Impact of a Mobile Application (Pacifica) on Stress, Anxiety, and Depression

Over 61 million adults in the U.S. experience mental illness in a given year, and only 1 in 3
will receive professional care due to difficulties with access to care, stigma, cost, or time
involved in seeking treatment. Pacifica Labs, Inc., produces a Mobile Application ("app")
which integrates existing best practices in treatment for stress, anxiety, and depression.
One major goal of the app is to empower individuals to effectively self-manage their anxiety
and depression. Pacifica has been used in a pilot research study, amongst a group of
nonclinical college student volunteers. It was found to have a preventative effect on stress
levels (as measured by the DASS-21). The current study is designed to consider a broader
population of potential users.

Study Product Pacifica is a mobile app designed to teach users strategies to manage their
stress, anxiety, and depression. Users can choose which tools they want to use. The
strategies are digital implementations of existing practices in psychology such as thought
records, mindfulness meditation & relaxation exercises, and behavioral activation. Pacifica
includes optional "guided paths" of daily psychoeducation and and activities, which users can
follow if they like. The app also includes features like mood and health tracking to help
individuals notice patterns in their moods and make adjustments to their activities to manage
their emotions more effectively. Additionally, there is a "hope board" which serves as a
place for users to put inspirational quotes, reassuring photos, or save their completed
activities to be reminded of their successes in using the app. Finally, the app offers a peer
support community, which is a discussion board for users to connect with others going through
similar experiences or who share interests.

The interventions based on Cognitive-Behavioral Therapy (CBT) include the "Thoughts" tool,
which educates users about the effect of thinking errors or "cognitive distortions" on
emotions and then prompts users to complete a text-based thought record, identify any
cognitive distortions, and then challenge those thoughts (via positive reframe). The "Goals"
tool is also based on CBT and allows users to create a list of goals to face their fears (in
the case of anxiety) or re-engage with life (for those struggling with depression). The tool
helps users to track their tasks and progress.

The interventions based on Mindfulness include "Meditations" which provides a suite of
activities for users to learn mindfulness, practice deep breathing or body scans, guided
relaxation activities, or simply listen to soothing sounds.

Pacifica also offers health-behavior tracking which allows users to monitor activities of
their choice such as caffeine consumption, exercise, time spent with loved ones, etc. Users
can also track their mood state "How are you feeling?" (scale of 1 = awful to 7 = great).
Additionally, users can create and track custom health activities and associate words with
their mood from pre-set options such as "stressed" or "happy" or can specify their own words
using a hashtag such as "#engaged".

Users are able to see a visual display of their within-app self-monitoring data through the
"Progress" function of the app.

The commercially available Pacifica app also allows users to connect to their health care
providers through the "My Therapist" tab. This feature will be disabled for the present
research study.

Participants in the study will be allowed to use whichever tools they want, in the same way
that regular app users can. There is no minimum or maximum "dose" specified.

Inclusion Criteria:

- Target disease: participants who score between 5 and 14 on the GAD-7 OR between 5 and
14 on the PHQ-8 and are therefore believed to be experience mild to moderate
depression or anxiety

- No previous experience using the Pacifica app.

- Regular access to a smartphone

- Fluent in English

- Living in U.S.

Exclusion Criteria:

- Below 5 or over 14 on GAD-7 or below 5 or over 14 on PHQ-8

- Positive response on screener of presence of diagnosis of bipolar disorder,
schizophrenia, other psychotic spectrum disorder, organic brain disease, currently
pregnant