Unwinding Anxiety Review

In this pilot study, 34 participants who worked as physicians in a large US healthcare network and reported having anxiety participated in a nonrandomized app-based mindfulness intervention. All participants completed the Generalized Anxiety Disorder-7 (GAD-7) to measure their anxiety levels and Maslach Burnout Inventory to measure burnout. Participants took these questionnaires three times – at baseline, at a 1 month post-treatment, and at a 3 months follow-up. After participants completed the intervention, their GAD-7 scores were seen to decrease significantly at 1 month post-treatment (48% reduction, P<.001) and at 3 months follow-up (57% reduction, P<.001). Similarly, participants’ scores in cynicism also decreased significantly when it came to cynicism (50% reduction, P=.003 at 1 month post-treatment; 50% reduction, P=.009 at the 3 months follow-up) and emotional exhaustion at both time points (20% reduction, P<.001 at 1 month post-treatment; 20% reduction, P=.003 at the 3 months follow-up). The pilot study showed initial support that this intervention may be useful in decreasing anxiety levels for physicians.

Citation: Roy, A., Druker, S., Hoge, E.A., & Brewer, J.A. (2020). https://mhealth.jmir.org/2020/4/e15608/

A randomized controlled trial was conducted to test the efficacy and mechanism of the Unwinding Anxiety app, which was designed to target a potential mechanism of anxiety (reinforcement learning). Individuals were recruited for the study through Facebook advertisements. Sixty-five participants were randomized to receive either: 1) treatment as usual (n = 33), or 2) treatment as usual + Unwinding Anxiety app (n = 32). In the second group, participants were asked to complete 30 modules in the Unwinding Anxiety app over a 2-month period. Associated changes in outcomes were evaluated using self-report questionnaires 1 and 2 months after treatment initiation. Results showed that the Unwinding Anxiety app group demonstrated a significant reduction in anxiety (Generalized Anxiety Disorder-7; GAD-7) compared with the control group at 2 months (67% vs 14%; median change in GAD-7: –8.5 [IQR 6.5] vs –1.0 [IQR 5.0]; P<.001; 95% CI 6-10). Additionally, increases in mindfulness at 1 month (nonreactivity subscale) mediated reductions in worry at 2 months (Penn State Worry Questionnaire (p=.02) and decreases in worry at 1 month mediated reductions in anxiety at 2 months (p=.03). These results support the clinical efficacy of the Unwinding Anxiety app for individuals with anxiety (Roy et al., 2021).

A nonrandomized pilot study by Roy, Druker, Hoge, & Brewer (2020) assessed whether the Unwinding Anxiety app could reduce anxiety in physicians and to explore if anxiety and burnout were correlated (i.e., if the app led to a reduction in both anxiety and burnout). Participants included 34 physicians who worked in a large US health care network and reported having anxiety. The main outcome measure was anxiety (measured by the Generalized Anxiety Disorder-7 (GAD-7), and the secondary outcome measures assessed burnout (cynicism and emotional exhaustion items from the Maslach Burnout Inventory). Results showed that GAD-7 scores decreased significantly at posttreatment by 48% (p < .001). There was also a significant correlation between anxiety and burnout, as well as a significant decrease in cynicism at posttreatment and emotional exhaustion at both time points. (Roy, Druker, Hoge, & Brewer (2020); https://mhealth.jmir.org/2020/4/e15608/PDF).