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

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_p²=0.02) and worry (mean difference -3.97, 95% CI -6.21 to -1.73; P<.001; η_p²=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.

Keywords: anxiety; app; application; depression; mobile health application; mobile phone; mobile-based interventions; prevention-mechanism; repetitive negative thinking; rumination; well-being; worry.

Figure 1

CONSORT flow diagram for the trial. CONSORT: Consolidated Standards of Reporting Trials; ITT: intention-to-treat; PHQ-9: Patient Health Questionnaire-9; RNT: repetitive negative thinking.

Figure 2

Screenshots from the MyMoodCoach app from left to right: screen from the library of visual resources, screen within the challenges menu to enter the abstract and concrete thinking challenge, screen within the tools menu to enter the opposite action tool.

Figure 3

Graph of mean RRS scores for RNT-targeting app and waitlist control participants with 95% CI error bars. RNT: repetitive negative thinking; RRS: Ruminative Response Scale.

Figure 4

Graph of mean PSWQ scores for RNT-targeting app and waitlist control participants with 95% CI error bars. PSWQ: Penn State Worry Questionnaire; RNT: repetitive negative thinking.