Smartphone-Delivered Digital CBT Improves Anxiety Symptoms in Adults
Key Clinical Summary
- Smartphone-delivered digital cognitive behavioral therapy (DCBT) produced greater anxiety symptom reductions than online psychoeducation in adults with generalized anxiety disorder (GAD).
- Remission rates were significantly higher at both 10 weeks (71.0% vs 34.6%) and 24 weeks (77.7% vs 52.0%).
- Secondary outcomes improved significantly, including depressive symptoms, sleep quality, and clinician-rated severity, with no difference in adverse events.
A smartphone-delivered digital cognitive behavioral therapy (DCBT) program significantly improved symptoms of generalized anxiety disorder (GAD) in adults, according to a randomized clinical trial published in JAMA Network Open. The findings suggest that digital CBT may serve as a scalable first-line treatment option, addressing barriers to accessing traditional in-person psychotherapy.
Study Findings
The single-blind, parallel-group, decentralized randomized trial enrolled 351 adults aged 22 years and older who met DSM-5 criteria for generalized anxiety disorder and had a baseline score of at least 15 on the 7-item Generalized Anxiety Disorder (GAD-7) scale. Participants were randomized to a 10-week, self-directed DCBT program delivered via smartphone or to an online psychoeducation control intervention.
The digital CBT intervention, known as DaylightRx, incorporated evidence-based CBT techniques including cognitive restructuring, applied relaxation, mindfulness, problem solving, and imaginal exposure.
At week 10, 71% of participants in the digital CBT group met remission criteria on the Clinical Global Impressions–Improvement (CGI-I) scale, compared with 34.6% in the psychoeducation group (OR 4.63, 95% CI 2.85–7.54; P<0.001). Remission rates remained higher at week 24 (77.7% vs 52%; OR 3.22, 95% CI 1.95–5.32; P<0.001).
Self-reported anxiety symptoms, measured using the GAD-7, improved substantially in the digital CBT group. Mean scores decreased from 15.58 at baseline to 7.88 at week 10 and 7.23 at week 24. In contrast, the control group showed smaller reductions, from 16.14 at baseline to 11.68 and 10.68 at the same time points. Engagement was an important factor, as symptom improvement was dose-dependent, with greater benefits seen among participants completing more lessons.
Clinical Implications
CBT and pharmacotherapy are both considered first-line treatments for GAD, but access to trained therapists and the demands of in-person care often limit uptake. Smartphone-delivered digital CBT offers a potential solution by reducing logistical barriers and expanding reach.
In this trial, digital CBT not only improved anxiety symptoms but also led to clinically meaningful improvements in depression, sleep quality, and clinician-rated anxiety severity. Importantly, these benefits were maintained through 24 weeks of follow-up, suggesting durability beyond the active intervention period.
The findings may be particularly relevant for patients already receiving pharmacologic treatment. Participants taking anxiety medications at baseline experienced significantly greater benefit from digital CBT than from psychoeducation, supporting its potential role as an adjunctive therapy.
No differences in adverse events were observed between groups, and no unanticipated device-related harms were reported, supporting the safety of smartphone-based CBT in this population.
Expert Commentary
DaylightRx “has yielded larger effects than those of other digital interventions, which may reflect more effective treatment elements within this digital CBT or a format that drives stronger engagement with treatment,” explained E. Marie Parsons, PhD, Boston University, Boston, Massachusetts, and study authors. They emphasized the clinical relevance of the results, noting that “the consistent evidence for the efficacy of this smartphone-accessible DCBT suggests it is a scalable, first-line treatment option for adults with GAD.”
Conclusion
This randomized clinical trial demonstrates that smartphone-delivered digital CBT can significantly improve anxiety and related outcomes in adults with GAD. The findings support further consideration of DCBT as a scalable, accessible treatment option and highlight the need for future studies assessing broader patient populations.
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