Message-Based Therapy Shows Comparable Benefit to Video Sessions for Depression
Key Clinical Summary
- In a randomized clinical trial of 850 adults, video-based psychotherapy (VBP) and message-based psychotherapy (MBP) achieved similar outcomes for depression.
- Treatment response and remission rates were similar for both modalities throughout the treatment period.
- Researchers suggest that insurance coverage of MBP may increase access to evidence-based care.
Adults with depression experienced similar treatment effects from asynchronous, message-based psychotherapy (MBP) and video-based psychotherapy (VBP), according to study results published in JAMA Network Open.
In the randomized clinical trial, 850 adult participants who scored 10 or more on the 9-item Patient Health Questionnaire (PHQ-9) and received a diagnosis of depression during intake assessment were assigned to either MBP (n=423) or weekly VBP (n=427). At 6 weeks of treatment, nonresponders were rerandomized to MBP with either weekly or monthly VBP. Participants received 12 total weeks of treatment.
Researchers assessed depression severity measured by PHQ-9 scores, social functioning, treatment response, and remission as primary outcomes. Treatment engagement and therapeutic alliance were among the secondary outcomes evaluated.
The researchers found that there was no significant difference in depression severity and social functioning score changes between those treated with VBP and MBP, or in depression score changes for nonresponders randomized to MBP with weekly versus monthly VBP. At week 12, the proportion of participants who responded to treatment (MBP, 47.5%; VBP, 47.2%) or who achieved remission (MBP, 31.4%; VBP, 30.3%;) was also similar between the MBP and VBP groups.
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In their secondary analyses, the researchers found that treatment disengagement at week 5 was significantly more likely for participants in the VBP group (21.3%) than the MBP group (13.2%). However, nonresponders had a stronger initial therapeutic alliance in VBP than MBP at week 4 (P < .001; d = 0.48-0.57), though therapeutic alliance increased across all modalities by week 10.
“These findings were consistent with prior studies that MBP is a viable alternative to video or face-to-face treatment,” wrote Michael D. Pullmann, PhD, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, and study coauthors. “Currently, however, most insurance companies do not reimburse for message-based care, limiting the widespread implementation of this likely preferred and effective approach.”
In addition to suggesting that broader coverage of message-based services may expand access to effective care, the authors highlight the need for additional research on intentional alliance-building efforts to ensure stronger therapeutic alliance in MBP.
