Background: Youper is a widely used, commercially available mobile app that uses artificial intelligence therapy for the treatment of anxiety and depression. Objective: Our study examined the acceptability and effectiveness of Youper. Further, we tested the cumulative regulation hypothesis, which posits that cumulative emotion regulation successes with repeated intervention engagement will predict longer-term anxiety and depression symptom reduction. Methods: We examined data from paying Youper users (N=4517) who allowed their data to be used for research. To characterize the acceptability of Youper, we asked users to rate the app on a 5-star scale and measured retention statistics for users’ first 4 weeks of subscription. To examine effectiveness, we examined longitudinal measures of anxiety and depression symptoms. To test the cumulative regulation hypothesis, we used the proportion of successful emotion regulation attempts to predict symptom reduction. Results: Youper users rated the app highly (mean 4.36 stars, SD 0.84), and 42.66% (1927/4517) of users were retained by week 4. Symptoms decreased in the first 2 weeks of app use (anxiety: d=0.57; depression: d=0.46). Anxiety improvements were maintained in the subsequent 2 weeks, but depression symptoms increased slightly with a very small effect size (d=0.05). A higher proportion of successful emotion regulation attempts significantly predicted greater anxiety and depression symptom reduction. Conclusions: Youper is a low-cost, completely self-guided treatment that is accessible to users who may not otherwise access mental health care. Our findings demonstrate the acceptability and effectiveness of Youper as a treatment for anxiety and depression symptoms and support continued study of Youper in a randomized clinical trial.

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中文翻译：

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人工智能治疗焦虑和抑郁的可接受性和有效性（Youper）：纵向观察研究

背景：Youper 是一款广泛使用的商用移动应用，它使用人工智能疗法来治疗焦虑和抑郁。目的：我们的研究检验了 Youper 的可接受性和有效性。此外，我们测试了累积调节假设，该假设假设通过重复干预参与累积情绪调节成功将预测长期焦虑和抑郁症状的减轻。方法：我们检查了允许将其数据用于研究的付费 Youper 用户（N=4517）的数据。为了描述 Youper 的可接受性，我们要求用户对应用程序进行 5 星评级，并测量用户订阅前 4 周的留存率统计数据。为了检查有效性，我们检查了焦虑和抑郁症状的纵向测量。为了检验累积调节假设，我们使用成功的情绪调节尝试的比例来预测症状减轻。结果：Youper 用户对应用的评价很高（平均 4.36 颗星，SD 0.84），到第 4 周留存了 42.66%（1927/4517）的用户。应用使用的前 2 周症状有所减轻（焦虑：d=0.57；抑郁症：d = 0.46）。在接下来的 2 周内，焦虑的改善得以维持，但抑郁症状略有增加，但效应量非常小（d = 0.05）。较高比例的成功情绪调节尝试显着预测焦虑和抑郁症状的减轻。结论：Youper 是一种低成本、完全自我指导的治疗方法，可能无法获得心理保健服务的用户可以使用。

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