Efficacy of a Smartphone App Intervention for Reducing Caregiver Stress: Randomized Controlled Trial

Abstract

Background Caregivers play a pivotal role in maintaining an economically viable health care system, yet they are characterized by low levels of psychological well-being and consistently report unmet needs for psychological support. Mobile app–based (mobile health [mHealth]) interventions present a novel approach to both reducing stress and improving well-being. Objective This study aims to evaluate the effectiveness of a self-guided mobile app–based psychological intervention for people providing care to family or friends with a physical or mental disability. Methods In a randomized, single-blind, controlled trial, 183 caregivers recruited through the web were randomly allocated to either an intervention (n=73) or active control (n=110) condition. The intervention app contained treatment modules combining daily self-monitoring with third-wave (mindfulness-based) cognitive-behavioral therapies, whereas the active control app contained only self-monitoring features. Both programs were completed over a 5-week period. It was hypothesized that intervention app exposure would be associated with decreases in depression, anxiety, and stress, and increases in well-being, self-esteem, optimism, primary and secondary control, and social support. Outcomes were assessed at baseline, postintervention, and 3-4 months postintervention. App quality was also assessed. Results In total, 25% (18/73) of the intervention participants were lost to follow-up at 3 months, and 30.9% (34/110) of the participants from the wait-list control group dropped out before the postintervention survey. The intervention group experienced reductions in stress (b=−2.07; P=.04) and depressive symptoms (b=−1.36; P=.05) from baseline to postintervention. These changes were further enhanced from postintervention to follow-up, with the intervention group continuing to report lower levels of depression (b=−1.82; P=.03) and higher levels of emotional well-being (b=6.13; P<.001), optimism (b=0.78; P=.007), self-esteem (b=−0.84; P=.005), support from family (b=2.15; P=.001), support from significant others (b=2.66; P<.001), and subjective well-being (b=4.82; P<.001). On average, participants completed 2.5 (SD 1.05) out of 5 treatment modules. The overall quality of the app was also rated highly, with a mean score of 3.94 out of a maximum score of 5 (SD 0.58). Conclusions This study demonstrates that mHealth psychological interventions are an effective treatment option for caregivers experiencing high levels of stress. Recommendations for improving mHealth interventions for caregivers include offering flexibility and customization in the treatment design. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12616000996460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371170

Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19–Related Stress: Pilot Feasibility Study

“…Participants were adherent to the study protocol and listened to an average of 2 files each day, surpassing the minimum requirement of listening to 1 audio file per day. Our results compare favorably with other studies that have shown modest adherence or engagement with mHealth stress management apps [ 52 , 55 , 56 ]. Based on participant feedback, our adherence results may have been due in part to the length of the guided imagery audio files because each file was approximately 5 minutes long.…”

“…Overall, participants found See Me Serene easy to use and useful. Our results were similar to previous studies of mHealth apps aimed at reducing stress, anxiety, and depression among a variety of different populations [55][56][57][58][59]. There were few reported technical issues, which were resolved with updates to the app.…”

“…Although this study was not designed to test efficacy, we found significant reductions in all outcome variables with small to medium effect sizes. The evidence regarding effectiveness of mHealth apps is limited and mixed [53,54,[56][57][58][59][60][61][62][63][64]. While several randomized controlled trials have shown these apps to be effective at reducing stress, anxiety, depression, or PTSD symptoms [53,54,57,59], some have not reported positive results [60,61,64].…”

The effect of active occupational stress management on psychosocial and physiological wellbeing: a pilot study

“…43,44 Importantly, improvements in heart rate variability with lifestyle interventions were associated with lower risk of diabetes, independent of weight loss and physical activity. 45 Moreover, recent study by Fuller-Tyszkiewicz et al 46 evaluated very similar app and con rmed these ndings. The authors proved that mHealth psychological interventions present an effective treatment option for users since the intervention group experienced signi cant reductions in stress and depressive symptoms, and higher levels of emotional well-being.…”

The effect of active occupational stress management on psychosocial and physiological wellbeing: a pilot study

“…Importantly, improvements in heart rate variability with lifestyle interventions were associated with lower risk of diabetes, independent of weight loss and physical activity [45]. Moreover, recent study by Fuller-Tyszkiewicz et al [46] evaluated very similar app and confirmed these findings. The authors proved that mHealth psychological interventions present an effective treatment option for users since the intervention group experienced significant reductions in stress and depressive symptoms, and higher levels of emotional well-being.…”