The Immediate Impact of App-Based Psychotherapeutic Exercises on Anxiety: An RCT.

Summary

In a large trial with over a thousand participants, twelve different psychotherapeutic exercises delivered through the Mind Ease app each reduced anxiety more than either a reading control or a no-activity control. The exercises included cognitive restructuring, diaphragmatic breathing, gratitude practice, positive expressive writing, progressive muscle relaxation, guided imagery, and several mindfulness techniques. Effect sizes ranged from medium to very large, with mindfulness exercises generally showing larger effects than cognitive restructuring. Differences between exercises were substantial, with 42% of pairwise comparisons reaching statistical significance. The findings suggest that a variety of brief, app-based exercises can provide immediate anxiety relief.

Study at a glance

Abstract

Background: Despite the growing integrative trend in psychotherapy, few studies have examined the potential for immediate anxiety relief of many different psychotherapeutic exercises side by side under the same conditions. This information might be important to enhance engagement and self-efficacy, stop negative feedback loops, and prevent avoidant or destructive behavior during crises. Technology-based psychotherapeutic exercises are of particular interest because they are accessible and scalable. Methods: This parallel, double-blind, randomized trial (N = 1092) compared 12 psychotherapeutic exercises of the Mind Ease app against a reading control and a measurement-only control. Efficacy was measured with a custom scale validated against the state subscale of the State-Trait Anxiety Inventory. Results: Each of the 12 exercises significantly reduced anxiety more than controls (p=0.018 to <0.001, η2 ⁣ p =0.06 to 0.37, d=0.5 to 1.5, d [95% CI] for all exercises together vs. reading control = 0.8 [0.6; 1.0], and vs. measurement-only control = 0.8 [0.6; 1.0]). Exercises employing cognitive restructuring had effect sizes d [95% CI] of 0.5 [0.2; 0.8], 0.7 [0.3; 1.0], and 0.9 [0.6; 1.2], diaphragmatic breathing of 0.6 [0.3; 0.9], gratitude practice of 0.8 [0.5; 1.1], positive expressive writing of 1.1 [0.7; 1.4], progressive muscle relaxation of 1.3 [0.9; 1.6], guided imagery of 1.3 [1.0; 1.6], and mindfulness of 0.9 [0.6; 1.2], 1.0 [0.7; 1.3], 1.2 [0.9; 1.5], and 1.5 [1.2; 1.9]. Twenty-eight comparisons between exercises (42%) had p < 0.05, nine met the Bonferroni-adjusted threshold of p < 0.0008. Conclusions: The 12 psychotherapeutic exercises proved effective at immediately mitigating anxiety. Differences between exercises were substantial even within categories. Mindfulness tended to have a larger effect than cognitive restructuring. Trial Registration: ClinicalTrials.gov identifier: NCT05850975.