Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 12, 2024
Date Accepted: Apr 29, 2025
An Application-Based CBT Program Tailored for College Students: A Randomized Controlled Trial
ABSTRACT
Background:
Technology-based Cognitive Behavioral Therapy (t-CBT) programs are increasingly recognized as accessible interventions for addressing mental health challenges, particularly among college students. Despite their potential, low adherence rates remain a key challenge that needs to be resolved to maximize the impact of such interventions.
Objective:
To assess the effects of the tailored content and gamification elements of Mind Booster Green on reducing depressive symptoms and improving college life adjustment.
Methods:
A randomized, unblinded controlled trial was conducted among college students. All study procedures, including recruitment and assessments, were conducted entirely online. Participants were randomly assigned to either the intervention group or a waitlist control group. The intervention group used Mind Booster Green, an app-based self-help CBT program for one month, which incorporated tailored case stories and gamification elements such as point and level systems to enhance user engagement and adherence. All outcomes were self-assessed via online questionnaires, including changes in depressive symptoms, college life adjustment, and both negative and positive automatic thoughts. Application usability was also evaluated. These outcomes were measured at three time points: pre-intervention, post-intervention, and at a two-month follow-up, using validated and standardized tools.
Results:
A total of 170 participants (mean age 22.60, SD 3.37, 80% female) were participated in the study. A chi-square analysis revealed no significant differences between the intervention and waitlist control groups at baseline in terms of age, gender, or class year (ps > .05). Generalized Estimating Equation (GEE) analysis revealed significant time x group interactions for all variables. The intervention group showed larger reductions in depressive symptoms (PHQ-9: Pre to Post, Cohen’s d = 1.12; Post to F/U, Cohen’s d = 1.15; BDI-II: Pre to Post, Cohen’s d = .90; Post to F/U, Cohen’s d = 1.04) and negative automatic thoughts (ATNQ-SF: Pre to Post, Cohen’s d = .36; Post to F/U, Cohen’s d = .58), as well as greater increases in adjustment to college life (SACQ-R: Pre to Post, Cohen’s d = -.87) and positive automatic thoughts (ATPQ-SF: Pre to Post, Cohen’s d = -.45) compared to the control group (Cohen’s d for all variables = -.22 to .04). Adherence rates were 89% for the intervention group and 99% for the control group. Usability test results, assessed using the MARS, showed an overall score of 3.88, with scores above the medium level in the categories of entertainment, functionality, aesthetics, and information.
Conclusions:
Mind Booster Green demonstrates substantial potential as a complementary or alternative intervention to traditional psychological counseling services for college students, providing a cost-effective and scalable solution for mental health issues. Future research should explore the applicability of this program in diverse populations. Clinical Trial: Korean Clinical Trial Registry (Clinical Research Information Service: CRIS) number KCT0009758 (retrospectively registered); https://cris.nih.go.kr/cris/search/detailSearch.do?seq=27868&search_page=L
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