A Study of Asynchronous Mobile-Enabled SMS Text Psychotherapy

Telemed J E Health. 2017 Mar;23(3):240-247. doi: 10.1089/tmj.2016.0114. Epub 2016 Oct 31.


Background: Many obstacles to obtaining psychotherapy continue to diminish its reach despite its documented positive effects. Using short message service (SMS) texting and Web platforms to enable licensed psychotherapists to deliver therapy directly to the lived context of the client is one possible solution.

Introduction: Employing a feasibility study design, this pilot trial further evaluated the external validity for treatment outcomes of text therapy and extended findings to include mobile-enabled text platforms.

Materials and methods: Adults seeking text therapy treatment for a variety of disorders were recruited from a text therapy service (N = 57). Clinical outcomes were measured using the General Health Questionnaire-12 (GHQ-12) through 15 weeks of treatment. A process variable, the therapeutic alliance, was measured with the Working Alliance Inventory. Treatment acceptability was assessed with ratings of satisfaction for several aspects of the treatment, including affordability, effectiveness, convenience, wait times to receiving treatment, and cost-effectiveness.

Results: Results indicate evidence for the effectiveness of the intervention (GHQ-12, Cohen's d = 1.3). Twenty-five (46%) participants experienced clinically significant symptom remission. Therapeutic alliance scores were lower than those found in traditional treatment settings, but still predicted symptom improvement (R2 = 0.299). High levels of satisfaction with text therapy were reported on dimensions of affordability, convenience, and effectiveness. Cost-effectiveness analyses suggest that text therapy is 42.2% the cost of traditional services and offers much reduced wait times.

Conclusion: Mobile-enabled asynchronous text therapy with a licensed therapist is an acceptable and clinically beneficial medium for individuals with various diagnoses and histories of psychological distress.

Keywords: SMS text; feasibility research design; mobile health; psychotherapy; text therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Feasibility Studies
  • Female
  • Humans
  • Internet*
  • Male
  • Middle Aged
  • Pilot Projects
  • Psychotherapy / methods*
  • Telemedicine / methods*
  • Text Messaging*