Feasibility and efficacy of a digital CBT intervention for symptoms of generalized anxiety disorder: a randomized multiple-baseline study
Abstract
Background and objectives Cognitive behavioral therapy (CBT) is a first-line treatment for anxiety, but it is not widely available as clinical guidelines recommend. We examined the feasibility and efficacy of a novel smartphone-based fully automated digital CBT intervention, 'Daylight™', to improve symptoms of Generalized Anxiety Disorder (GAD).Methods In this multiple-baseline design, 21 adults (20 F; mean age 43yrs. range 19-65yrs.) with moderate-to-severe symptoms of GAD were randomized to one of three baseline durations (2-, 4-, or 6-weeks) and then received access to digital CBT. Participants completed daily ratings of anxiety and worry, weekly measures of anxiety, depressive symptoms, and sleep, and measures of anxiety, worry, wellbeing, quality of life, CBT skill acquisition, and work performance at initial assessment prior to baseline randomization, post-intervention, and follow-up.Results Digital CBT was found to be feasible in terms of engagement, satisfaction, and safety. For preliminary efficacy, improvements were detected in daily and weekly outcomes of anxiety for most participants. Despite individual differences, significant improvements occurred with the introduction of digital CBT and not during baseline. Overall, 70% of participants no longer had clinically significant symptoms of GAD, 61% no longer had significant depressive symptoms, and 40% no longer had significant sleep difficulty at post-intervention.Limitations The study sample was recruited using the internet and was mostly female, limiting the generalizability of the findings.Conclusions Findings support the feasibility and efficacy of Daylight. Further examination in randomized controlled trials is now warranted.
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As evaluated by the Credibility/Expectancy Questionnaire, the program received moderate to high credibility scores.
“As evaluated by the Credibility/ Expectancy Questionnaire, the program received moderate to high credibility scores.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
In terms of feasibility, 76% of participants completed all 4 modules, 81% completed 3 modules, 86% completed 2 modules, and all participants completed at least 1 module.
“In terms of feasibility, 76% of participants completed all 4 modules, 81% completed 3 modules, 86% completed 2 modules, and all participants completed at least 1 module.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
43% of participants reported unwanted symptoms such as agitation, fatigue, low mood, or reduced motivation.
“but 43% of participants reported unwanted symptoms such as agitation, fatigue, low mood, or reduced motivation.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
In Miller et al., daily and weekly outcomes provided preliminary evidence of efficacy of the Daylight program for improving GAD symptoms.
“Daily and weekly outcomes provided preliminary evidence of efficacy of the program for improving GAD symptoms”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
No serious adverse events were observed.
“No serious adverse events were observed”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
40% had clinical and reliable change at follow-up.
“and 40% had clinical and reliable change at follow-up.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
Overall daily anxiety scores significantly decreased from baseline to postintervention (P < .001).
“Overall daily anxiety scores significantly decreased from baseline to postinter vention (P < .001).”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
Weekly anxiety scores significantly decreased from baseline to postintervention (P = .024), and follow-up (P = .017) as measured by the GAD-7.
“Weekly anxiety scores significantly decreased from baseline to postintervention (P = .024), and follow-up (P = .017) as measured by the GAD-7.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
For participants with sleep disturbances, 35% had clinical and reliable improvement at postintervention.
“For participants with sleep disturbances, 35% had clinical and reliable improvement at postintervention”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
44% maintained both at follow-up.
“and 44% maintained both at follow-up.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
For participants with depressive symptoms, 61% had clinical and reliable change at postintervention.
“For participants with depressive symptoms, 61% had clinical and reliable change at postintervention”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
Eighty percent had clinically significant and reliable change at follow-up.
“Eighty percent had clinically significant and reliable change at follow-up.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
The study had a small sample size.
“and the study had a small sample size.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
65% had both clinically significant and reliable change at postintervention.
“and 65% had both clinically significant and reliable change at postintervention.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
The daily and weekly outcomes support preliminary evidence of program efficacy in improving GAD symptoms.
“The daily and weekly outcomes support preliminary evidence of program efficacy in improving GAD symptoms.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
For participants with anxiety, 70% no longer had clinically significant anxiety symptoms postintervention.
“For participants with anxiety, 70% no longer had clinically significant anxiety symptoms postintervention”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
Participants indicated they were mostly satisfied with the program, although some expressed technical difficulties and a lack of specificity to their anxiety symptoms.
“Participants indicated they were mostly satisfied with the program, although some expressed technical difficulties and a lack of specificity to their anxiety symptoms.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
Daylight appears to be a feasible program with regards to acceptability, engagement, credibility, satisfaction, and safety.
“Daylight appears to be a feasible program with regards to acceptability, engagement, credibility, satisfaction, and safety.”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
Most participants identified as female and were recruited online, which limits generalizability.
“Most participants identified as female and were recruited online, which limits generalizability”
From Generalized anxiety disorder: 8 studies of psychosocial interventions (2022) · cites this paper as [11]
Previous evidence underlined the effectiveness of cognitive interventions focused both on symptoms and cognitive dysfunctional processes present in GAD, like worries.
“Previous evidence underlined the effectiveness of cognitive interventions focused both on symptoms and cognitive dysfunctional processes present in GAD, like worries (Covin et al., 2008; Hirsch et al., 2019; Miller et al., 2021).”
From Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder (2022) · cites this paper as Miller et al., 2021
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- Authors
- Miller, C. B., Gu, J., Henry, A. L., Davis, M. L., Espie, C. A., Stott, R., Heinz, A. J., Bentley, K. H., Goodwin, G. M., Gorman, B. S., Craske, M. G., & Carl, J. R.
- Affiliations
- University of Oxford (GB)
- Warneford Hospital (GB)
- Big Health Inc. (United States) (US)
- Adelphi University (US)
- Harvard University (US)
- University of California, Los Angeles (US)
- Corresponding author
- Miller, Christopher B.
- ORCID
- Venue
- Journal of Behavior Therapy and Experimental Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 70
- Pages
- 101609
- ISSN
- 0005-7916 (ISSN-L)
- OpenAlex
- W3084153107
- Cited by
- 40
- References
- 61
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 14 · 2023: 5 · 2022: 7 · 2021: 5 · 2020: 1
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Behavior Therapy and Experimental Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health Research
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- generalized anxiety disorder, digital cognitive behavioral therapy, smartphone-based intervention, daylight, feasibility, anxiety symptoms, depressive symptoms, sleep disorders, worry, quality of life, employee performance, internet-delivered treatment
- MeSH terms
- Smartphone, Adult, Aged, Anxiety Disorders, Feasibility Studies, Female, Humans, Male, Middle Aged, Quality of Life, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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