Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial

Jenna R Carl; Christopher B Miller; Alasdair L Henry; Michelle L Davis; Richard Stott; Jasper A J Smits; Richard Emsley; Jenny Gu; Olivia Shin; Michael W Otto; Michelle G Craske; Kate E A Saunders; Guy M Goodwin; Colin A Espie

doi:10.1002/da.23079

Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial

Depress Anxiety. 2020 Dec;37(12):1168-1178. doi: 10.1002/da.23079. Epub 2020 Jul 29.

Authors

Jenna R Carl^{1

2}, Christopher B Miller^{1

2

3}, Alasdair L Henry^{1

2

3}, Michelle L Davis^{1

2}, Richard Stott^{1

2

4}, Jasper A J Smits⁵, Richard Emsley⁶, Jenny Gu^{1

2

4}, Olivia Shin^{1

2}, Michael W Otto⁷, Michelle G Craske⁸, Kate E A Saunders^{4

9}, Guy M Goodwin⁴, Colin A Espie^{1

2

3}

Affiliations

¹ Big Health Inc., San Francisco, California.
² Big Health Inc., London, UK.
³ Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK.
⁴ Department of Psychiatry, University of Oxford, Oxford, UK.
⁵ Department of Psychology, The University of Texas at Austin, Austin, Texas.
⁶ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK.
⁷ Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts.
⁸ Anxiety and Depression Research Centre (ADRC), University of California, Los Angeles, California.
⁹ Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.

PMID: 32725848
DOI: 10.1002/da.23079

Abstract

Background: Cognitive behavioral therapy (CBT) is an efficacious intervention for generalized anxiety disorder (GAD). Digital CBT may provide a scalable means of delivering CBT at a population level. We investigated the efficacy of a novel digital CBT program in those with GAD for outcomes of anxiety, worry, depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life.

Methods: This online, two-arm parallel-group superiority randomized controlled trial compared digital CBT with waitlist control in 256 participants with moderate-to-severe symptoms of GAD. Digital CBT (Daylight), was delivered using participants' own smartphones. Online assessments took place at baseline (Week 0; immediately preceding randomization), mid-intervention (Week 3; from randomization), post-intervention (Week 6; primary endpoint), and follow-up (Week 10).

Results: Overall, 256 participants were randomized and intention-to-treat analysis found Daylight reduced symptoms of anxiety compared with waitlist control at post-intervention, reflecting a large effect size (adjusted difference [95% CI]: 3.22 [2.14, 4.31], d = 1.08). Significant improvements were found for measures of worry; depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life.

Conclusion: Digital CBT (Daylight) appears to be safe and efficacious for symptoms of anxiety, worry, and further measures of mental health compared with waitlist control in individuals with GAD.

Keywords: anxiety; cognitive behavioral therapy; generalized anxiety disorder; internet; web-based.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anxiety
Anxiety Disorders / therapy
Cognitive Behavioral Therapy*
Humans
Quality of Life*
Treatment Outcome