The common wisdom from psychiatry is that severe anxiety is a medical disorder that requires intensive treatment, usually including a combination of antidepressants and therapy.
But a new study contradicts that wisdom, demonstrating that minimal online interventions delivered via phone app led to full remission of anxiety in the majority of participants.
The study was a clinical trial of an app that delivered digital CBT (DCBT) at a patient-led pace. The app was compared to a control group of “digital psychoeducation”—online information about anxiety.
All participants began with severe generalized anxiety disorder (GAD). Both groups did extremely well, with remission in more than 52% of those who received psychoeducation and 77.7% of those who received DCBT, at 24 weeks.
In total, 351 participants were randomly assigned to receive either psychoeducation or DCBT. About three-quarters were women, and about three-quarters were white. Participants were excluded if they were already receiving therapy for anxiety. About a quarter in both groups were taking medications for anxiety already—which means that about three-quarters of the participants received the digital intervention as their only form of treatment.
The study was led by E. Marie Parsons at Boston University and published in JAMA Network Open.
The main finding of the study was that DCBT was superior to the control group. Indeed, a remission rate of more than three-quarters, all who had severe anxiety at baseline, is a powerful outcome. But equally striking is that the psychoeducation group also did very well. It seems that just receiving information about anxiety led to remission in more than half of those participants, too.
One interesting point is that at 10 weeks, the DCBT group had already received the effect, with a 71% remission rate. However, the control group had a remission rate of 34.6% at this time point. This could indicate that the additional participants may have experienced their anxiety improving over time even without any intervention.
Strangely, medication seemed to increase the likelihood of remission in the DCBT group while reducing the likelihood of remission in the psychoeducation group. The researchers don’t address whether this could be due to a “nocebo” effect where those who took the medication believed they needed more intensive treatment.
The study had few dropouts, and the blinding was maintained for almost all participants. Questions remain about whether the participants reflect the general population in terms of gender, race, comorbidities, and more.
The researchers conclude that “the consistent evidence for the efficacy of this smartphone-accessible DCBT suggests it is a scalable, first-line treatment option for adults with GAD.” Yet their data also demonstrates that even less intensive approaches, like psychoeducation, were effective for more than half of the participants, and that medications may not be needed to treat even severe anxiety.
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Parsons, E. M., Ball, T., Carl, J., Henry, A. L., Emsley, R., Miller, C. B., . . . & Otto, M. W. (2025). Digital cognitive behavioral treatment for generalized anxiety disorder: A randomized clinical trial. JAMA Network Open 8(12), e2548884. doi:10.1001/jamanetworkopen.2025.48884 (Full text)