The Effectiveness and Mechanisms of Action of App-Based Interventions for Improving Mental Health and Workplace Well-Being: Randomized Controlled Trial

Clinical Snapshot

Key Findings

• P Value: p=0.004 for anxiety, p=0.02 for depression with executive function training

• Effect Size: Beta coefficients of approximately -2.8 for both anxiety and depression with executive function training

• Primary Outcome: Executive function training reduced anxiety (β=-2.79, p=0.004) and depression (β=-2.77, p=0.02) at 12-week follow-up only

• Nnt Or Sensitivity: Cannot be calculated due to insufficient data reporting

• Confidence Interval: Not reported

Clinical Application

High feasibility given smartphone ubiquity, though requires sustained engagement over 4 weeks with minimum 21 app uses Highly relevant to Australian workplace mental health initiatives and may complement existing EAP services. Could be considered alongside current PBS-subsidised psychological therapies for mild-to-moderate presentations Working adults with mild-to-moderate depression and anxiety symptoms seeking accessible mental health interventions

Abstract

BACKGROUND: Depression is the most common mental health disorder worldwide and frequently leads to workplace absence. As face-to-face treatment can be difficult to access, app-based interventions are a popular solution, although their effectiveness in working populations and their mechanisms of action are unclear. Deficits in executive function may contribute to the onset and maintenance of depression, and executive function training is proposed to improve symptoms by enhancing executive function. Responders to cognitive behavioral therapy (CBT) show improvements in executive function, suggesting that this may be one mechanism of action. OBJECTIVE: This study investigated the effectiveness of app-based interventions (executive function or CBT-based) for reducing depressive and anxiety symptoms and improving workplace well-being, and assessed whether changes in executive function mediated improvements. METHODS: A total of 228 participants (147 female participants) with mild-to-moderate symptoms of depression and anxiety were recruited online and randomly assigned to a waitlist control group, an executive function training group (NeuroNation app, Synaptikon GmbH), or a self-guided CBT group (Moodfit app, Roble Ridge LLC) for a 4-week intervention period. Participants assigned to the active intervention groups were asked to use their apps a minimum of 21 times during the intervention. Participants completed measures of depressive symptoms, anxiety symptoms, and workplace well-being, and a working memory task at baseline, postintervention, and follow-up (12 weeks). RESULTS: Executive function training reduced anxiety (β=-2.79; P=.004) and depressive (β=-2.77; P=.02) symptoms at follow-up but not at postintervention, and it did not affect workplace well-being. There were no reductions in depressive or anxiety symptoms in the self-guided CBT group, though workplace well-being was improved at postintervention (β=3.72; P=.02) and follow-up (β=4.46; P=.02). Improvements in executive function did not mediate intervention-related changes in symptoms or workplace well-being. Self-reported adherence rates were high (executive function training: 48/54, 89%; self-guided CBT: 52/54, 96%), although attrition was high at follow-up (58% missing). CONCLUSIONS: These results suggest that app-based executive function training may be effective at managing symptoms of anxiety and depression in a working population, while self-guided CBT apps may improve workplace well-being. However, improving executive function did not appear to be a mechanism of action of either intervention.

References

1. 1.MacLellan, A., Fairchild, G., & Button, K. S. (2026). The effectiveness and mechanisms of action of app-based interventions for improving mental health and workplace well-being: Randomized controlled trial. JMIR Mental Health. https://doi.org/10.2196/91564