Worry Knot is part of the Intellicare Suite* of mental health apps. Worry Knot is designed to help users identify and manage daily worries and anxieties.The main page of the Worry Knot app encourages users to “Learn”, “Practice”, and “Review” skills related to managing excessive worry. The “Learn” section includes lessons on the causes of excessive worrying, and challenges the user to explore the CBT principle of “tangled thinking” and how it applies to the worries they experience. The “Practice” section invites users to describe worrying situations in a neutral, nonjudgmental way. The “Review” section provides users with options to log and identify the strategies and practices that were most effective in helping manage excessive worry and anxiety.
*Stephen Schueller, the Executive Director of PsyberGuide and David Mohr, a PsyberGuide Scientific Advisory Board Member, were both involved with the development of IntelliCare. Dr. Schueller has no commercial interest in IntelliCare, nor Actualize Therapy. Dr. Mohr has an ownership interest in Actualize Therapy.
Available for: Requires iOS 11.0 or later. Compatible with iPhone, iPad, and iPod touch. Requires Android 5.0 and up
Developer: Adaptive Health, Inc
Type of Treatment: Cognitive Behavioral Principles, Symptom Tracking/Self-Monitoring, Psychoeducation & Information
Targeted Conditions: Stress and Anxiety
Target Audience: Not Specified
Designed to be used in conjunction with a professional? No
Languages Available: English
Get it on: Apple App Store, Google Play
Worry Knot is part of the IntelliCare Suite of apps.
In one study, 301 participants with depression or anxiety were randomized into 1 of 4 treatments that lasted 8 weeks and were followed for 6 months post-treatment. Treatment groups included coached treatment with weekly app recommendations, coached treatment with no weekly app recommendations, self-guided treatment with weekly app recommendations, and self-guided treatment with no weekly app recommendations. No control group was included due to the fact that apps could easily be accessed by the public, and therefore was not a controllable platform. All participants completed the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7) at baseline, week 4, week 8 (end of treatment), 3- and 6- months post-treatment. Three metrics were used to measure engagement – time since last usage of app, number of app sessions, and number of IntelliCare apps downloaded. Participants showed significant reductions in the PHQ-9 and GAD-7 regardless of treatment group. Participants who received weekly recommendations had a significantly higher number of app usage sessions during treatment. Participants who were coached had more app downloads. Participants who were coached had larger reductions in GAD-7 than those in the self-guided treatment (P=.03) but no significant effects were found in PHQ-9 (P=.06). (Mohr, D. C., Schueller, S. M., Tomasino, K. N., Kaiser, S. M., Alam, N., Karr, C., … & Lattie, E. G. 2019. https://www.jmir.org/2019/8/e13609/)
In another study, 146 participants were randomized to either 8 weeks of a coach-supported platform through the IntelliCare suite or to a waitlist control group, who received treatment as usual for 8 weeks then the mobile app. All participants completed the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7) online every 4 weeks for 16 weeks. Participants were on average 42.3 years old and 81.5% female. 83.6% of participants were diagnosed with having depression and 89.7% of participants were diagnosed with having anxiety. 59% in the intervention group achieved significant reduction in depression symptoms versus 31% in the control group. A similar pattern was found when it came to anxiety where 57% in the intervention group achieved significant reduction in anxiety symptoms versus 38% in the control group. During a follow-up assessment, these effects seemed to sustain for depression scores and for anxiety scores. Participants were able to be compensated up to $100 USD for completing the assessments. (Graham AK, Greene CJ, Kwasny MJ, et al. 2020. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2766444)
In this study, 99 participants with elevated symptoms of anxiety or depression were recruited through a health-care system, Web-based advertising, community advertising, and clinical research registries. There was no control group. Participants were given full access to the 14 IntelliCare Suite apps through Google Play and additionally received 8 weeks of coaching. Coaching included participants receiving an initial phone call, 2 or more texts per week over the 8 weeks, and possibly another brief phone call. All participants completed the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder scale (GAD-7) and took these assessments at baseline, week 4, and week 8. Over the course of the study, participants used the app, on average, 195.4 times (SD 141). The average length of usage for these apps was 1.1 minutes. Participants seemed to show significant improvements for both PHQ-9 and GAD-7 (P<0.001). By the end of the treatment period, 37% of participants were able to meet criteria for full remission or no symptoms of depression (PHQ-9<5), 40% and 42% of participants were able to meet criteria for full remission or no symptoms of anxiety (GAD-7<5). Participants were compensated up to $90 USD for completing the assessments; compensation was not related to app usage or how engaged they were with the treatment. (Mohr, D. C., Tomasino, K. N., Lattie, E. G., Palac, H. L., Kwasny, M. J., Weingardt, K., … & Caccamo, L. 2017. https://www.jmir.org/2017/1/e10/)
In this pilot study, 40 participants with breast cancer who were actively receiving treatment for cancer were recruited through a US National Cancer Institute-designated clinical cancer center. Participants took part in a within-subject (took part in all treatments) study design for 7 weeks. All participants were given access to the IntelliCare suite apps with coaching. Participants received a text message every week to try two new exercise modules in the app. All participants completed the Patient Health Questionnaire-4 (PHQ-4) to self-report distress and Patient-Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales to report mood symptoms and were given these assessments at baseline and post-intervention. During post-intervention, app usability was also assessed. On average, participants were 56.8 years old, mostly White (82%), and diagnosed with stage 2 cancer (39%). The median number of times the IntelliCare app was launched was 97, which is around 2 times a day over the 7-week trial. Significant reductions were found on the PROMIS scores in symptoms of depression after the intervention period. There was a reduction in anxiety symptoms, but significance was not reached. Participants reported significant reductions in the PHQ-4 over the intervention period. 22% of participants reported at least a moderate level of distress at baseline, whereas only 8% of participants reported at least a moderate level of distress post-intervention. Participants were able to be compensated with a $50 USD gift card for providing feedback. (Chow, P. I., Showalter, S. L., Gerber, M. S., Kennedy, E., Brenin, D. R., Schroen, A. T., … & Cohn, W. F. 2019. https://www.researchprotocols.org/2019/1/e11452/)
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