Is Text-Based Messaging Therapy as Effective as Video Therapy for Depression?

Is text-based messaging therapy as effective as video therapy for depression?

If you have ever looked into online counselling with an actual therapist, you have probably run into two very different offers. One is a video call with a therapist at a set time each week (VBP). The other is a messaging plan (MBP): you write to a licensed therapist whenever something is on your mind, and they write back within a few hours. The second option is usually cheaper and easier to fit around a job or childcare. This raises an obvious question — is text-based messaging therapy as effective as video therapy for depression, or are you trading results for convenience?

A trial published in JAMA Network Open in October 2025 went looking for an answer. Researchers randomly assigned 850 adults with moderate to moderately severe depression to one of the two formats and followed them for 12 weeks. Everyone worked with a real, licensed therapist — 76 of them across the study — with a master's or doctoral degree.

The headline result: depression scores improved in both groups, and the researchers could not find a meaningful difference between them. Social functioning, measured by how much people felt able to take part in work, family and social life, also improved similarly in both groups.

What makes this interesting is that the researchers expected messaging to win. Their hypothesis was that being able to reach a therapist in the moment, more often, with a written record you can scroll back through, would produce better outcomes than a single scheduled session per week. It didn't. It produced roughly the same outcomes. As the authors put it, "The data suggest that MBP is a viable depression treatment" — MBP being their shorthand for message-based psychotherapy.

Why did fewer people drop out of messaging therapy?

The most consistent difference between the two formats wasn't about symptoms at all. It was about staying in treatment.

By week five, 21% of the video group had disengaged — switched therapists, withdrawn, or stopped participating enough to count. In the messaging group it was 13%. That eight-point gap was small but statistically real, and it matters, because dropping out early is one of the biggest problems in depression care. Plenty of research shows that most people who start therapy never finish a full course of it.

The authors' explanation is unglamorous and plausible: a weekly 45-minute appointment is a logistical commitment. You need childcare, a private room, a free slot at a specific hour, energy at that hour. Depression is not kind to any of those things. Messaging asks less of you on a bad day. If your treatment is one you can actually keep doing, that counts for something even when the per-session experience is less rich.

Does video therapy build a stronger connection with the therapist?

There were hints that it does. The study measured therapeutic alliance — the sense that you and your therapist trust each other, agree on goals and are working as a team. Alliance is one of the more reliable predictors of whether therapy helps.

People who started in video therapy tended to rate their alliance a little higher, and people who began with messaging and later had video sessions added saw their alliance ratings drift up toward video-level. There was another small signal at the end: 97% of the video group said they would recommend their treatment to someone else, compared with 88% of the messaging group. Both are high numbers. Still, the direction is worth noticing.

One caution about interpreting alliance scores here: people whose depression was improving rated their alliance much higher than people who weren't improving, in both formats. It is genuinely hard to untangle whether a good relationship drove the improvement or the improvement made the relationship feel good.

Did adding video sessions help people who weren't getting better?

At week six, everyone who hadn't improved was reshuffled. People who had been messaging got video sessions added, either weekly or monthly. Surprisingly, it made no clear difference. Response rates at week 12 among the people who hadn't improved early were broadly similar no matter which combination they got. If someone is six weeks into therapy and not moving, this trial suggests the answer probably isn't "add more channels."

What are the limits of this study?

Quite a few, and they should temper any strong conclusion.

There was no comparison group that received nothing or waited for care. Therapists were trained but their actual sessions weren't monitored for fidelity to any particular approach, so "therapy" here means whatever these licensed clinicians normally do. People with active suicidal thoughts or a diagnosis of psychosis were excluded, so this says nothing about severe or high-risk depression. Everyone was recruited in the US, mostly through one commercial platform, and that platform was a research partner — a real conflict to hold in mind, even in a rigorously designed trial.

You can read the full paper here: https://doi.org/10.1001/jamanetworkopen.2025.40065

What does this mean if you're choosing between them?

Cautiously, and with the study's limits in view: if messaging therapy is what you can afford, or what fits your week, or what you can imagine actually doing, this trial suggests it is a real option rather than a watered-down one. That is genuinely good news, because for a lot of people the honest choice isn't messaging versus video — it's messaging versus nothing.

Worth saying clearly: this study looked at licensed human therapists writing to their clients. It doesn't tell us anything about AI chat tools. If you are waiting for care, or between sessions, or simply need somewhere to put your thoughts at 2am, Serena is built for exactly that kind of moment — a place to be heard, not a substitute for the treatment described here.

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This article is for general information and is not medical advice. It cannot tell you which treatment is right for you; please discuss options with a doctor or licensed therapist, and don't start or stop any treatment based on a single study. If you are in crisis or thinking about harming yourself, contact your local emergency number or a crisis line in your country now.