Comparative effectiveness and user-rated helpfulness of digital just-in-time adaptive interventions for psychological distress

Digital just-in-time adaptive interventions (JITAIs), or interventions that can be offered in a context when support is needed most, represent a promising development for improving scalable, personalized interventions. However, the comparative efficacy of specific JITAIs has yet to be examined. The present study examines engagement with and usefulness of JITAIs provided through a mental health application, Youper. This study uses data from Youper users (N = 8323) collected between July and October of 2020. Users were randomized to one of nine cognitive or behavioral interventions, although the present study examined interactions with only six cognitive interventions (e.g., gratitude, mindfulness, cognitive restructuring). If users engaged with the intervention, they subsequently rated its helpfulness. Engagement was examined with logistic regression and user-rated helpfulness of JITAIs was explored through a multi-level model. A secondary analysis examined whether pre-intervention emotions moderated the results. Compared to acceptance-based interventions, users had significantly greater odds of engaging with cognitive restructuring, problem-solving, self-compassion, and gratitude interventions (all ps < 0.001), but significantly lower odds of engaging with mindfulness-based interventions (p < .001). Cognitive restructuring, gratitude, mindfulness, and problem-solving were rated as more helpful than acceptance (all ps < 0.001). There was a non-significant difference between perceived helpfulness of self-compassion and acceptance (p > .05). Pre-intervention emotions did not moderate effects (p > .05). These results suggest that JITAIs, which can be implemented at the moment when users most need support, are helpful emotion regulation tools.