The feasibility study of Brief Cognitive Behavioral Therapy based on mobile apps in overcoming anxiety in young adults’ Balinese rural area: Mixed methods study

Abstract

Background: During the COVID-19 pandemic in 2022, a preliminary investigation revealed an increase in untreated anxiety symptoms among young people living in rural Bali. The isolation, economic uncertainty, and other stressors exacerbated mental health issues, particularly anxiety, making it imperative to develop accessible interventions. Brief-Cognitive Behavioral Therapy (B-CBT) is widely recognized as an effective treatment for anxiety disorders, yet its accessibility remains limited in rural areas, where mental health resources are scarce. Purpose: This study aimed to develop and evaluate the feasibility of a mobile-based intervention, Mobile Brief-Cognitive Behavioral Therapy (MB-CBT), designed to help young adults in rural Bali manage and reduce anxiety symptoms. The objective was to assess the usability, effectiveness, and community acceptance of the MB-CBT prototype. Method: A mixed-methods approach was employed to test the feasibility and usability of the MB-CBT prototype. Quantitative assessments included the System Usability Scale (SUS) and pre- and post-intervention measures of anxiety and stress using the Generalized Anxiety Disorder Scale (GAD-7) and the Perceived Stress Scale (PSS). Content validation was performed through semi-structured interviews with participants to assess the relevance and clarity of the app’s content. Findings: The MB-CBT intervention significantly reduced anxiety (p≤0.002) and perceived stress (p≤0.000) among participants. The System Usability Scale (SUS) score was 74.5, indicating good usability and high community acceptance. Content validation through interviews indicated that participants found the app’s content highly relevant and user-friendly, with a very good level of content validity. Implication: The findings suggest that MB-CBT is an effective and feasible tool for addressing anxiety and stress in young adults in rural Bali. The high usability score and positive content validation support the potential for expanding such digital mental health interventions to other underserved rural areas. Healthcare providers should consider integrating mobile-based CBT into mental health programs for young adults in rural settings to address the increasing need for accessible mental health resources.