A mobile app can improve the symptoms of one of the commonest mental health problems in students—even with limited engagement, according to University of Manchester researchers.
The app, called Cerina, uses the principles of cognitive behavioral therapy to treat Generalized Anxiety Disorder (GAD)—which affects a significant number of students, studies show.
The peer-reviewed study, sponsored by IT4Anxiety—a partnership between Cerina Health and Ulster University—is published in JMIR mHealth and uHealth.
A sample of 158 Ulster University students with mild to moderate GAD symptoms were randomly allocated to either an intervention group of 79 or to a wait-list control group of 79.
The wait-list group would still have the opportunity to complete the intervention following the study and were offered optional on-campus well-being services during the study period.
The intervention group had direct access to Cerina and followed CBT-based interactive sessions for six weeks.
All participants completed online self-reported assessments on anxiety, depression, worry, and usability at three time points. When they completed the intervention, they were invited to an online interview to understand the implementation of the intervention in more depth.
In the intervention group, 13% dropped out and 61% completed two sessions—the minimum required. Overall, 12% completed six or seven sessions.
The students who completed two or more sessions, when the modules on worry started, showed significant improvement in GAD, worry symptoms and functional impairment: The greater the engagement, the greater the impact on worry symptoms.
When they re-ran analyses for all participants, including those who dropped out or were lost to follow-up, the significant improvements in GAD symptoms were maintained. There was also marginally significant improvement in worry symptoms.
Participants who completed their assessments, argue the researchers, engaged better with the app, completed more sessions, including the ones focusing on worry, and benefitted more.
Lead author Dr. Ozlem Eylem-Van Bergeijk from the University of Manchester said, “University students can sometimes be vulnerable to generalized anxiety disorder because the rigors of academic pressure and financial uncertainty, let alone the issues young people often go through when they leave home for the first time.
“But despite the need for treatments, the availability of psychological services is patchy for students. And perceived stigma, long waiting times, service availability can restrict access to treatment.”
The study was managed by Dr. Eylem-Van Bergeijk, and the Ulster University study team led by Prof. Gerard Leavey. Study participant recruitment took place at Ulster University campuses from April 2023 until April 2024.
She added, “Our results suggest that even with limited engagement, Cerina had a meaningful impact on reducing GAD symptoms and modest impact in reducing worry symptoms among participants.
“Our study supports findings from other trials showing that digital CBT-based interventions are effective and feasible for a wide range of age groups and populations experiencing GAD symptoms—none the least because they are cheap, accessible and anonymous.
“However, many participants did not complete the recommended number of sessions, highlighting the importance of making the Cerina app even more engaging and user-friendly in future.
“Co-design with users might be a good way to test the effects of the technology-driven engagement features such as AI-based chatbot on engagement with longer follow-ups.”
More information:
Ozlem Eylem-van Bergeijk et al, Cerina—Cognitive Behavioral Therapy–Based Mobile App for Managing Generalized Anxiety Disorder Symptoms Among University Students: Results From a Pilot Feasibility Randomized Controlled Trial, JMIR mHealth and uHealth (2025). DOI: 10.2196/70691
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