Two-way Messaging Therapy for Depression and Anxiety:  Longitudinal Response Trajectories

Abstract

Background: Telemedicine is a strategy for overcoming barriers to access evidence-based psychotherapy. Digital modalities that operate outside session-based treatment formats, such as ongoing two-way messaging, may further address these challenges. However, no study to date has established suitability criteria for this medium. Methods: A large outpatient sample (n = 10,718) engaged in daily messaging with licensed clinicians from a telemedicine provider. Patients consisted of individuals from urban and rural settings in all 50 states of the US, who signed to a telemedicine provider. Using a longitudinal design, symptoms changes were observed during a 12 week treatment course. Symptoms were assessed from baseline every three weeks using the Patient Health Questionnaire (PHQ-9) for depression, and the Generalized Anxiety Disorder (GAD-7) for anxiety. Demographics and engagement metrics, such as word count for both patients and therapists, were also assessed. Growth mixture modeling was used to tease symptoms trajectories, and identify predictors of treatment response. Results: Two subpopulations had GAD-7 and PHQ-9 remission outcomes (Recovery and Acute Recovery, 30.7% of patients), while two others showed amelioration of symptoms (Depression and Anxiety Improvement, 36.9% of patients). Two subpopulations experienced no changes in symptoms (Chronic and Elevated Chronic, 32.4% of patients). Higher use of written communication, patient characteristics, and engagement metrics reliably distinguished patients with the greatest level of remission (Recovery and Acute Recovery groups). Conclusions: Remission of depression and anxiety symptoms was observed during delivery of psychotherapy through messaging. Improvements rate were consistent with face-to-face therapy, suggesting the suitability of two-way messaging psychotherapy delivery. Characteristics of improving patients were identified and could be used for treatment recommendation. These findings suggest the opportunity for further research, to directly compare messaging delivery with a control group of treatment as usual.

Proceedings of the Eighth Workshop on Computational Linguistics and Clinical Psychology

“…We utilized a corpus of messaging therapy sessions from over 6,500 unique patients previously collected via the Talkspace platform (Hull et al, 2020). Talkspace offers a paid service utilizing licensed and credentialed therapists to conduct asynchronous, message-based therapy conversations.…”

Digital phenotyping of complex psychological responses to the COVID-19 pandemic

“…Talkspace is a telemental health platform that enables licensed psychotherapists to deliver care through asynchronous two-way messaging including text messages, audio messages, video messages, and by scheduled live video sessions to patients within their regions of licensure. It has demonstrated acceptability and feasibility for increasing access to care 6 and is in use by over two thousand therapists who serve fifteen to twenty patients each on average at any given time throughout the United States and globally. The platform enables seamless integration of symptom and outcome measures, as well as crisis and referral services for those in need of higher levels of care.…”