Comparative effectiveness of remote digital gamified and group CBT skills training interventions for anxiety and depression among college students: Results of a three-arm randomised controlled trial

Digital interventions can enhance access to healthcare in under-resourced settings. However, guided digital interventions may be costly for low- and middle-income countries, despite their effectiveness. In this randomised control trial , we evaluated the effectiveness of two digital interventions designed to address this issue: (1) a Cognitive Behavioral Therapy Skills Training (CST) intervention that increased scalability by using remote online group administration; and (2) the SuperBetter gamified self-guided CBT skills training app, which uses other participants rather than paid staff as guides. The study was implemented among anxious and/or depressed South African undergraduates (n = 371) randomised with equal allocation to Remote Group CST, SuperBetter, or a MoodFlow mood monitoring control. Symptoms were assessed with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Intention-to-treat analysis found effect sizes at the high end of prior digital intervention trials, including significantly higher adjusted risk differences ( ARD ; primary outcome) in joint anxiety/depression remission at 3-months and 6-months for Remote Group CST ( ARD = 23.3–18.9%, p = 0.001–0.035) and SuperBetter ( ARD = 12.7–22.2%, p = 0.047–0.006) than MoodFlow and mean combined PHQ-9/GAD-7 scores (secondary outcome) significantly lower for Remote Group CST and SuperBetter than MoodFlow. These results illustrate how innovative delivery methods can increase the scalability of standard one-on-one guided digital interventions. 47,089,643. • The joint remission rate at 3 and 6 months were 29.6% and 33.8% in the entire sample. • SuperBetter and Remote Group CST had higher remission rates than MoodFlow. • The remission rate was nonsignificantly higher for Remote Group CST than SuperBetter. • SuperBetter and Remote Group CST had lower 6-month PHQ-ADS scores than MoodFlow. • Additional research is required to ascertain the feasibility of developing an ITR.