App-Based CBT, Mindfulness, and ACT Exercises: Their Immediate Impact on Anxiety - A Randomised Controlled Trial

BackgroundDespite the growing integrative trend in psychotherapy, few studies have examined the potential for immediate anxiety relief of many different psychotherapeutic exercises side by side under the same conditions. This information might be important to enhance engagement and self-efficacy, stop negative feedback loops, and prevent avoidant or destructive behaviour during crises. Technology-based psychotherapeutic exercises are of particular interest because they are accessible and scalable. MethodsThis parallel, double-blind, randomised trial (N=1092) compared twelve psychotherapeutic exercises of the Mind Ease app against a reading control and a measurement-only control. Efficacy was measured with a custom scale validated against the state subscale of the State-Trait Anxiety Inventory. ResultsEach of the twelve exercises significantly reduced anxiety more than controls (p = 0.018 to <.001, 2P = .06 to .37, d = 0.5 to 1.5, d [95% CI] for all exercises together vs reading control = 0.8 [0.6; 1.0], and vs measurement-only control = 0.8 [0.6; 1.0]). Exercises employing cognitive restructuring had effect sizes d [95% CI] of 0.5 [0.2; 0.8], 0.7 [0.3; 1.0], and 0.9 [0.6; 1.2], diaphragmatic breathing of 0.6 [0.3; 0.9], gratitude practice of 0.8 [0.5; 1.1], positive expressive writing of 1.1 [0.7; 1.4], progressive muscle relaxation of 1.3 [0.9; 1.6], guided imagery of 1.3 [1.0; 1.6], and mindfulness of 0.9 [0.6; 1.2], 1.0 [0.7; 1.3], 1.2 [0.9; 1.5], and 1.5 [1.2; 1.9]. Twenty-eight comparisons between exercises (42%) had p < .05, nine met the Bonferroni-adjusted threshold of p < .0008. ConclusionsThe twelve psychotherapeutic exercises proved effective at immediately mitigating anxiety. Differences between exercises were substantial even within categories. Mindfulness tended to have a larger effect than cognitive restructuring. Trial registrationThe trial was prospectively registered (clinicaltrials.gov identifier: NCT05850975, https://osf.io/36ukh).