Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 19, 2018
Date Accepted: Apr 28, 2019
(closed for review but you can still tweet)
Guided Self-Help Works: A Randomized Waitlist Controlled Trial of Pacifica, a Mobile App Integrating CBT and Mindfulness for Stress, Anxiety, and Depression
ABSTRACT
Background:
Despite substantial improvements in technology and increased demand for technology-enabled behavioral health tools amongst consumers, little progress has been made on easing the burden of mental illness. This may be due to the inherent challenges of conducting traditional clinical trials in a rapidly-evolving technology landscape.
Objective:
The current study sought to validate the effectiveness of a popular commercially available application for the self-management of stress, anxiety, and depression amongst a sample of individuals seeking digital tools to address their mental health.
Methods:
500 adults with mild-to-moderate anxiety or depression were recruited from in-app onboarding to participate in a randomized, wait-list controlled trial (RCT) of Pacifica. Pacifica is a guided self-help app based on Cognitive Behavior Therapy (CBT) and Mindfulness and designed to address stress, anxiety, and depression. We conducted an all-virtual study, recruiting, screening, and randomizing participants through a web-based participant portal.
Results:
Study participants used the app for one month, with no level of use required, closely mimicking real-world app usage. Intent-to-treat (ITT) analysis indicate that self-reported depression, anxiety, and stress decreased at one month amongst individuals who had access to the app while self-reported self-efficacy increased. Participants used the app on average 19 times over the 30 day intervention. We did not find a relationship between overall engagement with the app and symptom improvement. However, follow-up analysis revealed that participants who completed relatively more thought record exercises sustained improvements in their symptoms through the two month-follow-up to a greater degree than those who completed fewer. Additionally, we found that participants who reported concomitantly taking psychiatric medications during the trial benefitted less from the app, as measured by the symptoms of anxiety and stress.
Conclusions:
This study provides evidence that Pacifica, a popular commercially available self-help app, is effective in reducing self-reported symptoms of depression, anxiety, and stress, particularly amongst individuals who utilize thought records and are not taking psychiatric medication. Clinical Trial: ClinicalTrials.gov (NCT03333707)
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