Effectiveness of a Personalized Video-Based Mobile App in Community-Dwelling Individuals with Severe Mental Illness and the Added Value of Early Minimal Coaching: A Randomized Clinical Trial (Preprint)

BACKGROUND Severe mental illness (SMI) often limits participation in traditional therapy due to motivational and cognitive deficits. These barriers may be overcome by digital mental health tools; however, there remains scarce clinical evidence from randomized clinical trials (RCTs). OBJECTIVE We evaluated the clinical effectiveness of a personalized video-based mobile app (MARO), which is a video-based mobile app providing psychoeducation, emotion regulation, cognitive restructuring, and behavioral activation, in community-dwelling individuals with SMI. Specifically, we aimed to examine whether the personalized video-based mobile app could reduce the symptoms of depression and anxiety and enhance positive automatic thoughts. Additionally, we aimed to determine the impact of early minimal human coaching on treatment outcomes. METHODS This 8-week crossover RCT compared an Immediate Coaching group (app + coaching → app only) and a Wait-list Coaching group (app only → coaching) using the personalized video-based mobile app. Among 40 randomized participants, 27 completed all assessments. Depression (Patient Health Questionnaire-9; PHQ-9), anxiety (Generalized Anxiety Disorder-7), and positive automatic thoughts (Automatic Thoughts Questionnaire–Positive; ATQ-P) were assessed at baseline as well as after 4 and 8 weeks. RESULTS Both groups showed significant improvement in the assessed parameters. Compared with the Wait-list Coaching group, the Immediate Coaching group showed larger gains in PHQ-9 (β= –2.45, P=.049) and ATQ-P (β=11.74, P=.007). CONCLUSIONS The personalized video-based mobile app effectively reduced depression and anxiety and enhanced positive cognition in individuals with SMI. Early minimal coaching further improved outcomes, supporting scalable hybrid digital–human approaches to community care. CLINICALTRIAL CRIS (Korea Disease Control and Prevention Agency), KCT0011492; https://cris.nih.go.kr