Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
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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 up to the 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 apart 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. Improvement rates 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. Trial registration: Clinicaltrials.gov Identifier: NCT03699488 , Retrospectively Registered October 8, 2018.
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Hull et al clustered patients using latent growth modeling and assigned labels to 6 trajectory groups: Acute Recovery, Recovery, Depression Improvement, Anxiety Improvement, Chronic, and Elevated Chronic.
“Based on patients’ longitudinal PHQ-9 and General Anxiety Disorder-7 (GAD-7) scores, Hull et al [38] clustered patients using latent growth modeling and assigned the following labels to the 6 trajectory groups that emerged: Acute Recovery, Recovery, Depression Improvement, Anxiety Improvement, Chronic, and Elevated Chronic.”
From Behavioral Activation and Depression Symptomatology: Longitudinal Assessment of Linguistic Indicators in Text-Based Therapy Sessions (2021) · cites this paper as [38]
Of the 6760 patients used for trajectory analysis, 47.2% improved and 52.8% did not improve.
“Of these patients, which Hull et al [38] identified as strictly “improving” or “nonimproving,” 47.2% (3189/6760) improved (classified as Recovery or Acute Recovery), and 52.8% (3571/6760) did not improve (classified as Chronic or Elevated Chronic).”
From Behavioral Activation and Depression Symptomatology: Longitudinal Assessment of Linguistic Indicators in Text-Based Therapy Sessions (2021) · cites this paper as [38]
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- Authors
- Hull, T. D., Malgaroli, M., Connolly, P. S., Feuerstein, S., & Simon, N. M.
- Affiliations
- Columbia University (US)
- New York University (US)
- Mount Sinai Beth Israel (US)
- Yale University (US)
- Corresponding author
- Hull, Thomas D.
- Venue
- BMC Psychiatry
- Published
- 2020-06-12
- Volume
- 20
- Issue
- 1
- Pages
- 297-297
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC7291694
- OpenAlex
- W3035148362
- Cited by
- 46
- References
- 46
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 9 · 2023: 5 · 2022: 12 · 2021: 5 · 2020: 1
- FWCI
- 5.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Columbia Academic Commons (Columbia University)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- telemedicine, depression, anxiety, symptom trajectories, treatment response, remission, patient engagement, digital psychotherapy, outpatient care, predictors of treatment response
- MeSH terms
- Anxiety, Depression, Female, Humans, Longitudinal Studies, Male, Psychotherapy, Telemedicine, Text Messaging
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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