JMIR Publications

ABSTRACT

Background:

Stress is an emotional response caused by external triggers and is known to be a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions have demonstrated efficacy for stress management. However, there is a limited understanding of the association between relaxation components and levels of stress using a digital app.

Objective:

This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and CBT- based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants’ perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions.

Methods:

Stress levels were evaluated in a real-world data cohort using the behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed users (n=490) who started with moderate levels of stress and completed at least two stress assessments. Levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in two-time segments (1-6 weeks and 6-10 weeks). Next, simple slope analysis was used for the interpretation of the interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the two segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions.

Results:

Analysis revealed a significant decrease in stress symptoms (B=-0.25, CI 95% -0.32- -0.17, p<0.001) during the period of 1-6 weeks of app usage which was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (B=-0.07, CI 95% -0.13- -0.01, P=0.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions as well as breathing exercises significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items.

Conclusions:

This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and CBT-based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective.