Fuhrmann Lukas M, Lukas Christian Aljoscha, Schindler-Gmelch Lena, Berking Matthias
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.
mentalis GmbH, Nuremberg, Germany.
Sci Rep. 2025 Jun 23;15(1):20257. doi: 10.1038/s41598-025-06588-4.
Perceived stress is prevalent in industrial societies, negatively impacting mental health. Smartphone-based stress management interventions provide accessible alternatives to traditional methods, but their efficacy remains modest, potentially due to limited integration of smartphone sensor technology. The primary aim of this study was to evaluate the efficacy of an 18-day smartphone-based stress management intervention, MT-StressLess with integrated heart rate (HR)-based biofeedback using built-in accelerometer sensors, compared to a waitlist control (WLC) condition. Secondary outcomes included emotion regulation skills, depressive symptoms, overall well-being, usbiality and usage data. As exploratory aims, we investigated whether the MT-StressLess version without HR-based biofeedback was also superior to the WLC condition, and whether the version with HR-based biofeedback provided additional benefits compared to the version without. In a three-arm randomized controlled trial, 166 participants were assigned to MT-StressLess with HR-based biofeedback, MT-StressLess, or the WLC condition. Linear mixed-effects models were used to analyze intervention effects over time (baseline, postintervention, and 1-month follow-up). At postintervention, MT-StressLess with HR-based biofeedback showed significantly greater reductions in perceived stress compared to the WLC condition (d = 0.41, 95% CI [0.03, 0.79]), whereas the version without biofeedback did not differ significantly (d = 0.14, 95% CI [-0.24, 0.51]). No significant differences were observed between the two active conditions (d = 0.29, 95% CI [-0.08, 0.66]). Both active conditions, however, led to significant improvements in the secondary outcomes of emotion regulation skills and well-being compared to the WLC (all ds = -0.58 to -0.27). These patterns persisted at the 1-month follow-up. Usability ratings were high, but overall adherence was moderate. The findings in the main comparison may reflect increased interoceptive awareness and self-regulation. Yet, the limited effects of the core intervention and the biofeedback component also suggest the influence of non-specific factors, such as placebo effects, outcome expectancy and user engagement, which highlights the need to better understand optimal intervention duration, motivation, reinforcement, and more individualized approaches to stress reactivity. Overall, the findings provide preliminary support for the potential of a smartphone-based intervention that includes HR-based biofeedback to reduce perceived stress compared to no intervention. As these interventions are still in their early stages, future research should explore how personalization driven by artificial intelligence and real-time physiological tracking can enhance engagement and efficacy.
感知压力在工业社会中普遍存在，对心理健康产生负面影响。基于智能手机的压力管理干预为传统方法提供了便捷的替代方案，但其效果仍较为有限，这可能是由于智能手机传感器技术的整合有限所致。本研究的主要目的是评估一项为期18天的基于智能手机的压力管理干预措施MT-StressLess的效果，该干预措施使用内置加速度计传感器集成基于心率（HR）的生物反馈，与等待列表对照（WLC）条件进行比较。次要结果包括情绪调节技能、抑郁症状、总体幸福感、可用性和使用数据。作为探索性目标，我们研究了没有基于HR生物反馈的MT-StressLess版本是否也优于WLC条件以及与没有该生物反馈的版本相比，基于HR生物反馈的版本是否提供了额外的益处。在一项三臂随机对照试验中，166名参与者被分配到具有基于HR生物反馈的MT-StressLess组、MT-StressLess组或WLC组。使用线性混合效应模型分析随时间（基线、干预后和1个月随访）的干预效果。在干预后，与WLC条件相比，具有基于HR生物反馈的MT-StressLess在感知压力方面的降低更为显著（d = 0.41，95% CI [0.03, 0.79]），而没有生物反馈的版本则没有显著差异（d = 0.14，95% CI [-0.24, 0.51]）。在两个干预组之间未观察到显著差异（d = 0.29，95% CI [-0.08, 0.66]）。然而，与WLC相比，两个干预组在情绪调节技能和幸福感的次要结果方面均有显著改善（所有d值 = -0.58至-0.27）。这些模式在1个月随访时持续存在。可用性评分较高，但总体依从性中等。主要比较中的结果可能反映了内感受性意识和自我调节的增强。然而，核心干预和生物反馈成分的有限效果也表明了非特异性因素的影响，如安慰剂效应、结果预期和用户参与度，这突出了需要更好地理解最佳干预持续时间、动机、强化以及更个性化的压力反应方法。总体而言，研究结果为基于智能手机的干预措施（包括基于HR生物反馈）与无干预相比在降低感知压力方面的潜力提供了初步支持。由于这些干预措施仍处于早期阶段，未来研究应探索由人工智能驱动的个性化和实时生理跟踪如何能够提高参与度和效果。
