record of conversations that patients can review to deepen understanding and help implement action plans.
Text-based therapy has gradually gained ground in everyday life prior to this study. For years, advertising on streaming platforms like YouTube has promoted at-home text and video therapy services such as BetterHelp and TalkSpace. There are also numerous affordable online platforms — like Hims and Grow Therapy — that remove the need for in-person doctor visits and prescriptions.
Options for online therapy, whether through video calls or text messages, allow individuals to set their own pace and frequency, making treatment more accessible and less intimidating. This flexibility not only helps alleviate symptoms of depression and other mental health issues but also makes these services more appealing — especially for groups that have historically been less likely to seek mental health treatment than their white counterparts.
For example, in the U.S., only about 25% of Black Americans seek mental health care for issues like depression, anxiety, or PTSD, compared to around 40% of white Americans, according to McLean Hospital’s Deconstructing Stigma initiative.
Marginalized communities — Black, Hispanic, and Asian Americans — often view mental health treatment with stigma, believing that their struggles aren’t “bad enough” or that seeking help signals weakness. Online therapy could be the breakthrough needed to combat community stigma and help individuals overcome their own depression.