The Efficacy of a Mobile Application-Based Cognitive Behavioral Therapy (CBT) in Reducing Anxiety and Depression Symptoms Among Young Adults in the Post-COVID-19 Pandemic: A Randomized Controlled Trial
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Abstract
The COVID-19 pandemic has significantly increased anxiety and depression prevalence among young adults globally, with Indonesia experiencing substantial mental health challenges. Mobile application-based cognitive behavioral therapy (mCBT) interventions have emerged as promising solutions to address these widespread mental health issues. Objective: This randomized controlled trial aimed to evaluate the efficacy of a mobile CBT application in reducing anxiety and depression symptoms among Indonesian young adults in the post-COVID-19 pandemic period through comprehensive qualitative analysis. Methods: A mixed-methods randomized controlled trial was conducted with 25 young adults aged 18-25 years. Participants were randomly assigned to receive either the mCBT intervention or waitlist control. Qualitative data were collected through in-depth semi-structured interviews, focus group discussions, and thematic analysis following a phenomenological approach. Results: Thematic analysis revealed six major themes: Digital Therapeutic Alliance (89 mentions), Behavioral Change Process (92 mentions), Empowerment Through Technology (76 mentions), Resilience Building (67 mentions), Social Connection in Digital Space (54 mentions), and Challenges and Barriers (43 mentions). Participants demonstrated significant improvements in coping mechanisms, stress management, and emotional regulation through the mCBT intervention. Conclusions: Mobile CBT applications show promising efficacy in addressing post-pandemic anxiety and depression among Indonesian young adults. The intervention facilitated meaningful behavioral changes, enhanced self-efficacy, and provided accessible mental health support during challenging recovery periods
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References
J. N. Bress et al., “Efficacy of a Mobile App-Based Intervention for Young Adults With Anxiety Disorders,” JAMA Netw. Open, vol. 7, no. 8, p. e2428372, Aug. 2024, doi: 10.1001/jamanetworkopen.2024.28372.
N. K. Y. Anasuyari, M. Latifah, and L. N. Yuliati, “Adolescents’ mental health during the COVID-19 pandemic: Do loneliness, family, and online friends matter?,” Humanit. Indones. Psychol. J., pp. 53–68, Feb. 2023, doi: 10.26555/humanitas.v20i1.32.
A. Malla and R. Joober, “COVID-19 and the Future with Digital Mental Health: Need for Attention to Complexities,” Can. J. Psychiatry, vol. 66, no. 1, pp. 14–16, Jan. 2021, doi: 10.1177/0706743720957824.
L. W. Chau, R. W. Lam, H. Minas, K. Hayashi, V. C. Nguyen, and J. O’Neil, “Digital Health Interventions for Depression and Anxiety in Low- and Middle-Income Countries: Rapid Scoping Review,” JMIR Ment. Heal., vol. 12, p. e68296, Aug. 2025, doi: 10.2196/68296.
A. L. Rathbone, L. Clarry, and J. Prescott, “Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review,” J. Med. Internet Res., vol. 19, no. 11, p. e399, Nov. 2017, doi: 10.2196/jmir.8598.
A. Ahmed et al., “Thematic Analysis on User Reviews for Depression and Anxiety Chatbot Apps: Machine Learning Approach,” JMIR Form. Res., vol. 6, no. 3, p. e27654, Mar. 2022, doi: 10.2196/27654.
A. d’Arqom, M. Akram, N. S. Azzahranisa, M. Z. Nasution, E. R. Surjaningrum, and J. Yusof, “Societal Influence and Psychological Distress Among Indonesian Adults in Java on the Early Omicron Wave of COVID-19,” Futur. Sci. OA, vol. 9, no. 10, Dec. 2023, doi: 10.2144/fsoa-2023-0104.
E. L. Funnell et al., “Learnings from user feedback of a novel digital mental health assessment,” Front. Psychiatry, vol. 13, Oct. 2022, doi: 10.3389/fpsyt.2022.1018095.
E. Nugroho, A. A. Nisa, W. H. Cahyati, and N. Najib, “Perception, mental health, and social media exposure on adolescents in Indonesia during COVID-19 pandemic,” J. Pharm. Pharmacogn. Res., vol. 11, no. 3, pp. 426–436, May 2023, doi: 10.56499/jppres22.1560_11.3.426.
R. H. Ibrahim, M. H. Yaas, M. Q. Hamarash, S. H. Al-Mukhtar, M. F. Abdulghani, and O. Al Mushhadany, “Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes,” JMIR Pediatr. Parent., vol. 8, pp. e67137–e67137, Apr. 2025, doi: 10.2196/67137.
M. A. Marciniak et al., “Development of Powerly, unguided mobile app intervention preventing postpartum depression and anxiety & study protocol of randomized clinical trial,” Internet Interv., vol. 41, p. 100843, Sep. 2025, doi: 10.1016/j.invent.2025.100843.
S. B. Goldberg, S. U. Lam, O. Simonsson, J. Torous, and S. Sun, “Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials,” PLOS Digit. Heal., vol. 1, no. 1, p. e0000002, Jan. 2022, doi: 10.1371/journal.pdig.0000002.
R. Taher, D. Stahl, S. Shergill, and J. Yiend, “The Safety of Digital Mental Health Interventions: Findings and Recommendations From a Qualitative Study Exploring Users’ Experiences, Concerns, and Suggestions,” JMIR Hum. Factors, vol. 12, p. e62974, Feb. 2025, doi: 10.2196/62974.
C. Oliveira, A. Pereira, P. Vagos, C. Nóbrega, J. Gonçalves, and B. Afonso, “Effectiveness of Mobile App-Based Psychological Interventions for College Students: A Systematic Review of the Literature,” Front. Psychol., vol. 12, May 2021, doi: 10.3389/fpsyg.2021.647606.
C. Zhu, T. Zhang, Q. Li, X. Chen, and K. Wang, “Depression and Anxiety During the COVID-19 Pandemic: Epidemiology, Mechanism, and Treatment,” Neurosci. Bull., vol. 39, no. 4, pp. 675–684, Apr. 2023, doi: 10.1007/s12264-022-00970-2.
T. J. Philippe et al., “Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-review,” JMIR Ment. Heal., vol. 9, no. 5, p. e35159, May 2022, doi: 10.2196/35159.
J. Burkauskas, I. Branchi, S. Pallanti, and K. Domschke, “Anxiety in post-covid-19 syndrome – prevalence, mechanisms and treatment,” Neurosci. Appl., vol. 3, p. 103932, 2024, doi: 10.1016/j.nsa.2023.103932.
A. Lan et al., “Review of cognitive behavioural therapy mobile apps using a reference architecture embedded in the patient-provider relationship,” Biomed. Eng. Online, vol. 17, no. 1, p. 183, Dec. 2018, doi: 10.1186/s12938-018-0611-4.
C. Tudor-Sfetea et al., “Evaluation of Two Mobile Health Apps in the Context of Smoking Cessation: Qualitative Study of Cognitive Behavioral Therapy (CBT) Versus Non-CBT-Based Digital Solutions,” JMIR mHealth uHealth, vol. 6, no. 4, p. e98, Apr. 2018, doi: 10.2196/mhealth.9405.
T. Munteanu, L. Kannis-Dymand, P. Millear, and M. Jones, “Analysis of cognitive behavioural therapy apps for generalised anxiety disorder: Evidence-based content and user experience,” Cyberpsychology J. Psychosoc. Res. Cybersp., vol. 18, no. 4, Sep. 2024, doi: 10.5817/CP2024-4-6.
C. Chang, E. Palermo, S. Deswert, A. Brown, and H. J. Nuske, “Money can’t buy happiness: A randomized controlled trial of a digital mental health app with versus without financial incentives,” Digit. Heal., vol. 9, Jan. 2023, doi: 10.1177/20552076231170693.
E. R. Watkins et al., “Emotional competence self-help app versus cognitive behavioural self-help app versus self-monitoring app to prevent depression in young adults with elevated risk (ECoWeB PREVENT): an international, multicentre, parallel, open-label, randomised controlled,” Lancet Digit. Heal., vol. 6, no. 12, pp. e894–e903, Dec. 2024, doi: 10.1016/S2589-7500(24)00148-1.
S. Nagamitsu et al., “Usefulness of Interventions Using a Smartphone Cognitive Behavior Therapy Application for Children With Mental Health Disorders: Prospective, Single-Arm, Uncontrolled Clinical Trial,” JMIR Form. Res., vol. 9, pp. e60943–e60943, Jul. 2025, doi: 10.2196/60943.
S. Tan, M. A. Bin Ismail, T. I. M. Daud, R. Hod, and N. Ahmad, “A randomized controlled trial on the effect of smartphone-based mental health application among outpatients with depressive and anxiety symptoms: A pilot study in Malaysia,” Indian J. Psychiatry, vol. 65, no. 9, pp. 934–940, Sep. 2023, doi: 10.4103/indianjpsychiatry.indianjpsychiatry_240_23.
M. Naeem, W. Ozuem, K. Howell, and S. Ranfagni, “A Step-by-Step Process of Thematic Analysis to Develop a Conceptual Model in Qualitative Research,” Int. J. Qual. Methods, vol. 22, Oct. 2023, doi: 10.1177/16094069231205789