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Text Messaging Intervention Promising for Patients With SMI

August 12, 2020

A text-messaging intervention appears a safe, feasible, and clinically promising way to augment care for patients with serious mental illness, according to a pilot study published online in Psychiatric Services. 

“When pandemics such as COVID-19 block the possibility of in-person patient-provider contact, evidence-based texting interventions can serve a crucial role in supporting continuity of care,” researchers wrote.

The 3-month pilot was a randomized controlled trial that involved 49 patients with serious mental illness. Among participants, 62% had schizophrenia/schizoaffective disorder, 24% had bipolar disorder, and 14% had depression.

Licensed mental health clinicians were trained in how to serve as mobile interventionists who engaged patients in recovery-oriented texting exchanges. The study compared the mobile interventionist approach as an add-on to assertive community treatment with assertive community treatment alone.

Prompt, Dense Messages Key to Text-Based Counseling

The texting intervention was initiated by 95% of participants assigned to the mobile interventionist arm, who texted 69% of possible days with an average 4 texts per day, according to the study. Some 91% of participants reported satisfaction with the texting intervention, 94% said it made them feel better, and 87% said they would recommend it to a friend.

Posttreatment clinical effect estimations found greater reductions in the severity of paranoid thoughts and depression, researchers found, as well as improved illness management and recovery in the mobile interventionist group. No adverse events were reported. 

“This study is very exciting because we saw real improvement in those who utilized the text messaging-based intervention on top of normal care. This was true for individuals with some of the most serious forms of mental illness,” said coauthor William J. Hudenko, PhD, of Dartmouth College and Dartmouth’s Geisel School of Medicine, Hanover, New Hampshire. “The results are promising, and we anticipate that people with less severe psychopathology may even do better with this type of mobile intervention.” 

—Jolynn Tumolo


Ben-Zeev D, Buck B, Meller S, Hudenko WJ, Hallgren KA. Augmenting evidence-based care with a texting mobile interventionist: a pilot randomized controlled trial. Psychiatric Services. 2020 July 7;[Epub ahead of print].

Text messaging: the next gen of therapy in mental health [press release]. Hanover, New Hampshire: Dartmouth College; July 28, 2020.

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