Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 30, 2024
Date Accepted: Aug 4, 2025
Cerina- Cognitive Behavioural Therapy based mobile application for managing GAD symptoms among university students: results from a pilot feasibility randomised controlled trial
ABSTRACT
Background:
Generalised Anxiety Disorder (GAD) is common among university students due to academic pressure and financial uncertainty among other challenges. Despite the need, the receipt of available psychological services is often low.
Objective:
The present study investigates the feasibility of a digital unguided Cognitive Behavioural Therapy (CBT)-based mobile application-Cerina, and it examines the likely effects of this intervention in reducing GAD symptoms compared to the wait-list control group.
Methods:
Eligible students (N=158) with mild to moderate GAD symptoms were self-assessed through online questionnaires. They were randomly allocated to the intervention group (N=79) or to the wait-list control group (N=79) following their informed consent. The intervention group had direct access to Cerina and followed CBT-based interactive sessions for 6 weeks. The wait-list control group participants had access to optional on-campus wellbeing services and were given access to Cerina 6 weeks after their randomisation. Participants completed assessments on anxiety, depression, worry, and usability at three time points. Additionally, upon completing the intervention, they were invited to an online interview to understand the implementation of the intervention in more depth
Results:
On average, 13% (N=10/79) intervention group participants dropped out and 61 % (N=36/69) completed the core clinical content (2 sessions) and 12% (N=7/69) completed the desired number of sessions (6 and/or 7 sessions). Analyses of the completers (2 or more sessions) revealed significant group differences in GAD (P=.03) (d=-.7) and worry symptoms (P=.02 ) (d=-.8) as well as functional impairment (P=.04) (d=-.6) in favour of the intervention group at post-test with medium to large effect sizes. The intention-to-treat analyses confirmed significant group differences in GAD (P=.03) (d=-.4), and there were marginally non-significant group differences in worry symptoms (P=.05) (d=-.3) in favour of the intervention group at post-test with medium effect sizes. These results suggest that the intervention had a meaningful impact in reducing GAD symptoms and modest impact in reducing worry symptoms among participants.
Conclusions:
The Cerina app showed promising results in reducing GAD symptoms among students. This result supports findings from other RCTs showing that digital CBT-based interventions are effective and feasible for a wide range of age groups and populations experiencing GAD symptoms. The low number of participants completing the recommended number of sessions suggests a usability issue. To address this, the intervention could be refined through an iterative design process informed by user feedback, and the long-term impact of specific engagement features in improving usability and retention could be assessed through extended evaluations. Clinical Trial: ClinicalTrials.gov NCT06146530;https://clinicaltrials.gov/study/NCT06146530
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