JMIR Publications

ABSTRACT

Background:

Digital mental health platforms often consist of many different types of self-care exercises. Whether a high number of choices may backfire and pose negative consequences (i.e., not choosing any exercises, choice dissatisfaction) to individuals, especially those experiencing anxiety and depressive symptoms and unpleasant state emotions have not been empirically investigated, to the best of our knowledge.

Objective:

The present study investigated the impact of choice set size on practice decisions, completion, satisfaction, and subjective experiences, as well as potential moderators including depression and anxiety symptoms, state emotions, and trait-level motivational and decisional characteristics on these choice outcomes.

Methods:

Participants were recruited through university mass email and social media, and 652 participants were included in our analyses. Participants completed questions regarding anxiety and depressive symptoms, state emotions, and other trait-level characteristics. Then, they were randomly assigned to 1-choice, 4-choice, and 16-choice conditions, in which they may choose a self-care activity to practice or decide not to practice. Finally, they completed questions regarding completion, satisfaction, engagement, attitude, and perceived improvement in psychological state.

Results:

Presenting multiple choices resulted in a higher likelihood of practice and better decision satisfaction compared to presenting with a single choice. Anxiety symptoms and state emotions may be key moderators. Specifically, for individuals with more anxiety symptoms and intense negative emotions, presenting a larger choice set (16 choices) resulted in more positive chosen exercise satisfaction, better attitudes towards chosen activity, and higher perceived improvement in mental health state after the activity, when compared to presenting with smaller choice sets. No evidence was found for moderating effect of trait-level characteristics.

Conclusions:

The moderation results found in the present study were contradictory to our hypotheses and prior articles. We speculated a possible reason for these findings may be that people with more anxiety symptoms and unpleasant emotions may have stronger need to reduce these uncomfortable symptoms and emotions, and by presenting with more choices on self-care activities, they may pose a higher possibility that these self-care activities can address their distress. Clinical Trial: Open Science Framework puwxb; https://osf.io/puwxb/ (Note: This is not a clinical trial, but an experiment)