Can group texting therapy help new moms with depression?

Many women have a heightened risk for depression during the peripartum period, the time during pregnancy and months to years after giving birth. But the options for mental health care aren’t always convenient, accessible or affordable — if they’re even available.

Ilang M. Guiroy, M.D., a child, adolescent and adult psychiatrist as well as a postdoctoral research scholar in psychiatry, is hoping to help solve that problem by developing a new technology that facilitates group text therapy to help care for pregnant people, mothers, and those they care for.

In a recent study, Guiroy and colleagues surveyed new and expecting mothers to assess whether they would be interested in accessing psychotherapy via text message. The national, cross-sectional survey found that mothers who want to access treatment for depression, but are unable to, are often willing to try text message therapy.

Guiroy is developing a text message group therapy (TMGT) intervention, in which mothers of babies discuss their stresses and successes and share advice, guided by a therapist trained in the Mothers and Babies therapy modality. Guiroy hopes the intervention helps peripartum moms feel less isolated during a scary and solitary time.

Guiroy discussed the importance of treating peripartum depression and how a group text intervention could support the mental health of mothers of babies — and potentially well beyond. This interview was edited for length and clarity.

Talk about the importance of accessible treatments for mothers with peripartum depression?

Pregnancy is very stressful on most bodies. The biological shifts that come from physiological and emotional stress, as well as sleep deprivation, can have huge impacts on mental health. So can other factors such as poverty, discrimination and the impact of pregnancy on your job or career. Other risk factors include low social support, history of mood disorders, violence at home, negative pregnancy and birth experience, and complications with the baby.

Untreated peripartum depression, depression during pregnancy or after childbirth, can impact mood and make new and to-be moms more anxious. It also impacts their ability to care for other people. I focus on moms in my research because I consider them to be a linchpin of care. If you take care of the person who takes care of everybody else, there’s a huge ripple effect.

Studies have shown that one of the biggest risk factors for childhood, adolescent and adulthood mental illness is peripartum depression of the individual’s mother. We talk about a kids and teen health crisis, but underneath that there’s a massive maternal mental health crisis.

We talk about a kids and teen health crisis, but underneath that there’s a massive maternal mental health crisis.

Ilang Guiroy

Why did you do the survey? What did you find?

I saw the impact of untreated peripartum depression in 2021 during my residency at Los Angeles County ad USC Medical Center, which is now Los Angeles General Medical Center, and the difficulties people had with accessing care. When I’m designing interventions, I’m thinking of moms who have additional barriers that go beyond long wait lists for care.

Text therapy interventions have been studied for some groups, such as people with eating disorders or depression, and there is good evidence for success in those treatments. But the use of this approach with moms and pregnant people is understudied.

My first questions were, ‘Do people want this? Do they need it?’ I conducted a survey that asked questions about depression symptoms, willingness and barriers to engaging in text/phone/in-person therapy, and demographics and communication preferences of people who may be interested.

During pregnancy, 51.5% of people wanted mental health care, but 38.1% of people could not access it. Within the two years after giving birth, 64.4% of people wanted mental health care, and 35.1% could not access it. That may be because it’s really resource intensive going to therapy. It’s not just the money or finding a therapist, but also physically going there and finding transportation that’s an additional burden, especially for peripartum mothers.

It’s not just the money or finding a therapist, but also physically going there and finding transportation that’s an additional burden, especially for peripartum mothers.

Ilang Guiroy

The survey showed that 53% of participants were willing to try text message therapy. There was no significant difference in age, education or whether they were eligible for public assistance such as WIC (Special Supplemental Nutrition Program for Women, Infants and Children). People from across different demographics were interested.

Also, whether people liked texting generally, or whether they were feeling overwhelmed didn’t seem to matter. People who have done text therapy before were also more likely to be interested.

What does text therapy look like? What are some of the challenges and benefits?

It’s a synchronous group chat therapy where three to five patients and a therapist text back and forth. If you’ve ever been in a group chat, there’s a flow where you’re getting into the zone. What I love about the idea of group therapy is that you’re getting a bunch of experts together — the patients are experts in their lived experience, and the therapist is an expert in keeping the conversation helpful and teaching skills.

Being an expectant or new mother can be a very solitary time. It feels like a lot of weird stuff is happening only to you, but it’s happening to lots of people. To give and receive advice and see how other people do things can be nourishing and healthy.

The modality that I’m using is called Mothers and Babies. It combines cognitive behavioral therapy (CBT), mindfulness, and attachment theory to manage stress and depression in pregnant people and new parents.

I’m building a text message group therapy proof-of-concept intervention using user-centered design. I’m seeking input from participants who are interested in accessing it. If someone says, ‘I really wish I could have bold text,’ or ‘I want to be able to send reactions,’ I can adjust the tool accordingly.

The idea is to reduce harm and add opportunities to access therapy where people wouldn’t otherwise be able to. There are other benefits too: because of the group aspect, one therapist can have a bigger impact, and therapists don’t have to get trained in a new therapy type. They can just do the Mothers and Babies therapy, which many therapists are already trained in.

Miscommunication via text is always a possibility, but almost everyone is already texting, so you’re leveraging skills that people already have. There are ways to express ourselves that are unique to text language, and sometimes spill over into real life, like ‘LOL,’ ‘JK’ — even emojis have meanings.

There are elements that will take adjusting to, though. Engaging in therapy without seeing someone’s face will be new, and people might be less engaged over text. We also don’t yet know whether group text therapy is as helpful as other forms of therapy. But for people who have no access to mental health care, gaining some access through group text therapy is likely beneficial. There will always be challenges with this approach. That’s OK — it doesn’t have to be perfect in order for it to work.

What are the next steps to build and test this intervention?

The next step would be building or adapting a secure messaging system and trying it with people in a randomized control trial to see if users report a difference. Longer term, my goal is to look at infant outcomes too. I hope to see that ripple effect for kids. I think we’ve underestimated the power of relational health and the importance of interpersonal treatments.

We are so focused on the individual, which is important, but individuals exist in groups. In the long term, I’m hoping this work will have an impact on not just the moms, but their partners and their kids.

Photo: Cameron Prins via Getty Images

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