MMore than a decade ago, Thomas Derrick Hull, a clinical psychologist who researches digital health, had a wild idea. What if therapists who cannot meet demand Mental health care providers in the US have started sending patients text messages instead of forcing them to come into the office?

Back then, even Hull thought it unlikely that patients and providers would be able to use a screen to create the connections and meaningful conversations that flourish in person. But the benefits were compelling: Text messaging is cheap, fast, accessible, and easy to use on the fly, potentially allowing therapists to interact with their patients regularly rather than waiting for a weekly session. So Hull started studying the effectiveness of textual assistanceeventually becoming an executive at online therapy company Talkspace. (He left the company in 2020 and now works at digital wellness startup.)

Even if texting was only 60% or 70% as effective as traditional therapy, its convenience and availability might make it a better option than nothing, Hull thought. “It seemed like a fair deal,” Hull says. “But when we started looking at the data, it seemed to be just as effective.”

Recent research, some funded by text therapy providers like Talkspace, continues to suggest that texting is a legitimate and effective way to deliver mental health care. for people of all ages. IN study For example, data published in July showed that therapy via text or voice messages was as effective as teletherapy, which has itself been shown to be effective. about as effective as face-to-face therapy– to relieve symptoms of anxiety and depression within three months.

That means people who like the idea of texting a therapist can be confident they'll get the same quality of care as those who choose video appointments, says senior study author Michael Pullmann, who conducted the study while a research professor at the University of Washington School of Medicine.

How can this be, when the connection between patient and therapist is considered one of the best indicators of whether treatment will be successful? Can this connection really develop through text? American Psychological Association did not take an official position on text therapy since 2015 and Some therapists remain skeptical ideas. But Research Review 2021 suggests that strong connections can be strengthened through text messages or email just as they are through face-to-face interactions. Other studies even finds that people can “connect” with AI chatbots.

Some research suggests that in-person relationships produce better results than online connections — but Adrian Aguilera, an assistant professor at the University of California, Berkeley, who studies digital health, isn’t too worried about that. Aguilera says he’s less concerned about whether text therapy is as effective as in-person therapy and more concerned about whether it’s better than nothing — because that's how much mental health care most people in the US receive today. “Is it the best? Probably not,” he says. “The better question is, 'Can this fill an unmet need?'

The answer appears to be yes. During the pandemic, Aguilera tested the system where people received daily automated text messages designed to improve their mental health. (Example: “Self-soothing is an important skill for coping with stress. What are two ways you can use your feelings [e.g., smell, taste, touch] (Will this be calming?) Overall, people who received the text messages reported improvements in anxiety and depression symptoms after 60 days. But the program seemed to be especially helpful for Latinx users, who reported learning new information from the messages, perhaps because they were less likely than white participants to have previously received mental health care.

Another Aguilera Study also shown that patients tend to stay in therapy longer when it includes a text element. And perhaps that’s not so surprising, given that almost all of us are glued to our phones these days. “Have you ever texted a friend when you were upset or worried about something?” Pullman asks. The answer is almost certainly yes.

Pullman says that, like having a regular conversation, texting a therapist offers the benefits of both immediacy (you can send a message as soon as an unpleasant feeling arises) and asynchrony (the person on the other end of the line can take the time to compose a thoughtful response).

Some people may also find it easier to express dark, embarrassing, or vulnerable thoughts in writing, and research consistently shows that people benefit from doing so. translating your thoughts into written wordsnotes Hull. He also says that text therapy may offer the benefits of “state-based learning,” the old psychological principle that says it’s best to study for a test in the room where you’ll take it. In other words, it’s possible that therapeutic principles are best learned when they’re delivered in an environment where people actually need the ideas, like at home or at work.

Text therapy isn't perfect. Two of the largest online providers, Talkspace and BetterHelp, have faced criticism, with Talkspace subject of a class action lawsuit alleging that it charged users money even when therapists were unavailable to see them. (All claims in the lawsuit have now been either dismissed or settled, according to a statement from Talkspace.) On Wall Street in 2022 Magazine articleService providers who have worked with Talkspace have also criticized the quality of services offered on the platform.

In a statement provided to TIME, Dr. Nicole Benders-Hadi, Talkspace’s chief medical officer, said the platform’s therapists are vetted and licensed, and that research shows text-based therapy is effective. “Imagine people having an always-on, open-ended option to connect with their therapists, rather than having to lock themselves away and wait for the next session,” Benders-Hadi said in a statement. “Ultimately, what’s most important is meeting participants where they are and allowing them to choose the way that works best for how they’d like to engage in therapy.”

Meanwhile, BetterHelp agreed to pay nearly $8 million last year to settle Federal Trade Commission allegations of improper data sharing practices. public statement Following the settlement, the company said its “technology, policies and procedures are designed to protect and secure our members' information so that it is not used or shared without their approval and consent.”

BetterHelp has also recently faced backlash on social media from customers who say therapists have given bad advice or behaved inappropriately. In a statement provided to TIME, a BetterHelp spokesperson did not directly address the allegations but emphasized that the company provides customers with “multiple ways” to contact therapists, including phone and video calls, and said that it’s “very rare” that members use text messages exclusively.

Quality control is a problem with any form of therapy, Hull says. There will always be good therapists and bad therapists, good patients and bad patients, whether the encounters take place in a private practice or via an iPhone.

“I don’t think there’s anything about message-based care that inherently reduces quality,” he says. The evidence is increasingly on his side.

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