A Mobile App-Based Gratitude Intervention's Effect on Mental Well-Being in University Students: Randomized Controlled Trial.

Background: Gratitude interventions are used to cultivate a sense of gratitude for life and others. There have been mixed results of the efficacy of gratitude interventions' effect on psychological well-being with a variety of populations and methodologies.

Objectives: The objective of our study was to test the effectiveness of a gratitude intervention smartphone app on university students' psychological well-being.

Methods: We used a randomized experimental design to test our objective. Participants were recruited undergraduate students from a web-based university study recruitment system. Participants completed 90 web-based survey questions on their emotional well-being and personality traits at the beginning and end of the 3-week research period. Their depression, anxiety, and stress levels were measured with the Depression, Anxiety, and Stress Scale (DASS-21). After the baseline survey, participants were randomly assigned to either the control or the intervention. Participants in the intervention group used both a fully automated mobile sensing app and a gratitude intervention mobile iOS smartphone app designed for youth users and based on previous gratitude interventions and exercises. The gratitude intervention app prompted users to complete daily gratitude exercises on the app including a gratitude journal, a gratitude photo book, an imagine exercise, a speech exercise, and meditation. Participants in the control group used only the mobile sensing app, which passively collected smartphone sensory data on mobility, screen time, sleep, and social interactions.

Results: A total of 120 participants met the inclusion criteria, and 27 were lost to follow-up for a total of 41 participants in the intervention group and 52 in the control group providing complete data. Based on clinical cutoffs from the baseline assessment, 56 out of 120 participants were identified as being in a subsample with at least moderate baseline symptomatology. Participants in the subsample with at least moderate baseline symptomatology reported significantly lower symptoms of depression, anxiety, and stress postintervention (Cohen d=-0.68; P=.04) but not in the full sample with low baseline symptomatology (Cohen d=0.16; P=.46). The number of times the app was accessed was not correlated with changes in either the subsample (r=0.01; P=.98) or the full sample (r=-0.04; P=.79).

Conclusions: University students experiencing moderate to severe distress can benefit from a gratitude intervention smartphone app to improve symptoms of depression, anxiety, and stress. The number of times the gratitude intervention app was used is not related to well-being outcomes. Clinicians could look at incorporating gratitude apps with other mental health treatments or for those waitlisted as a cost-effective and minimally guided option for university students experiencing psychological distress.