Generalized anxiety disorder: Do apps help people cope?

In the “ThemenCheck Medizin” procedure offered by the German Institute for Quality and Efficiency in Health Care (IQWiG), interested members of the public can submit proposals for the assessment of medical procedures and technologies. On behalf of IQWiG, an interdisciplinary team of researchers led by Gesundheit Österreich GmbH investigated the benefit of digital applications (e.g. apps) for the treatment of generalized anxiety disorder (GAD) in adolescents and adults.

To this end, the researchers analysed the results of a total of 20 studies that investigated the use of apps for GAD. Their conclusion: compared with no treatment, people with GAD can benefit from digital applications based on cognitive behavioural therapy, at least in the short term - there were indications of positive effects on symptoms, quality of life and activities of daily living.

However, the current studies do not allow any conclusions to be drawn about long-term or adverse effects. There are also no comparisons of apps with face-to-face psychotherapy. Likewise, there are no studies investigating the use of apps in adolescents aged 14 and over.

A question from a member of the public was the starting point for the ThemenCheck report

GAD is a common anxiety disorder. It is estimated that around five per cent of all people will be diagnosed with GAD at some point in their lives. Women are twice as likely to be affected as men. The onset of an anxiety disorder is usually in mid-adulthood, but can also occur in childhood or in old age. A characteristic feature of GAD is that people live in a constant, excessive state of anxiety: they are afraid not only of real dangers, but of practically everything. Many are also afraid of anxiety itself. They suffer from the fact that they are unable to control their anxiety and worries, which can markedly impair their ability to function in their professional and personal lives.

Psychotherapy, especially cognitive behavioural therapy, is usually recommended for the treatment of GAD. Relaxation techniques such as autogenic training or progressive muscle relaxation, medication or self-help groups can also help.

Digital apps may also help. These are often based on the principles of cognitive behavioural therapy and may provide texts and videos that people can work with and practise on their own. They may also include other features, such as an anxiety diary or automatic reminders, and may enable contact with a therapist.

The report is based on a proposal from a member of the public who pointed out that members of statutory health insurance funds in Germany are entitled to be provided with special apps, known as digital health applications (DiGA). He asked whether there was evidence that the use of apps could be beneficial in the treatment of anxiety disorders.

Against this background, the team of experts commissioned by IQWiG investigated whether adolescents aged 14 years and over and adults with GAD could expect to benefit from apps - for example, whether there was evidence that the use of an app led to fewer psychological and physical symptoms, a better ability to cope with everyday life or a higher quality of life.

Indications of positive effects, but some questions remain unanswered

The authors of the report identified a total of 20 suitable studies investigating the use of apps for GAD. Two of these studies examined apps listed in the German DiGA directory. In 14 of the studies analysed, apps whose content is based on cognitive behavioural therapy were compared with no treatment or a waiting list. The conclusions of these studies: there are indications of a benefit of apps in terms of

• symptoms of the disease (data from 14 studies),
• quality of life (data from 6 studies) and
• activities of daily living (data from 5 studies).

However, the authors of the report state that overall, these results should be interpreted with caution, because, for example, methodological standards were not always fully adhered to when the studies were conducted. They were also unable to rule out a risk of bias due to unpublished study results.

In addition, as with the studies of face-to-face psychological interventions, other important questions were not answered in the studies analysed: for example, adverse events were often not recorded or not recorded systematically. This means that it is unclear what potential harms are associated with the use of apps for GAD. Furthermore, the studies usually only lasted two or three months. Therefore, it is not possible to say whether people with GAD benefit from using apps in the long term, beyond the intervention period. There were also no studies that looked at the use of apps in adolescents aged 14 and older.

Whether apps are better or worse than face-to-face cognitive behavioural therapy cannot be determined from the studies analysed. This would require studies that directly compare these interventions with each other. However, no such studies are currently available.

The “ThemenCheck Medizin” procedure

In a two-stage selection process, which also involves members of the public, up to five new topics are selected each year from all the proposals submitted. According to the legal mandate, these should be topics of particular importance for patient care. The ThemenCheck reports are not written by IQWiG itself, but by external experts. Their assessment is published together with an easy-to-understand summary and a publisher’s comment by IQWiG.

The Institute published the preliminary results of the report "Generalized anxiety disorder: Do apps help people cope with their condition?" in November 2023 as a preliminary ThemenCheck report and invited comments. After the end of the commenting procedure, the report was revised and published in its final version in September 2024. An English translation was published in June 2025.