JMIR Publications

ABSTRACT

Background:

Ecological Momentary interventions (EMIs) open new and exciting possibilities for conducting research and delivering mental health interventions in real-life environments via smartphones. This makes designing psychotherapeutic EMIs a promising step towards cost-effective, scalable digital solutions for improving mental health and understanding the effects and mechanisms of psychotherapy.

Objective:

The first objective of this study is to formatively assess and improve the usability and efficacy of a gamified mobile application, the InsightApp, for helping people train some of the (meta-)cognitive skills taught in Cognitive Behavior Therapy and Acceptance Commitment Therapy. The app aims to help people constructively cope with stressful situations and difficult emotions in everyday life. The second objective of this study is to test the feasibility of using the InsightApp as a research tool for investigating the efficacy of psychological interventions and the underlying mechanisms.

Methods:

We conducted two experiments. In Experiment 1, 65 participants (average age: 27 years, range: 19–55 years, female n=41, 68%) completed a single-session with the app. The intervention’s effects on affect, belief endorsement and propensity for action were measured immediately before and after the intervention. Experiment 2 assessed the feasibility of running a randomized controlled trial with the app. We randomly assigned 142 participants to an experimental or a control condition and interacted with the app for 2 weeks (average age: 37 years, range: 20-78 years, 55% female). Experiment 2 included all outcome measures of Experiment 1 except for the self-reported propensity to engage in predefined adaptive and maladaptive behaviors. Both experiments included user experience surveys.

Results:

In Experiment 1, a single session with the app decreased participants’ emotional struggle, the intensity of their negative emotions, their endorsement of negative beliefs, and their self-reported propensity to engage in maladaptive coping behaviors (all P<.001, average effect size=-0.82). Conversely, participants' endorsement of adaptive beliefs and their self-reported propensity to act in accordance with their values significantly increased (all P<.001, average effect size=0.48). Experiment 2 replicated the corresponding findings of Experiment 1 (all P<.001, average effect size=0.55). Moreover, Experiment 2 identified a critical obstacle to running a randomized controlled trial (i.e., asymmetric attrition) and how it might be overcome. User experience surveys showed that the app’s design is suitable for helping people apply psychotherapeutic techniques to cope with everyday stress and anxiety. Users' feedback provided valuable information on how to further improve the app’s usability.

Conclusions:

In this article, we presented and tested the first prototype of the InsightApp. Our encouraging preliminary results show that it is worthwhile to continue developing the InsightApp and to evaluate it in a randomized controlled trial. This could lead to a highly cost-effective and highly scalable digital solution for studying underlying (meta-)cognitive mechanisms of mental health, improving people's mental health, and preventing anxiety disorders and depression.