Mobile therapy startup Talkspace is partnering with two universities to validate its text- and video-based mental health services. Talkspace has launched a 500-person study of anxiety, stress, and depression at Columbia University and is in talks to launch a study with Duke of post-traumatic stress disorder.

"We’re looking at the efficiency and the efficacy of our modality, which is primarily based on text messaging," Cofounder and CEO Oren Frank told MobiHealthNews. "[We're looking at] how it can do well against specific conditions, with the focus on managing anxiety, depression, and stress, the three leading factors in the influx of mental health on the population today. [The Columbia] study has actually already begun, and we hope to see the results within a few months. I’d say it’s a first of its kind study, both in the scale and the focus on the modality that we have developed."

The patients will be recruited from Talkspace's existing user base and evaluated via surveys and assessments delivered through the platform. 

"In a sense, the research we’re doing with Columbia and Duke is just an extension of what we’ve been doing," Frank said. "Every patient that uses Talkspace is undergoing what’s called evidence-based treatment, which is using the clinical outcome measures to gauge whether you’re better or not. If you’re not doing better, maybe the diagnosis was wrong, maybe the therapy was wrong, maybe the timing or maybe the approach was wrong, but we fix it. But if we don’t know what was wrong, we can’t fix it."

Talkspace, which has raised $13 million over the last two years, offers users access to a trained therapist via its platform, which primarily allows therapists and patients to communicate daily via text messages. Users can also request a video visit, but, Frank says, they generally don't do so unless they already have a very longterm relationship with their physician.

Frank says early studies have shown that Talkspace is comparable to traditional face-to-face therapy in terms of efficacy. What's lost in things like body language and nonverbal communication is made up for in the advantages of texting.

"We do a lot of video messaging, so if you want to see the face, you can do that as well. But we find a lot of the customers prefer text for two reasons," said Frank. "One, they’re used to it and it’s much more convenient for them, and the second is even more interesting: they feel much more safe and open to express what they feel in writing than face-to-face, when you have to consider everything, and there’s a meaning for everything you say. What we’re seeing is people open up far more quickly in writing than they do face-to-face."

Beyond that, there's a cost savings associated with doing therapy via mobile devices and it's more convenient for people who are busy or might have to travel far to find a therapist. Patients with PTSD, the planned focus of the Duke study, are already a large subgroup within the Talkspace user base. That study will begin soon.

"We’re getting a lot of veterans for two main reasons," Frank said. "Many of them are people that would just not go and talk about their experiences — many of them terrible experiences — with a person face-to-face. It’s too scary to get to that situation. So the fact that we allow remote access, which can be anonymous and feels very safe because you do it from afar, removes this stigma barrier for many of them. And the second reason is people who suffer from PTSD tend to need more engagement and have more frequent relationships with their therapist, because they need to react to things they experience in real time. Therefore, when they use Talkspace and they can interact with their therapist every day, sometimes more than once a day, it seems to be particularly good for them."

At Columbia, Talkspace will work with Dr. George Nitzburg and Dr. Barry Farber, who specialize in research around the use of technology in the therapy process. At Duke, they plan to work with PTSD research and clinical expert Dr. Patricia Resick. The company has also added behavioral health expert Dr. Andrew Sekel, who previously served as chief executive officer of specialty networks for Optum, as an advisor.

Correction: This story has been updated to reflect that the Talkspace is still in talks with Duke and the study has not been finalized.