Framing Helper Therapy to Support User Engagement: Causal Evidence from a Public Deployment of a Mental Health Support Text Messaging Program

Digital peer-to-peer mental health tools have shown promise in supporting the well-being of those receiving help and giving it (i.e. helper therapy), but promoting engagement remains a challenge. We examine whether the framing of helper therapy exercises motivates active user participation and how user characteristics shape differential effects of the framings in a publicly deployed interactive text messaging-based mental health program. Among 3,817 users randomized to different helper therapy framings, we find causal evidence that framings which emphasize helpng oneself increase written engagement rates as much as 4.6% over other framings, with even larger effects seen among minoritized identities. These self-focused framings also elicited messages with more positive, trust, and anticipation-related words and fewer fear, anger, disgust, and sadness words. Our findings highlight the importance of centering the user in the framing of digital intervention content, and personalizing digital mental health tools to align with a diversity of user identities.