Can Digital Health Address Anxiety?

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A lot of digital mental tools health focus on addressing depression. For many, anxiety is very present in their day to day lives. Depression and anxiety are often co-morbid. The literature for digital mental health tools is growing, and Cognitive Behavioral Therapy (CBT) has been translated into a compelling user experience in many apps that show clinically meaningful improvement. What about anxiety? The pandemic has raised awareness of anxiety and how debilitating it can be for those who experience it. In the USA, anxiety is one of the most prevalent mental health disorders, but over 36% of those impacted by it don’t seek help.

A new paper by Sarah Kunkle and colleagues from Ginger, a digital mental health company in San Francisco, shares some early data on anxiety outcomes based on Ginger users in the latest issue of the Journal of Medical Internet Research (JMIR). Ginger is a multi-modality mental health app that offers text-based coaching, teletherapy, and telepsychiatry as part of their solution to support their users. The sample in this study looked at 1,611 participants who were offered Ginger via their employer over a two-year pre-pandemic timeframe.

The study explores the odds for symptom improvement or, simply put, symptom relief for user’s anxiety by care modality, namely, text-based coaching, teletherapy, and telepsychiatry. Findings show that all care modalities increased the odds that people experience symptom relief. Those who used the services at higher rates saw more significant improvements. Participants who used more than one care modality experienced more relief than those who used only one care option, specifically those who leveraged text-based coaching in addition to therapy. 

While this study is retrospective and observational, it shows promise for how digital mental health can provide real-time support for people experiencing anxiety. While the study didn’t have access to data beyond app use, and there wasn’t a comparable control group, it sheds some light on the cadence of utilization that is more likely to lead to improvement. These tools are nascent, and in traditional medication, we see a reliable dose-response. This study brings us further in our understanding of the potential of what I call a use- response. The participants were working-age as they received access via their employer and the largest participant sample were aged 25-44 years old. More research needs to be conducted on younger and older populations to see if this trend in improvement holds across the life-span. The paper also shows the value of text-based coaching, and this may be delivered by trained coaches who are not necessarily therapists. Given the demand for services, this may allow a stepped care model to increase access to care options, which is good news.

Thanks for reading – Trina

(Opinions are my own)


Kunkle S, Yip M, Hunt J, Ξ W, Udall D,Arean P, Nierenberg A, Naslund JA Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study JMIR Form Res 2021;5(1):e24662 doi: 10.2196/24662PMID: 33496679

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