Evaluating the Effectivity of the InsightApp: A Longitudinal Randomized Controlled Trial on Anxiety, Valued Action, and Psychological Resilience (Preprint)
Authors: Amo Victoria , Lieder Falk 
Published: August 2023

BACKGROUND

Anxiety disorders are a common mental health condition, and stress plays a significant role in their development. Ecological Momentary Interventions (EMIs) hold great potential to help people manage stress and anxiety by training emotion regulation and coping skills in real-life settings. The InsightApp is a gamified EMI and research tool that incorporates elements from evidence-based therapeutic approaches. The app is designed to strengthen people’s metacognitive skills for coping with challenging real-life situations and embracing anxiety and other emotions.

OBJECTIVE

This study examines the potential of the InsightApp to improve individuals' metacognitive strategies for coping with stress and anxiety. Additionally, the study evaluates the app's effectiveness at promoting value-congruent action and investigates the retention of these effects. By exploring the impact of metacognitive training on emotional reactivity to stress and daily behavior in real-life contexts, this study aims to contribute to our understanding of the role of metacognition in emotional and behavioral reactivity to stress.

METHODS

We ran a randomized controlled trial (n=228, completion rate: 197/228, 86.4%). The study design and data analysis plan were preregistered to ensure transparency and minimize biases in the analysis and interpretation of the results. Participants (mean age 38, SD 11.50; range 20–80 years; 101/192 52.6% female, 175/192, 91.1% white) in this study were randomly assigned to either the experimental or control group. During the one-week intervention phase of the study, the experimental condition engaged with the InsightApp, while participants in the control group interacted with an alternative version of the app focused on training cognitive skills instead. We used experience sampling to measure the within-subject causal effects of the intervention on daily anxiety, struggle with anxiety, and value congruent action. We utilized a multilevel model to analyze the longitudinal data, focusing on the within-subject process of emotional reactivity to daily stressors. Additionally, we assessed differences in pre-test, post-test, and follow-up assessments of mental health and well-being between the two groups.

RESULTS

The results of our study indicate that the InsightApp had a significant positive effect during the intervention period. When confronted with real-life stress, participants in the treatment group experienced a 15% lower increase in anxiety (t197=-2.4; P<.01, Cohen’s f=-0.002 ) and an 11% lower increase in struggle with anxiety (t197=-1.73, P=.042, Cohen’s f=-0.005) than the control group. Furthermore, individuals in the treatment group demonstrated a higher tendency to align their actions with their personal values by 7.5% compared to the control group (t₁₉₇=3.52; P<.001; Cohen’s f= 0.002). After the intervention period, the InsightApp’s positive effects on struggle with anxiety in reaction to stress were sustained and increased to a 15.6% lower reactivity to stress (t₁₉₇=-2.39; P<.01; Cohen’s f=0.003). The two condition’s post-test scores on measures of mental health and well-being did not significantly differ directly after the intervention nor seven days later (all p > 0.22).

CONCLUSIONS

The results suggest that the InsightApp is a valuable tool for improving stress management, reducing anxiety, and facilitating value-congruent action in real-world contexts. Overall, our findings suggest that guiding people to apply adaptive metacognitive strategies to cope with real-life stress on a daily basis with a gamified mobile app is a promising approach that deserves further evaluation.