Randomized Controlled Trial of Smartphone-Based Interpretation Bias Intervention for Anxiety and Depression
Abstract
Objective: HabitWorks (HW) is a personalized, transdiagnostic, Smartphone-based interpretation bias intervention for depression and anxiety that has demonstrated feasibility and acceptability in prior pilot studies. This preregistered randomized controlled trial (https://doi.org/10.17605/OSF.IO/EJ89T; Silverman et al., 2025) tested the effectiveness of HW compared to a symptom tracking (ST) control condition. Method: A nonclinical community sample of U.S. adults with at least mild anxiety and depression symptoms (N=340; Mage=33.04 years, 57.4% women, 60.6% White, 14.7% Black, 11.2% Asian, 10.9% Multiracial, 22.1% Hispanic/Latine) were randomly assigned to complete three weekly interpretation bias exercises and once weekly depression and anxiety symptom surveys (HW), or three weekly depression and anxiety symptom surveys (ST) for four weeks. Results: A priori benchmarks for retention, adherence and satisfaction were achieved: 77.8% of HW participants were still using the app in Week 4, 43.7% achieved perfect adherence, and app usability and acceptability were rated positively. As hypothesized, HW was superior to ST at improving negative and benign interpretation biases (Word-Sentence Association Paradigm) and functional impairment (Work and Social Adjustment Scale); and HW (vs. ST) participants reported significantly greater global improvement (Clinical Global Impressions Scale-Improvement Self-Report) and subjective engagement (Twente Engagement with eHealth Technologies…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 340 participants or records.
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