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Ultra-low-intensity SMS nudges and gratitude practice reduce depression and anxiety in health professionalsSimple text nudges ease depression and anxiety in health workers

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Key Takeaway
Consider ultra-low-intensity interventions like SMS nudges or gratitude practice to reduce symptoms in health professionals.

This randomized controlled trial enrolled 305 Australian health professionals to evaluate the impact of ultra-low-intensity interventions on mental health. Participants were assigned to either an SMS nudge group (TYD), a gratitude practice group, or a waitlist control (WL) for a period leading to a 3-month follow-up.

Both the TYD and gratitude groups reported significantly lower depression (PHQ-2) and anxiety (GAD-2) scores compared to the waitlist at post-trial. No significant difference was found between the two active intervention groups. Additionally, both active groups showed higher scores in satisfaction with life (SWLS), gratitude (GRAT-6), and frequency of TYD actions (TYDQ-15) compared to the waitlist.

Primary outcome gains were sustained at the 3-month follow-up. Analysis of mechanisms revealed that improvements in depression were associated with both TYD actions and gratitude. However, improvements in anxiety were only associated with changes in TYD actions. No adverse events or discontinuations were reported. These results suggest these interventions may offer a scalable way to support mental health in demanding professional environments.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap by providing evidence for ultra-low-intensity, scalable interventions for professionals, contrasting with the more intensive and specialized modalities previously covered. While online CBT was shown to reduce dental anxiety, and transcranial direct current stimulation provided modest relief in treatment-resistant depression, these findings suggest that simple SMS nudges and gratitude practices may offer a different, less intensive approach for general professional populations.

If you work in healthcare, you know the toll it can take on your mental health. Long hours, high stakes, and little time for self-care. Now, a new study offers a surprisingly simple tool that might help: text messages.

Researchers in Australia tested two ultra-low-intensity programs with 305 health professionals. One group got SMS nudges encouraging them to do small, concrete actions, like acts of kindness or connecting with others. The other group got prompts to practice gratitude. A third group got nothing and served as the comparison.

After the program, both text message groups reported significantly lower symptoms of depression and anxiety compared to the waitlist group. They also felt more satisfied with life and more grateful. And the good news: those improvements stuck around at the 3-month follow-up.

Here's an interesting twist. When the researchers looked at why the programs worked, they found that improvements in depression were linked to both the small actions and gratitude. But improvements in anxiety were only tied to the small actions, not gratitude. So if anxiety is your main struggle, the "Things You Do" approach might be the one to try.

This is early evidence, and the study didn't report on side effects or how well people tolerated the programs. But the idea that a few text messages could make a real difference is promising, especially for busy professionals who can't easily fit therapy into their schedules. If you're curious, talk to your doctor about what might work for you.

What this means for you:
Simple text nudges can ease depression and anxiety in health workers, with benefits lasting 3 months.

Common questions

What were the text message programs in the study?

The study tested two ultra-low-intensity programs. One sent SMS nudges for 'Things You Do' (TYD), which are small, concrete actions you can take. The other sent prompts to practice gratitude. Both were designed to be simple and easy to fit into a busy day.

Who did the study include?

The study included 305 Australian health professionals. That means doctors, nurses, and other healthcare workers who often face high stress and demanding schedules. The results might not apply to everyone, but they suggest these simple tools could help people in similar roles.

How long did the benefits last?

The improvements in depression and anxiety symptoms were still noticeable at the 3-month follow-up. That means the positive effects weren't just temporary. The study didn't track beyond that, so we don't know if they last longer.

Did the study report any side effects?

The study did not report any information about side effects, serious adverse events, or how well people tolerated the programs. So we don't know if there were any downsides. It's always a good idea to talk to your doctor before starting any new mental health approach.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up3.0 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Ultra-low-intensity interventions using regular SMS or emails can reduce symptoms of anxiety and depression. However, limited research has examined whether some nudged actions are more beneficial than others. AIMS: The primary aim was to compare the relative benefits of SMS nudges prompting five groups of actions called the Things You Do (TYD) with nudges prompting gratitude practice. The secondary aim was to examine mechanisms of change. METHODS: 305 Australian health professionals were randomly allocated to a TYD group, a gratitude group (GRAT), or a waitlist control (WL). TYD and GRAT participants first read a brief online lesson on the benefits of their respective actions, then received weekday SMS prompts for four weeks. WL participants maintained usual routines. Primary outcomes were depression (PHQ-2) and anxiety (GAD-2) symptoms. Secondary and tertiary outcomes were satisfaction with life (SWLS), gratitude (GRAT-6), frequency of TYD actions (TYDQ-15), and perceived changes in mental wellbeing, measured at mid-treatment, post-trial (week 5), and 3-month follow-up. RESULTS: Both TYD and GRAT participants reported significantly lower PHQ-2 and GAD-2 scores and higher SWLS, GRAT-6, and TYDQ-15 scores at post-trial compared with WL, with no significant differences between active groups. Gains were sustained at follow-up. Improvements in depression symptoms were strongly associated with changes in TYD actions, although were also related to changes in gratitude. Improvements in anxiety were only associated with changes in TYD actions. CONCLUSION: These findings show a strong relationship between the frequency of certain actions and mental wellbeing and how symptoms of depression and anxiety can be reduced by nudging these actions. These findings also suggest that these actions may be activated by different interventions. This study demonstrates the potential of scalable, ultra-low-intensity interventions to support mental health in demanding professional roles.
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