JMIR Publications

ABSTRACT

Background:

Anxiety disorders are among the most prevalent mental disorders, and stress plays a significant role in their development. Ecological Momentary Interventions (EMIs) hold great potential to help people manage stress and anxiety by training emotion regulation and coping skills in real-life settings. The InsightApp is a gamified EMI and research tool that incorporates elements from evidence-based therapeutic approaches. The app is designed to strengthen people’s metacognitive skills for coping with challenging real-life situations and embracing anxiety and other emotions.

Objective:

This randomized controlled trial examines how effective the InsightApp is at 1) improving individuals' metacognitive strategies for coping with stress and anxiety, and 2) promoting value-congruent action. It additionally evaluates how long these effects are retained. By exploring the impact of metacognitive training on emotional reactivity to stress and daily behavior in real-life contexts, this experiment advances our understanding of the role of metacognition in emotional and behavioral reactivity to stress.

Methods:

We ran a randomized controlled trial (n=228, completion rate: 197/228, 86.4%). Participants (mean age 38, SD 11.50; range 20–80 years; 101/192 52.6% female, 175/192, 91.1% white) in this experiment were randomly assigned to either the experimental group or a placebo-control group. During the one-week intervention-phase, the treatment group engaged with the InsightApp, while participants in the control group interacted with a placebo version of the app that delivered executive functions training. We assessed differences between the two groups in post-test and follow-up assessments of mental health and well-being while controlling for pre-existing differences. Additionally, we utilized a multilevel model to analyze the longitudinal data, focusing on the within-subject causal effects of the intervention on emotional and behavioral reactivity to daily stressors. Specifically, we measured daily anxiety, struggle with anxiety, and value congruent action.

Results:

The intervention delivered by the InsightApp yielded mixed results. On one hand, we found no significant post-test scores on measures of mental health and well-being directly after the intervention nor seven days later (all p > 0.22). On the other hand, when confronted with real-life stress, the treatment group experienced a 15% lower increase in anxiety (t197=-2.4; P<.01) and a 12% lower increase in struggle with anxiety (t197=-1.87, P=.042) than the control group. Furthermore, individuals in the treatment group demonstrated a 7% higher tendency to align their actions with their personal values compared to the control group (t₁₉₇=3.23; P<.01). After the intervention period, the InsightApp’s positive effects on struggle with anxiety in reaction to stress were sustained and increased to an 18% lower reactivity to stress (t₁₉₇=-2.84; P<.01).

Conclusions:

Given that our study yielded mixed results, further studies are needed to obtain an accurate and reliable understanding of the effectiveness of the InsightApp. Overall, our findings tentatively suggest that guiding people to apply adaptive metacognitive strategies for coping with real-life stress on a daily basis with a gamified ecological momentary intervention is a promising approach that deserves further evaluation.