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What happens to the many individuals who are feeling depressed and/ or anxious and finally work up the courage to seek help? They reach out but the screening assessment scales determine that they have a ‘subthreshold depression’ or anxiety but not a diagnosable disorder.
Some of these folks may find their way to a counselor if many of their stressors are job or career related. Others might check out the numerous online Chatbots. But these digital “therapists” are an unproven and unregulated option and require more research and time to prove their value and skills..
A Novel Approach
A team of researchers from Kyoto University has developed a smartphone app that delivers core techniques of cognitive-behavioral therapy (CBT)—a proven treatment for depression and anxiety— into the hands of users, and tested it in the largest-ever individually randomized trial of its kind.
They have developed a resilience training app, called RESiLIENT, that was tested on nearly 4,000 adults across Japan experiencing subthreshold depression—a form of low-level but persistent depressive symptoms that doesn’t meet criteria for major depressive disorder but can still be debilitating. This condition affects an estimated 11% of people worldwide and often goes untreated.
The Key is CBT
According to lead author Prof. Toshiaki Furukawa , “CBT is highly effective, but delivering it at scale has always been a challenge. Our goal was to make these skills available to anyone, anywhere.”
The app teaches five fundamental CBT skills: behavioral activation, cognitive restructuring, problem solving, assertion training, and techniques for managing insomnia. Participants used the app over six weeks and were followed for six months. The study included three control groups, one of which used a health information app, another a self-check app, and the third no treatment at all (waiting list).
Results
Statistical analysis indicated that six weeks of learning was effective for up to 26 weeks, and in treating not only subthreshold depression but also anxiety and insomnia. The effect of the app compared favorably to the effect of antidepressants. Importantly, use of the app did not result in any serious adverse effects.
Next Steps
The research team plan to use the knowledge gained from the study to personalize and optimize which skills to administer for each individual to match their needs and characteristics. “This opens the door to optimized, long-term support.” says Furukawa.
The next step is to prepare a platform to administer the best interventions for each individual over the course of 12 months, which they hope will continue to provide the necessary skills to minimize the total burden of depression.
As the world continues to grapple with a mental health crisis, this study offers hope that the very devices often blamed for contributing to emotional distress might also become powerful tools for healing.
Study: “Cognitive behavioral therapy skills via a smartphone app for subthreshold depression among adults in the community” appeared on 23 April 2025 in Nature Medicine, with doi: 10.1038/s41591-025-03639-1
