Smartphone-delivered CBT intervention safe, effective for reducing anxiety
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A digital cognitive behavioral therapy intervention was safe and effective for reducing symptoms of anxiety and worry among individuals with generalized anxiety disorder, according to study results published in Depression and Anxiety.
“Our objectives were to evaluate the safety and efficacy of the Daylight product for symptoms of anxiety,” Jasper A.J. Smits, PhD, of the department of psychiatry at the University of Texas, Austin, told Healio Psychiatry. “This study sample included adults with moderate-to-severe symptoms of GAD (as indicated by the GAD-7 measure at baseline) to ensure that we were evaluating the program in a clinically relevant population, rather than a population with more mild or transient anxiety.
“We know that it’s harder to help people with higher levels of worry and anxiety, which is why we decided to focus on these people in our study,” Smits added. “Our thinking was, if we can demonstrate favorable impact in this population, then we can have confidence Daylight can offer relief to people along the entire continuum.”
Anxiety interventions delivered via smartphone were shown in a meta-analysis of 29 randomized controlled trials to be associated with significant reductions in GAD symptoms. However, these results showed a small effect size compared with waitlist and/or inactive controls, which leaves room for improvement in the efficacy of digital interventions delivered via smartphone because effect sizes for in-person CBT for GAD are typically large.
In the current study, Smits and colleagues sought to evaluate Daylight, “a novel, smartphone-based and fully automated digital CBT intervention designed to enhance efficient learning and realtime application of CBT concepts and skills.” The investigators conducted an online, two-arm parallel-group superiority randomized controlled trial to compare digital CBT with waitlist control among 256 individuals with moderate-to-severe GAD symptoms. The intervention was delivered through participants’ smartphones, and online assessments occurred at baseline, which was week 0 and immediately preceding random assignment, mid-intervention, which was 3 weeks from randomization, post-intervention, which was 6 weeks and the primary endpoint, and follow-up, which was 10 weeks.
Results showed Daylight reduced anxiety symptoms compared with waitlist control after the intervention, and the researchers reported a large effect size with an adjusted difference of 3.22. They also found significant improvement in measure of worry, depressive symptoms, sleep difficulty, wellbeing and participant-specific quality of life.
“By week 10, 71% of the Daylight users had achieved statistically and clinically significant improvements in their anxiety levels, as compared with 33% of those in the control group,” Smits told Healio Psychiatry. “Those findings are commensurate to the kinds of improvements one would see with evidence-based in-person care.
“Equally important, these improvements were maintained over the next six months,” Smits added. “This is really interesting, because this 6-month follow up period in our study coincided with the COVID-19 pandemic. It’s actually remarkable that trial participants were able to maintain their improved anxiety levels during this unprecedented pandemic, which is a highly stressful time for us all.”