MRI brain scans help identify effective use of self-guided anxiety app

By understanding differences in how people's brains are wired, clinicians may be able to predict who would benefit from a self-guided anxiety care app, according to a new analysis from a clinical trial led by Weill Cornell Medicine and NewYork-Presbyterian investigators. The preliminary study suggested that young people with weaker connections between two brain areas involved in both attending to and regulating responses to anxiety were more likely to benefit from a self-guided anxiety care app than those with stronger connections.

The study, published July 31 in JAMA Network Open, looked at data from a subset of clinical trial participants who agreed to undergo a brain MRI before using the anxiety care app developed by the investigators. The app, called Maya, is essentially a course in cognitive behavioral therapy, a gold standard psychotherapeutic intervention that provides users with skills to support them in shifting their thinking, completing challenging behaviors and learning new ways to cope. The interactive platform guides young adults with anxiety through videos, exercises and educational content.

Initial results of the clinical trial with 59 participants showed that using the app reduced anxiety symptoms for many patients; now the new analysis may help identify which patients benefit most.

People with weaker connections in key brain networks involved in anxiety and regulating emotions were more likely to see improved anxiety symptoms with the use of the app. That makes sense because cognitive behavioral therapy helps teach people how to regulate their responses to emotions."

Dr. Faith Gunning, senior author, associate professor of psychology and vice chair for research in the Department of Psychiatry at Weill Cornell Medicine

An app to help with anxiety

Dr. Gunning and her colleagues developed the Maya app to help fill critical gaps in access to care for young adults with anxiety. Young adults between the ages of 18 and 25 are at a stage in life where they are experiencing many life changes, and studies have shown they are at fairly high risk for anxiety disorders. During this time, they may also have gaps in health care coverage or may have difficulties accessing or affording in-person mental health care. Some may also be hesitant to seek in-person care because of stigma surrounding mental health or because of their anxiety symptoms.

For the clinical trial, 59 young adults with anxiety used the app twice a week for six weeks. Investigators tracked participants' symptoms during that time and for an additional six weeks. Those who used the app experienced reduced anxiety symptoms throughout the 12-week monitoring period. Some continued to use the app after the initial 6-week trial period, and others experienced lasting improvements in symptoms even after discontinuing use of the app after 6 weeks.

A deeper look into the results

The investigators were able to use data from 30 participants who had MRIs before using the Maya app to determine if specific patterns of brain activity indicated individuals who were more likely to experience symptom improvements.

The results suggest that young adults experiencing anxiety whose brains were less efficient at regulating their responses to anxiety-provoking information benefited more from learning cognitive behavioral therapy techniques through the app. In contrast, those with stronger connections in circuits involved with greater attention to potentially threatening or anxiety provoking information were less likely to benefit from using the app.

"App-based interventions like Maya are poised to address a critical barrier to care for people with anxiety, but like any mental health treatment, some people will benefit more than others," said first author Dr. Abhishek Jaywant, assistant professor of neuropsychology in the Department of Psychiatry at Weill Cornell Medicine and a psychologist at NewYork-Presbyterian/Weill Cornell Medical Center. "Our study is among the first to suggest that patterns of brain function are relevant in helping researchers and clinicians understand response to app-based treatments for anxiety. These findings could one day help us to recommend an app like Maya to patients most likely to benefit."

"Our study will help us better tailor treatments to patients in the future," said Dr. Gunning, who is also a psychologist at NewYork-Presbyterian/Weill Cornell Medical Center. "Anxiety symptoms can be very disabling to young adults at an important life stage, so matching them with an effective therapy as soon as possible is important."