Burst versus continuous delivery design in digital mental health interventions: evidence from a randomized clinical trial.

Abstract

Objective: Digital mental health interventions delivered via smartphone-based apps effectively treat various conditions, but optimizing their efficacy while minimizing participant burden remains a key challenge. Here, we investigated the potential benefits of a burst delivery design, i.e., intervention delivered only in pre-defined time intervals, in comparison to the continuous delivery of the intervention.Methods: We randomly assigned ninety-three participants to continuous delivery (CD) or burst delivery (BD) groups. The CD engaged in ReApp, a mobile app that increases positive cognitive reappraisal with a consistent delivery schedule with five prompts per day throughout the three-week-long study, while BD received five daily prompts only in the first and third weeks of the study.Results: No significant differences were found between the groups in adherence, mental health outcomes, specifically depressive and anxiety symptoms, and the level of perceived stress, and perceived helpfulness of the intervention. BD group significantly decreased in perceived difficulty of the intervention over time.Conclusions: These results suggest that the burst delivery may be as suitable for digital mental health interventions as the continuous delivery. The perceived difficulty of the intervention declined more steeply for the BD group, indicating that it has improved the feasibility of the positive cognitive reappraisal intervention, without hurting its efficacy. This outcome may inform the design of less burdensome interventions with improved outcomes in future research.

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