Text-based psychotherapy can be as effective as live video sessions for patients being treated for depression, new research suggests.
The study , published Oct. 30 in JAMA Network Open, compared outcomes of 850 adults who received either message-based psychotherapy or weekly video-based psychotherapy through a commercial online mental health platform, Talkspace.
“We found that patients improved at similar rates, regardless of whether they were communicating with their therapist through messaging or live video calls,” said Patricia A. Areán , retired professor in psychiatry and behavioral sciences at the University of Washington School of Medicine and a senior author of the study. “This supports the use of text-based therapy as a viable, evidence-based way to treat the millions of Americans who experience depression every year.”
Participants were randomly assigned to one of the two formats for 12 weeks. Those who did not respond after six weeks of treatment were re-randomized to receive a combination of both modalities. At the end of the trial, participants in both groups showed comparable improvements in depression symptoms and social functioning.
The research team noted that patients receiving video-based therapy were slightly more likely to disengage early in treatment, while message-based therapy offered greater flexibility for patients to engage with therapists.
“Depression is one of the leading causes of disability and mortality worldwide,” said healthcare practice and policy researcher Michael Pullmann, former research professor of psychiatry at the UW School of Medicine and the paper’s lead author. “Message-based psychotherapy can help practitioners reach patients who may not otherwise be able to access care.” Pullmann is now a senior program officer in implementation science at the Patient-Centered Outcomes Research Institute in Washington, D.C.
The authors emphasized that expanding insurance reimbursement for message-based therapy could make effective treatment more accessible.
The study was a collaboration between the University of Washington School of Medicine and Talkspace. The National Institute of Mental Health provided funding (R44 MH124334).
JAMA Network Open
10.1001/jamanetworkopen.2025.40065
Randomized controlled/clinical trial
People
Message-Based vs Video-Based Psychotherapy for Depression
30-Oct-2025
Dr Raue reported receiving personal fees from AbleTo, Sanvello, and Iona Mind outside the submitted work. Ms Griffith Fillipo reported receiving grants from the National Institute of Mental Health for research activities outside the submitted work. Dr Heagerty reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Padmanabhan reported receiving grants from and being an employee of Talkspace LLC during the conduct of the study. Dr Hull reported receiving personal fees from and being an employee of Talkspace LLC during the conduct of the study; and receiving compensation from Hero Journey Club and Slingshot AI during the editing of the manuscript. No other disclosures were reported.