Spending lots of time online can lead to depression, but it's also true that texting with a friend can help when you're feeling isolated and low.

But what if texting could be used as part of therapy to treat depression? A new study from the University of Washington (UW) School of Medicine suggests it just might. Researchers found that exchanging written online messages with a therapist, what they called “asynchronous therapy”, because the messages do not occur in the same block of time, can work just as well as traditional weekly video sessions. The findings could revolutionize how mental health care is delivered and make getting help more accessible than ever.

The beauty of message-based therapy is that it can happen on your time, from your own space, and the written record remains so that you can revisit the communication exchanged between you and your therapist.

The study enrolled 850 U.S adults diagnosed with moderate to severe depression who were randomly assigned to one of two treatment formats. One group exchanged written messages by text or email with a licensed therapist via a commercial digital platform. The other received standard weekly video sessions. After 12 weeks, the two groups showed remarkably similar improvements in depression symptoms and social functioning.

“We found that patients improved at similar rates, regardless of whether they were communicating with their therapist through messaging or live video calls,” senior author Patricia A. Arean, a retired professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, said in a press release. The finding supports the value of text-based therapy as a viable, evidence-based way to treat the millions of Americans who experience depression every year, she added.

People who are seeking help for depression often face a number of practical barriers, including: scheduling a weekly hour, finding a quiet private space for a video therapy session, and dealing with travel or technology glitches. The beauty of message-based therapy is that it can happen on your time, from your own space, and the written record remains so that you can revisit the communication exchanged between you and your therapist.

Another benefit is that the results suggest text-based therapy could expand access for people who cannot easily attend video appointments. Moreover, the initial dropout rate was lower in the texting format than the live-video group. The reason? The flexibility of messaging may keep more people engaged early on.

It's important to note that the research excluded people with severe depression, suicidal ideation or psychosis. So, while these findings are promising, they don't automatically apply to every person seeking mental health help. The study also found that people who participated in video sessions felt a slightly stronger sense of connection or “therapeutic alliance” with their therapists, compared to those using text messaging.

The findings could revolutionize how mental health care is delivered and make getting help more accessible than ever.

If you are thinking about trying message-based therapy, here are a few pointers:

  • Make sure the service is with a fully licensed therapist, not just a chatbot or untrained responder.
  • Ask about the structure. How often should you message? How quickly will the therapist reply? Is there still a live weekly check-in if needed?
  • Clarify how the platform handles crisis situations. If you ever feel unsafe, how quickly will you get a response?
  • Understand cost and insurance: Many insurers still don't cover pure message-based therapy, though the study's authors suggest that may be changing.
  • Monitor progress: If after several weeks you're not feeling better, it's reasonable to revisit live video or in-person options.

The landscape of mental health care is shifting. This study offers solid evidence that communicating with your therapist by text isn't just a matter of convenience, it can really work. For people with mild to moderate depression, and with the right supports in place, it could be a practical and effective option.

The study is published in JAMA Network Open.