JMIR Publications

ABSTRACT

Background:

Low-Intensity Cognitive Behavioural Therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with Generalized Anxiety Disorder (GAD) and support emotional wellbeing. However, barriers to access limit scalability and a large treatment gap remains. A solution has been to incorporate LICBT techniques derived from an evidence-based treatment protocol within the Iona Mind Wellbeing app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent.

Objective:

Examine engagement with a mobile phone app to support worry management with specific attention directed towards interaction with specific factors and examine the potential to reduce symptoms of anxiety.

Methods:

Log data was examined with respect to a sample of ‘engaged’ users that had interacted with the LICBT Problem Solving and Worry Time specific techniques. Paired samples t-tests were undertaken to examine the potential for IMWW to reduce anxiety, with multivariate linear regressions examining the extent to which completion of each of the specific techniques led to reductions in anxiety.

Results:

There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the CBT model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully employed to support the user with lower levels of engagement. With Worry Time, several users engaged with it out-of-app. Forgetting to use the app was the most common reason for lack of engagement with lower levels of engagement features of the app such as completion of routine outcome measures and weekly reflections. Despite difficulties in collection of endpoint data, there was a significant reduction in severity for both anxiety [t(53) = 5.5; P < .0001; 95% CI = 2.4-5.2] and low mood [t(53) = 2.3; P<.05; 95% CI=.2-3.3]. A statistically significant linear model was also fitted to GAD-7 [F(2,51) = 6.73; P < .001] whilst the model predicting changes in the PHQ-8 did not reach significance [F(2,51) = 2.33; P = 0.1078]. This indicates that reduction in these measures was affected by engagement with in-app Worry Time and Problem Solving.

Conclusions:

There were good levels of engagement with the LICBT techniques informed by an evidence-based protocol. This potentially accounts for promising data indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of adopting log data to inform future developments. However, attention needs to be directed towards enhancing engagement with features of the app given that larger improvements were associated with greater engagement.