Evaluation of a CBT‐Based Program for Mental Health in the General Population During the COVID‐19 Pandemic: A Stepped‐Care Approach Using a Chatbot and Digitized Group Intervention

Abstract

Background: The COVID‐19 pandemic exposed a substantial portion of society to multiple stressors, while access to mental health care was limited. To address this, we introduced a digital stepped‐care program rooted in cognitive–behavioral therapy (CBT) principles, aiming to alleviate mental health distress among the general public seeking help. Methods: The program comprises a 4‐week digital application using “Aury” the chatbot, followed by an optional 6‐week online group session for those still symptomatic. A 4‐week waiting period separated these steps. Participants entered based on self‐identified mental health concerns. Interventions addressed prevalent pandemic mental health issues: sleep disturbances, anxiety, depression, worry/rumination, interpersonal issues, and resource mobilization. Outcomes focused on depressive, anxiety, and somatic symptoms, assessed by the Patient Health Questionnaire (PHQ). Results: Of the 1261 initial participants, postchatbot results (N = 142) indicated small to medium effects (d = 0.412 to d = 0.523). Those finishing the entire program (N = 41) saw substantial symptom decline with medium to large effects (d = 0.757 to d = 0.818). No shifts were seen in the waiting phase. At follow‐up 6 months after baseline, both groups—those who only used the chatbot (N = 60; d = 0.284 to d = 0.416) and those who completed the entire program (N = 27; d = 0.854 to d = 0.926)—showed sustained symptom reduction. Comparing groups that received no intervention, used the chatbot only, and completed the entire program, we observed a dose–response effect. Conclusions: This resource‐efficient and adaptable digital approach effectively reduced pandemic‐induced mental health issues, indicating its potential in crisis periods with limited health resources. Randomized controlled trials are recommended for further validation. Trial Registration: Clinical Trial Registry identifier: DRKS00023220 .

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