JMIR Publications

ABSTRACT

Background:

Anxiety and depression continue to be prominent experiences of students approaching their university counseling service. These services face unique challenges to ensure that they continue to offer quality support to a growing student population and with less resource. The convenience and availability of mobile phone applications (apps) offer innovative solutions to address therapeutic challenges and expand the reach of traditional support.

Objective:

The primary aim of this study is to report on the outcomes of a feasibility trial in which guided use of a mobile phone well-being app was introduced into a student counseling service and offered as an adjunct to face-to-face counseling.

Methods:

The feasibility trial utilised a two-arm, parallel non-randomized design comparing counseling alone (Treatment As Usual) versus counseling supplemented with guided use of a mobile phone well-being app (intervention) for 38 university students experiencing moderate anxiety or depression. Students in both conditions received up to 6 sessions of face-to-face counseling within a 3-month period. Students who approached the counseling service and were accepted for counseling were invited to join the trial. Feasibility factors were evaluated including: recruitment duration, treatment preference, randomization acceptability and intervention fidelity. Clinical outcomes and clinical change were assessed with routine clinical outcome measures administered every counseling session and follow-up phases at 3- and 6-months after recruitment.

Results:

Both groups demonstrated reduced clinical severity by the end of counseling and this was particularly noticeable for depression and social anxiety, whereby students left the clinical boundary they reached at the intake assessment (baseline). By the 6-month follow-up, TAU clients’ (n = 18) anxiety had increased whereas intervention clients’ (n = 20) anxiety continued to reduce and this group difference was significant (GAD-7: (t(22) = 3.46, P = .002). This group difference was not replicated for levels of depression whereby students in both groups continued to reduce their levels of depression by a similar extent at the 6-month follow-up (PHQ-9: t(22) = 1.30, P = .21).

Conclusions:

Supplementing face-to-face counseling with guided use of a well-being app is a feasible and acceptable treatment option for university students experiencing moderate anxiety or depression. The feasibility trial was successfully embedded into a university counseling service without denying access to treatment and with minimal disruption to the service. This study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling. The design of the feasibility trial provides the groundwork for the development of future pilot trials and definitive trials embedded in a student counseling service. Clinical Trial: Registration: This trial was registered on 20/06/2016 (Ref: ISRCTN55102899)