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Digital Health App Promising in Tandem with Counseling


With scarce behavioral health resources, digital health apps could help bridge the gap.


The use of a well-being app is a feasible option for college students with moderate anxiety or depression who are seeking counseling, a recent study published in JMIR mHealth and uHealth revealed.

Those who used the Pacifica app following counseling continued to have decreasing anxiety levels at the six-month mark, compared to rising anxiety levels for those not using the app, according to the results.

“The study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling,” the study authors wrote.

Who Participated in the Study?

The study included 38 help-seeking university students who were at least 18 years old. Participants were accepted for counseling and met clinical criteria on one of two standardized outcome measures for anxiety or depression.

To be included, participants also needed to be newly registered for counseling, be an undergraduate or postgraduate student, have access to a smartphone that could install the application.

Exclusion criteria included:

  • Patients who presented a high risk to self or others
  • Those already receiving therapeutic support
  • Students with complex mental health problems beyond anxiety and/or depression

What the Researchers Measured

The research team used the seven-item Generalized Anxiety Disorder and the nine-item Patient Health Questionnaire to measure anxiety and depression. Participants completed the questionnaires at baseline, three months and six months following recruitment.

Before the intervention and at every counseling session, participants filled out the 10-item Clinical Outcomes in Routine Evaluation Outcome Measure to measure changes in general psychological functioning.

Using the Pacifica Digital Health App

All participants went to face-to-face counseling, which occurred every eight to 10 days. Sessions lasted 50 minutes in length.

Participants in the intervention group received the standard level of care and counseling sessions were supplemented with feedback on client use of a well-being app. Clients were supposed to use the app between counseling sessions to review app exercises with their therapist during face-to-face sessions.

The Pacifica app included:

  • A daily behavior monitor for mood, sleep, exercise, alcohol consumption, medication use and time spent outside
  • Reflective thinking exercises with guided cognitive behavioral therapy, mindfulness and positive visualization
  • Guided relaxation with breathing and meditation
  • Peer-led support through anonymous online communities and private groups
  • Tracking short- and long-term goals

Pacifica also gave users daily prompts to encourage participants to log their mood and behavior.

Analyzing the Results

Participants in both groups decreased their scores on social anxiety, alcohol use and hostility.

Both groups saw a decrease in depression from baseline through the six-month follow-up. Both groups also demonstrated reduced clinical severity by the end of counseling.

While one in five millennials diagnosed with major depression not seeking any form of treatment, telemedicine services could provide a solution. And there is a large gap in behavioral health specialists and care.

Using digital health apps in tandem with traditional counseling gives students a chance to be more in control of their well-being through self-guided programs, the authors concluded.

“The future of digital technology is promising for addressing some of the treatment barriers of traditional therapeutic interventions and provides an innovative solution to extend existing services,” the authors wrote. “Offering therapeutic technologies as a low-level preventive measure for subclinical symptoms of depression is particularly promising for the student population and has been shown to be effective.”

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