App for self-directed cognitive behavioral therapy reduces anxiety in young adults

Researchers from Weill Cornell Medicine and NewYork-Presbyterian found that a self-directed cognitive behavioral therapy (CBT) app called Maya significantly reduced anxiety in young adults with mental health problems. The reduction in anxiety symptoms was clinically and statistically significant after six weeks and was sustained at the 12-week follow-up period, with levels of improvement similar to those seen in studies of anxiety medications.

The study, published Aug. 20 in JAMA Network Open, examined how young adults ages 18 to 25 would respond to cognitive behavioral therapy (CBT) from an app called Maya, which researchers at Weill Cornell Medicine began developing in 2019 in collaboration with members of Weill Cornell Information Technologies & Services. Cognitive behavioral therapy is a gold-standard psychotherapeutic intervention that teaches users skills to help them change their thinking, stop challenging behaviors, and learn coping strategies. Nearly all of the 59 participants, 98 percent, participated for the full six weeks of the main study period, completing an average of about 11 of the 12 intervention sessions.

While Maya is not a substitute for professional help, it teaches strategies based on cognitive behavioral therapy. The app offers skill-building tools and real-time feedback that can help reduce stress and negative thoughts.

We hear a lot about the negative impact of technology use on mental health in this age group. But the ubiquitous use of mobile phones to obtain information could be one way to ease the fears of some people who, even if they had access to mental health services, would not seek them out. If the app helps to alleviate symptoms, they could then take the next step and see a mental health professional if needed.”

Dr. Faith M. Gunning, lead author of the study, associate professor of psychology in psychiatry and associate director for research in the Department of Psychiatry at Weill Cornell Medicine

Combating fears in adolescents

Maya is designed to address anxiety in early adulthood, when people are going through stressful changes, such as starting a new job, moving away from home, or graduating from college. Research has shown that anxiety disorders increase more among young people aged 18 to 25 than any other age group.

Maya is an interactive platform that guides users through videos, exercises, and educational content to help them learn and implement new skills. Although cognitive behavioral therapies are effective in treating anxiety symptoms, researchers point out that the lack of available doctors makes it difficult to find appointments, especially since the pandemic. In the meantime, a self-directed mobile app may be helpful until a mental health professional is available, and may appeal to a younger population more comfortable with digital tools.

“We believe these apps are promising, but they“They’re only helpful if people use them,” said co-lead author Dr. Jennifer N. Bress, Peter Edwin Stokes, MD, Clinical Scholar in Psychobiology, assistant professor of psychology in psychiatry at Weill Cornell Medicine, and psychologist at NewYork-Presbyterian Westchester Behavioral Health. “We wanted to develop an evidence-based app to empirically test whether we are actually engaging people and alleviating their anxiety.” Although there is a lot of evidence from clinical trials that cognitive behavioral therapy is effective in treating anxiety, testing the app itself in clinical trials is an important step to ensure its effectiveness.

Because users often download an app, try it a few times, and then delete it, features were added to the app to encourage engagement, such as interactive exercises, videos, and an interface that test groups found visually appealing.

Designed to captivate

To see if they could motivate users even further, the authors randomly divided the 59 study participants into three groups with different incentives. These included the opportunity to win points, the opportunity to lose points, and a point-earning opportunity that paired participants with a person in their life who encouraged them throughout the process. Participants received virtual “medals” for reaching certain point levels.

Surprisingly, the researchers found that using the Maya app reduced anxiety, regardless of the incentive people received.

“These results demonstrate that the app can be an accessible and powerful tool for those seeking support for anxiety. It’s incredible to see our ideas come to life,” noted Dr. Avital Falk, Charisse Chinery Clinical Scholar in Psychiatry, associate professor of psychology in clinical psychiatry, and director of the Division of Digital and Treatment Innovation. Dr. Falk, who is also director of the Pediatric OCD, Anxiety, and Tic Disorders (POCAT) program in collaboration with the Center for Youth Mental Health at NewYork-Presbyterian, was co-first author and designed the app’s content.

“Given the number of clinics we have, it’s going to be difficult to meet the mental health needs of society,” said Dr. Gunning, who is also George Alexopoulos, MD, honorary director of the Institute of Geriatric Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian and a psychologist at NewYork-Presbyterian Westchester Behavior Health. “Our initial results suggest that the app could be an effective tool to bridge the wait times for people waiting to see a therapist.”