A smartphone-based digital health intervention found that current anxiety symptoms predicted both current and later symptoms of depression.

In a 12-week therapist-smartphone-assisted digital health intervention for symptoms of anxiety and depression, researchers found that the symptoms of the two conditions overlapped and fluctuated together.

The intervention also demonstrated that anxiety symptoms predicted later depressive symptoms compared to depressive symptoms predicting anxiety symptoms.

These findings were published in Journal of Clinical Psychology.

The study included 290 participants, mostly female (79%), with a mean (SD) age of 39.64 (10.25) years. The authors of the study noted that more than half (54%) of patients reported using psychotropic drugs. In addition, all patients scored at least 5 on either the Patient Health Questionnaire (PHQ-9) or the General Anxiety Questionnaire (GAD-7).

The smartphone-based intervention included a pre-defined sequence of evidence-based modules integrating components of mindfulness-based stress reduction and cognitive therapy, cognitive behavioral therapy, and heart rate variability biofeedback (HRVB) training.

The authors used linear mixed models to analyze both parallel and lead-lag relationships between anxiety and depression.

In the first hypothesis, the authors predicted that an increase in anxiety would be associated with an increase in depression during the current week. In the second hypothesis, they also predicted that an increase in anxiety in the previous week would be followed by an increase in depression in the current week.

In support of the first prediction, the authors found that higher levels of anxiety during the current two-week assessment were associated with more severe depressive symptoms during the current two-week assessment.

In support of the second hypothesis, higher levels of anxiety during the previous biweekly assessment were associated with an increase in depressive symptoms during the current biweekly assessment.

“Our results, limited by the absence of a comparison group, are consistent with day-to-day data on anxiety symptoms at the time. t-1 were a stronger predictor of depressive symptoms at the time t than depressive symptoms during t-1 prediction of anxiety level over time t“, the authors said.

The authors also noted that these results are “far from conclusive, but raise a number of questions,” adding that it would be useful in future studies to analyze the effects of anxiety mediators and moderators on subsequent depressive symptoms and certain emotional effects of anxiety reduction.

“Third, it would be important to examine specific GAD-7 items that predict a subsequent reduction in depression, such as nervousness and nervousness, anxiety about a series of events, difficulty controlling anxiety, difficulty relaxing, irritability, and fear of a negative event occurring. in the future,” they added.

In addition, due to the relationship between anxiety and depression, changing weekly treatment approaches based on changes in levels of anxiety and depression may benefit patients more than the structured approach used in this particular intervention.

“For example, if a patient’s anxiety is higher than depression in a particular week, the patient may benefit from psychoeducation about the cyclic nature of anxiety and depression, as well as from working with the clinician to develop skills to mitigate a possible impending deterioration in mood. the authors suggested.


Allende S., Foreman-Hoffman V.L., Goldin P.R. Exploring the temporal dynamics of anxiety and depressive symptoms during therapist-assisted smartphone-assisted depression treatment: a longitudinal observational study. Jay Clean Psychol. Published online June 10, 2022 doi:10.1002/jclp.23401

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