(PS2-B44) Domains of Impairment in GAD: Improvements in Patient Generated Concerns After Digital CBT

Background: Generalized anxiety disorder (GAD) affects about 4% of the population in the United States and significantly impairs functioning especially in work, social, and family life domains. Daylight is a smartphone-based digital therapeutic designed to deliver CBT techniques and has been shown to improve GAD symptoms and impairment. The present study aimed to identify 1) which participant-generated life domains were reported to be most affected by anxiety and 2) which domain(s) were most improved using Daylight.

Methods: A randomized controlled trial evaluated the effectiveness of Daylight compared to a waitlist control in 256 adult participants with GAD. Participants completed the Patient-Generated Index (PGI) at baseline and 10 weeks after randomization. The PGI asked participants to identify the three most important areas of their lives affected by GAD in a free-response text box, and then score the degree to which each area is affected (0 = worst they could imagine to 100 = exactly as they would like it to be). Participant-generated concerns were coded by theme into the following life domains: work, social, family, and health. Life domains were categorized based on prior research establishing these areas as most commonly affected by GAD. Analyses were then restricted to the highest ranking concern for each participant. Participants with missing PGI data at week 10 (n = 39) or who had highest ranking concerns that fit multiple domains (n=3) were excluded from analysis, leaving a final sample of 214 participants. T-tests examined group differences in domain improvement for domains reported by greater than 10% of the final sample.

Results: The final sample (N = 214, age M = 30.6, SD = 10.5) was mostly female (71.0%), predominately white (84.1%), highly educated (59.8% with at least a bachelor’s degree, 84.6% having attended college), and at least part-time employed (66.8%; 52.3% full-time). Descriptive statistics showed that most commonly reported domains of concern were work (34.6%), social (35.0%), and family (17.8%) with fewer reporting physical health (7.0%) or other concerns (6.0%). No significant differences were found by age, gender, education, or employment status. Within the Daylight group, participants reported significant decreases in impairment in work (M = 14.6, t = 3.11, p = .003), social (M = 28.2, t = 4.96, p < .001), and family (M = 15.0, t = 2.82, p = .014) domains. Compared to the waitlist control group, the Daylight group showed significantly greater improvements in social functioning (t = 3.83, p < .001).

Conclusion: Work, social, and family domains of functioning were the most impaired by GAD. Of these domains, social concerns may be the most amenable to digital CBT treatment. Future research should explore how to best address work and family domains of functioning for adults with GAD.