Joseph Firth1, John Torous2, Jennifer Nicholas3, Rebekah Carney4, Simon Rosenbaum3, Jerome Sarris5. 1. Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK. Electronic address: joseph.firth@postgrad.manchester.ac.uk. 2. Department of Psychiatry, Beth Israel Deaconess Medical Canter, Harvard Medical School, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. 3. Black Dog Institute, UNSW Australia, Australia; School of Psychiatry, Faculty of Medicine, UNSW Australia, Australia. 4. Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK. 5. Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Melbourne, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia; NICM, School of Science and Health, University of Western Sydney, Australia.
Abstract
BACKGROUND: Various psychological interventions are effective for reducing symptoms of anxiety when used alone, or as an adjunct to anti-anxiety medications. Recent studies have further indicated that smartphone-supported psychological interventions may also reduce anxiety, although the role of mobile devices in the treatment and management of anxiety disorders has yet to be established. METHODS: We conducted a systematic review and meta-analysis of all randomized clinical trials (RCTs) reporting the effects of psychological interventions delivered via smartphone on symptoms of anxiety (sub-clinical or diagnosed anxiety disorders). A systematic search of major electronic databases conducted in November 2016 identified 9 eligible RCTs, with 1837 participants. Random-effects meta-analyses were used to calculate the standardized mean difference (as Hedges' g) between smartphone interventions and control conditions. RESULTS: Significantly greater reductions in total anxiety scores were observed from smartphone interventions than control conditions (g=0.325, 95% C.I.=0.17-0.48, p<0.01), with no evidence of publication bias. Effect sizes from smartphone interventions were significantly greater when compared to waitlist/inactive controls (g=0.45, 95% C.I.=0.30-0.61, p<0.01) than active control conditions (g=0.19, 95% C.I.=0.07-0.31, p=0.003). LIMITATIONS: The extent to which smartphone interventions can match (or exceed) the efficacy of recognised treatments for anxiety has yet to established. CONCLUSIONS: This meta-analysis shows that psychological interventions delivered via smartphone devices can reduce anxiety. Future research should aim to develop pragmatic methods for implementing smartphone-based support for people with anxiety, while also comparing the efficacy of these interventions to standard face-to-face psychological care.
BACKGROUND: Various psychological interventions are effective for reducing symptoms of anxiety when used alone, or as an adjunct to anti-anxiety medications. Recent studies have further indicated that smartphone-supported psychological interventions may also reduce anxiety, although the role of mobile devices in the treatment and management of anxiety disorders has yet to be established. METHODS: We conducted a systematic review and meta-analysis of all randomized clinical trials (RCTs) reporting the effects of psychological interventions delivered via smartphone on symptoms of anxiety (sub-clinical or diagnosed anxiety disorders). A systematic search of major electronic databases conducted in November 2016 identified 9 eligible RCTs, with 1837 participants. Random-effects meta-analyses were used to calculate the standardized mean difference (as Hedges' g) between smartphone interventions and control conditions. RESULTS: Significantly greater reductions in total anxiety scores were observed from smartphone interventions than control conditions (g=0.325, 95% C.I.=0.17-0.48, p<0.01), with no evidence of publication bias. Effect sizes from smartphone interventions were significantly greater when compared to waitlist/inactive controls (g=0.45, 95% C.I.=0.30-0.61, p<0.01) than active control conditions (g=0.19, 95% C.I.=0.07-0.31, p=0.003). LIMITATIONS: The extent to which smartphone interventions can match (or exceed) the efficacy of recognised treatments for anxiety has yet to established. CONCLUSIONS: This meta-analysis shows that psychological interventions delivered via smartphone devices can reduce anxiety. Future research should aim to develop pragmatic methods for implementing smartphone-based support for people with anxiety, while also comparing the efficacy of these interventions to standard face-to-face psychological care.
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