To receive and respond to text messages with Node.js, Express, and Twilio, first install the necessary dependencies, including Express and Twilio's Node library. Create an Express app, add a route for GET requests, and start listening on port 3000. Set up your Twilio account by purchasing a phone number and configuring it in the Twilio dashboard. Use ngrok to provide a publicly accessible URL to your app. Finally, add a route to handle incoming text messages, which will respond with a TwiML response containing a message and an optional picture. When a text message is received, Twilio sends a POST request to the /sms route, triggering the callback function, which responds with TwiML instructing Twilio to send a message back in response.