Evaluating the Effects of a Self-Help Mobile Phone App on Worry and Rumination Experienced by Young Adults: Randomized Controlled Trial

Overview

Journal JMIR Mhealth Uhealth

Specialties Biomedical Engineering
Medical Informatics

Date 2024 Aug 13

PMID 39137411

Authors

Daniel Edge

Edward Watkins

Alexandra Newbold

Thomas Ehring

Mads Frost

Tabea Rosenkranz

Affiliations

Soon will be listed here.

Abstract

Background: Delivery of preventative interventions via mobile phone apps offers an effective and accessible way to address the global priority of improving the mental health of adolescents and young adults. A proven risk factor for anxiety and depression is elevated worry and rumination, also known as repetitive negative thinking (RNT).

Objective: This was a prevention mechanism trial that aimed to investigate whether an RNT-targeting self-help mobile phone app (MyMoodCoach) reduces worry and rumination in young adults residing in the United Kingdom. A secondary objective was to test whether the app reduces symptoms of anxiety and depression and improves well-being.

Methods: A web-based, single-blind, 2-arm parallel-group randomized controlled trial was conducted with 236 people aged between 16 and 24 years, who self-reported high levels of worry or rumination. Eligible participants were randomized to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app, n=119) or a waitlist control group (usual practice with no access to the app until after 6 weeks, n=117). The primary outcome was changes in worry and rumination 6 weeks after randomization. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after 6 weeks and changes in all measures after 12 weeks.

Results: Participants randomly allocated to use the RNT-targeting self-help app showed significantly lower levels of rumination (mean difference -2.92, 95% CI -5.57 to -0.28; P=.03; η=0.02) and worry (mean difference -3.97, 95% CI -6.21 to -1.73; P<.001; η=0.06) at 6-week follow-up, relative to the waitlist control. Similar differences were observed for well-being (P<.001), anxiety (P=.03), and depression (P=.04). The waitlist control group also showed improvement when given access to the app after 6 weeks. Improvements observed in the intervention group after 6 weeks of using the app were maintained at the 12-week follow-up point.

Conclusions: The MyMoodCoach app had a significant positive effect on worry and rumination, well-being, anxiety, and depression in young adults, relative to waitlist controls, providing proof-of-principle that an unguided self-help app can effectively reduce RNT. This app, therefore, has potential for the prevention of anxiety and depression although longer-term effects on incidence need to be directly evaluated.

Trial Registration: ClinicalTrials.gov NCT04950257; https://www.clinicaltrials.gov/ct2/show/NCT04950257.

International Registered Report Identifier (irrid): RR2-10.1186/s12888-021-03536-0.

References

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

Andrews G, Sanderson K, Corry J, Lapsley H . Using epidemiological data to model efficiency in reducing the burden of depression*. J Ment Health Policy Econ. 2002; 3(4):175-186. DOI: 10.1002/mhp.96. View

Dickson K, Ciesla J, Reilly L . Rumination, worry, cognitive avoidance, and behavioral avoidance: examination of temporal effects. Behav Ther. 2012; 43(3):629-40. DOI: 10.1016/j.beth.2011.11.002. View

Lyubomirsky S, Nolen-Hoeksema S . Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Pers Soc Psychol. 1995; 69(1):176-90. DOI: 10.1037//0022-3514.69.1.176. View

Nolen-Hoeksema S, Parker L, Larson J . Ruminative coping with depressed mood following loss. J Pers Soc Psychol. 1994; 67(1):92-104. DOI: 10.1037//0022-3514.67.1.92. View

Kertz S, Koran J, Stevens K, Bjorgvinsson T . Repetitive negative thinking predicts depression and anxiety symptom improvement during brief cognitive behavioral therapy. Behav Res Ther. 2015; 68:54-63. DOI: 10.1016/j.brat.2015.03.006. View

Silva S, Silva S, Ronca D, Goncalves V, Said Dutra E, Carvalho K . Common mental disorders prevalence in adolescents: A systematic review and meta-analyses. PLoS One. 2020; 15(4):e0232007. PMC: 7179924. DOI: 10.1371/journal.pone.0232007. View

Bauer M, Glenn T, Geddes J, Gitlin M, Grof P, Kessing L . Smartphones in mental health: a critical review of background issues, current status and future concerns. Int J Bipolar Disord. 2020; 8(1):2. PMC: 6952480. DOI: 10.1186/s40345-019-0164-x. View

Topper M, Emmelkamp P, Watkins E, Ehring T . Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial. Behav Res Ther. 2017; 90:123-136. DOI: 10.1016/j.brat.2016.12.015. View

10.

Musiat P, Goldstone P, Tarrier N . Understanding the acceptability of e-mental health--attitudes and expectations towards computerised self-help treatments for mental health problems. BMC Psychiatry. 2014; 14:109. PMC: 3999507. DOI: 10.1186/1471-244X-14-109. View

11.

Just N, Alloy L . The response styles theory of depression: tests and an extension of the theory. J Abnorm Psychol. 1997; 106(2):221-9. DOI: 10.1037//0021-843x.106.2.221. View

12.

Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N . What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2014; 45(1):11-27. DOI: 10.1017/S0033291714000129. View

13.

Torous J, Roberts L . Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust. JAMA Psychiatry. 2017; 74(5):437-438. DOI: 10.1001/jamapsychiatry.2017.0262. View

14.

Watkins E . Constructive and unconstructive repetitive thought. Psychol Bull. 2008; 134(2):163-206. PMC: 2672052. DOI: 10.1037/0033-2909.134.2.163. View

15.

White I, Carpenter J, Horton N . Including all individuals is not enough: lessons for intention-to-treat analysis. Clin Trials. 2012; 9(4):396-407. PMC: 3428470. DOI: 10.1177/1740774512450098. View

16.

Merry S, Hetrick S, Cox G, Brudevold-Iversen T, Bir J, McDowell H . Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev. 2011; (12):CD003380. DOI: 10.1002/14651858.CD003380.pub3. View

17.

Meyer T, Miller M, Metzger R, Borkovec T . Development and validation of the Penn State Worry Questionnaire. Behav Res Ther. 1990; 28(6):487-95. DOI: 10.1016/0005-7967(90)90135-6. View

18.

Firth J, Torous J, Nicholas J, Carney R, Pratap A, Rosenbaum S . The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017; 16(3):287-298. PMC: 5608852. DOI: 10.1002/wps.20472. View

19.

Deady M, Choi I, Calvo R, Glozier N, Christensen H, Harvey S . eHealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis. BMC Psychiatry. 2017; 17(1):310. PMC: 5576307. DOI: 10.1186/s12888-017-1473-1. View

20.

Kaplan D, Palitsky R, Carey A, Crane T, Havens C, Medrano M . Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review. J Clin Psychol. 2018; 74(7):1126-1136. DOI: 10.1002/jclp.22585. View