Smartphone-Based Digital CBT Improves Generalized Anxiety Disorder Symptoms: JAMA
USA: Limited access to trained providers and the burden of in-person therapy restrict the use of cognitive behavioral therapy (CBT). A randomized trial demonstrated that a smartphone-delivered, self-paced digital CBT program significantly improved symptoms of generalized anxiety disorder in adults. The intervention incorporates evidence-based techniques, including cognitive restructuring, relaxation, mindfulness, problem solving, and exposure strategies, offering an accessible alternative to traditional CBT.
The study, published in JAMA Network Open by E. Marie Parsons from the Department of Psychological and Brain Sciences, Boston University, and colleagues, evaluated whether a smartphone-based digital cognitive behavioral therapy (DCBT) program could more effectively reduce symptoms of generalized anxiety disorder (GAD) than an active psychoeducation control.
GAD is a chronic and often disabling condition. Although CBT is considered a first-line treatment, many patients face barriers such as long wait times, cost, and limited availability of trained therapists. Digital interventions have emerged as a potential solution to bridge this gap.
Researchers conducted a single-blind, parallel-group randomized clinical trial using a fully remote, decentralized design. The study enrolled 351 adults aged 22 years or older from across the United States who met diagnostic criteria for current GAD and scored at least 15 on the Generalized Anxiety Disorder–7 (GAD-7) scale, indicating moderate to severe symptoms.
Participants were randomly assigned in a 1:1 ratio to receive either a self-directed DCBT program delivered via smartphone or an online psychoeducation intervention. The DCBT program was designed for flexible, independent use and tailored to help users efficiently learn and apply core CBT skills.
The primary outcomes included changes in anxiety severity, measured using the GAD-7, and remission status, assessed by blinded independent evaluators using the Clinical Global Impressions–Improvement scale. Outcomes were evaluated at 10 weeks, the primary endpoint, and again at 24 weeks to assess the durability of treatment effects.
Key Findings:
- Participants using the digital CBT program showed significantly greater reductions in anxiety symptoms compared with those who received psychoeducation.
- GAD-7 scores were substantially lower in the DCBT group at both follow-up assessments, reflecting sustained improvement in anxiety severity.
- Remission rates were consistently higher among participants who received digital CBT than among those in the psychoeducation group.
- At 10 weeks, more than 70% of individuals in the DCBT group achieved remission, compared with about one-third of participants receiving psychoeducation.
- The superiority of digital CBT was maintained at 24 weeks, with remission observed in over three-quarters of DCBT participants.
The authors noted several limitations, including underrepresentation of certain racial and ethnic groups and the exclusion of individuals with specific psychiatric comorbidities or lower anxiety severity. Additionally, the study did not assess how patient preferences or engagement time influenced outcomes. Despite these limitations, the findings provide strong evidence supporting the effectiveness of smartphone-delivered CBT.
"Overall, the study suggests that digital CBT can deliver meaningful and lasting benefits for adults with GAD. By reducing barriers to access and offering a scalable, evidence-based treatment option, smartphone-based DCBT programs may play an important role in expanding mental health care delivery and addressing unmet needs in anxiety treatment," the authors concluded.
Reference:
Parsons EM, Ball T, Carl J, et al. Digital Cognitive Behavioral Treatment for Generalized Anxiety Disorder: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(12):e2548884. doi:10.1001/jamanetworkopen.2025.48884
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