Efficacy of a Mobile App-Based Intervention for Young Adults With Anxiety Disorders

Author:

Bress Jennifer N.1,Falk Avital1,Schier Maddy M.1,Jaywant Abhishek1,Moroney Elizabeth1,Dargis Monika1,Bennett Shannon M.1,Scult Matthew A.12,Volpp Kevin G.3,Asch David A.4,Balachandran Mohan4,Perlis Roy H.567,Lee Francis S.1,Gunning Faith M.17

Affiliation:

1. Department of Psychiatry, Weill Cornell Medicine, New York, New York

2. Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York

3. Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia

4. Perelman School of Medicine, University of Pennsylvania, Philadelphia

5. Center for Quantitative Health, Massachusetts General Hospital, Boston, Massachusetts

6. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

7. Associate Editor, JAMA Network Open

Abstract

ImportanceAnxiety disorders are prevalent and undertreated among young adults. Digital mental health interventions for anxiety are promising but limited by a narrow range of therapeutic components and low user engagement.ObjectiveTo investigate the efficacy of and engagement with Maya, a scalable, self-guided, comprehensive mobile cognitive behavioral therapy (CBT) intervention with embedded engagement features, comparing the effects of 3 incentive conditions.Design, Setting, and ParticipantsThis randomized clinical trial recruited young adults aged 18 to 25 years with anxiety disorders through online advertisements and outpatient psychiatry clinics at Weill Cornell Medicine. Enrollment was between June 16, 2021, and November 11, 2022. Data analysis was performed from December 21, 2022, to June 14, 2024.InterventionParticipants received a 6-week program of the intervention and were randomized to 1 of 3 different text message–based incentive conditions (gain-framed, loss-framed, or gain–social support).Main Outcomes and MeasuresThe primary outcome was change in anxious symptoms from baseline to end of treatment, as measured by the Hamilton Anxiety Rating Scale (HAM-A). The Anxiety Sensitivity Index and the Leibowitz Social Anxiety Scale scores were secondary measures.ResultsThe sample consisted of 59 participants (mean [SD] age, 23.1 [1.9] years; 46 [78%] female; 22 [37%] Asian, 3 [5%] Black, 5 [8%] Hispanic or Latino, 1 [2%] American Indian or Alaska Native, 25 [42%] White, and 6 [10%] >1 race; 32 [54%] college-educated and 12 [20%] graduate or professional school-educated; mean [SD] baseline HAM-A score, 15.0 [6.5]). Anxiety, measured by HAM-A, decreased across conditions from baseline to end of the intervention (mean difference, −5.64; 95% CI, −7.23 to −4.05), and symptomatic improvement was maintained at the week 12 follow-up (baseline to follow-up mean difference, −5.67; 95% CI, −7.29 to −4.04). However, there was no evidence that change in anxiety differed by incentive condition (loss-framed vs gain–social support mean difference, −1.40; 95% CI, −4.72 to 1.93; gain-framed vs gain–social support mean difference, 1.38; 95% CI, −1.19 to 3.96). Secondary anxiety measures (Anxiety Sensitivity Index and Liebowitz Social Anxiety Scale scores) showed a similar pattern of improvement, with no evidence of differences between incentive conditions. Participants completed most of the 12 sessions (mean [SD], 10.8 [2.1]; 95% CI, 10.3-11.4), and User Mobile Application Rating Scale app quality ratings exceeded the published threshold for acceptability at all study visits. There was no evidence that either session completion or app quality ratings differed by incentive condition.Conclusions and RelevanceIn this randomized clinical trial of an app-based intervention for anxiety, the primary hypothesis that improvement in anxiety would be greatest in the condition using gain of points plus social incentives was not supported; however, the results suggest that a CBT application incorporating a full suite of CBT skills and embedded user engagement features was efficacious in improving symptoms in young adults with anxiety disorders. Given these findings, digital interventions represent a promising step toward wider dissemination of high-quality, evidence-based interventions.Trial RegistrationClinicalTrials.gov Identifier: NCT05130281

Publisher

American Medical Association (AMA)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3