Accepted for/Published in: JMIR Mental Health
Date Submitted: Feb 12, 2026
Date Accepted: Aug 31, 2026
Incorporating Data from Text Messages and Email into Psychotherapy: A Randomized Controlled Trial
ABSTRACT
Background:
As digital communication becomes central to daily life, psychotherapy increasingly has access to patients electronic media data. While digital phenotyping has been widely studied, less is known about whether incorporating personal communication data, such as text messages, improves clinical outcomes in psychotherapy.
Objective:
To determine whether integrating personalized text message data into psychotherapy improves depression, anxiety, health related quality of life, and therapeutic alliance, and to examine whether increased access to collateral information influences clinical decision making.
Methods:
The Electronic Media and its Impact on Psychotherapy (EMAP) study was a randomized controlled trial conducted in adult and geriatric outpatient and partial hospitalization settings at an academic psychiatric hospital. Participants receiving psychotherapy for primary depression or anxiety N = 101 were randomized to Electronic Media Enhanced Therapy EME n = 52 or Treatment as Usual TAU n = 49. In EME, research staff reviewed participants text messages prior to sessions using personalized mood related key terms and presented aggregated findings on a HIPAA compliant clinician dashboard. TAU participants received standard care without message review. Outcomes included change scores for PHQ 9, GAD 7, SF 36, and Working Alliance Inventory Short Revised WAI SR. Linear regression and nonparametric tests compared groups. Moderation analyses assessed whether frequency of information access influenced treatment changes.
Results:
No significant between group differences were observed in anxiety or working alliance. Among participants with SF 36 follow up data n = 65 EME participants demonstrated greater improvement in the pain subscale. Greater frequency of information access was associated with increased treatment related changes in the EME group. Access to additional collateral information was associated with more clinical actions but not improved distal outcomes.
Conclusions:
Integrating personalized text message data into short term psychotherapy did not significantly improve depression or anxiety, and neither improved nor worsened therapeutic alliance. However, access to greater amounts of collateral information including electronic media influenced clinical decision making, suggesting nuanced and context dependent effects. Clinical Trial: NCT03712267
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