JMIR Publications

ABSTRACT

Background:

Mobile health applications provide a promising avenue to help mitigate the burden on mental health services by complimenting therapist-led treatments for anxiety. However, it remains unclear how specific systems' use of application components (i.e., tools) may be associated with changes in clinical symptomatology (i.e., anxiety, worry).

Objective:

This study was a secondary analysis of systems usage data from the Stage I randomized controlled trial testing the impact of the Unwinding Anxiety mobile application among adults with GAD. This secondary analysis was conducted to assess how using specific application tools may be associated with improvements in anxiety, worry, emotional regulation, and interoceptive awareness.

Methods:

We present analyses of the intervention group (i.e., those who received the Unwinding Anxiety program) during the Stage 1 trial. Total use of specific mobile application tools (i.e., ecological tools, meditation practices, educational modules) as well use specific to each tool (e.g., stress meter, lovingkindness meditation practice) were calculated. We utilized multivariate linear models to investigate the effect of total use of these tools on anxiety, worry, interoceptive awareness, emotional regulation at 2-months post-program initiation controlling for baseline scores, age, and education level. In addition, associations between systems usage metrics and baseline participant characteristics were assessed for differences in usage groupings.

Results:

The sample was primarily female (n=25; 92.6%) and the average age was 42.9 years old (SD=15.6) and educational module completion, the central intervention component, averaged 20.2 + 11.4 modules out of XXX for the total sample. Multivariate models revealed that completing >75% of the program was associated with an average 22.6-point increase in interoceptive awareness (SE=8.32, p=0.013) and an 11.6-point decrease in worry (SE=4.12, p=0.009). In addition, a single log unit change in total number of meditations was associated with a 0.95-point reduction in GAD-7 scores (SE=0.27, p=0.005) while a single log unit use of the stress meter was associated with an average of a 0.5-point increase in emotional regulation scores (FFMQ) (SE=0.21, p=0.027).

Conclusions:

The work presented offers a clearer understanding of the impact of specific mobile app systems use on mental health outcomes. In addition, this research lays the groundwork for future comprehensive investigations of systems usage in dosing studies for health behavior change. Clinical Trial: Developing a Novel Digital Therapeutic for the Treatment of Generalized Anxiety Disorder (NCT03683472).