{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:48:49Z","timestamp":1791229729888,"version":"4.1.0"},"reference-count":84,"publisher":"JMIR Publications Inc.","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Ment Health"],"abstract":"\n Background<\/jats:title>\n Loneliness is a widespread and significant problem on college campuses. Prolonged loneliness in young adulthood is a risk factor for concurrent and future mental health problems and attrition, making college a critical time for support. Cognitive and behavioral interventions show promise for decreasing loneliness and can be widely disseminated through technology.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This pilot randomized controlled trial was conducted to examine the initial efficacy, feasibility, and desirability of a smartphone app, Nod, designed to deliver cognitive and behavioral skill-building exercises to reduce loneliness during the transition to college.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n First-year college students (N=221, mean age 18.7 years, 59% female) were recruited online during incoming student orientation, and randomized to either receive immediate access to Nod (experimental group, n=100) or access after 4 weeks (control group, n=121). The app delivered skills via fully automated (1) \u201csocial challenges,\u201d suggested activities designed to build social connections; (2) reflections, brief cognitive reframing exercises; and (3) student testimonials that encouraged a growth mindset toward social connection building. Main intention-to-treat analyses were used to compare the conditions on self-assessed loneliness, depressive symptoms, and other mental health and college adjustment outcomes at week 4, controlling for baseline values on those variables. Analyses were also performed to test the hypothesis that the treatment benefits would be particularly pronounced for participants with heightened psychological vulnerability at baseline (ie, higher baseline depressive symptoms and loneliness).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Retention was 97% at week 4, and participants viewed an average 36.7 pages of app content. There were no significant condition differences in loneliness at week 4 (F1, 211=0.05, P=.82; \u03b7p2 <.001). However, there was a significant condition-by-baseline depression interaction to predict week-4 loneliness (F1,209=9.65, P=.002; \u03b7p2 =.04). Simple slope analyses indicated that baseline depression positively predicted week-4 loneliness among control participants (r=0.30, t209=3.81, P<.001), but not among experimental participants (r=\u20130.09, t209=\u20130.84, P=.40), suggesting that Nod buffered participants with high baseline depression scores from experiencing heightened midquarter loneliness. Similarly, there were no significant condition differences in other week-4 outcomes. However, moderation by baseline vulnerability was found for week-4 depressive symptoms, sleep quality, and indices of college adjustment (eg, perceived social support and campus belonging).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Although Nod exposure did not impact outcomes for the full sample, these results provide initial evidence of its benefit for vulnerable students. The results of this trial suggest that cognitive and behavioral skills delivered via a mobile app can buffer psychologically vulnerable college students against heightened loneliness and depressive symptoms, as well as other negative college adjustment outcomes. Future work will aim to improve upon app engagement, and to address loneliness among other key populations.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n ClinicalTrials.gov NCT04164654; https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04164654<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/21496","type":"journal-article","created":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T10:31:56Z","timestamp":1603189916000},"page":"e21496","source":"Crossref","is-referenced-by-count":76,"title":["Smartphone App to Address Loneliness Among College Students: Pilot Randomized Controlled Trial"],"prefix":"10.2196","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3253-0685","authenticated-orcid":false,"given":"Emma","family":"Bruehlman-Senecal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3418-3701","authenticated-orcid":false,"given":"Cayce J","family":"Hook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6771-1873","authenticated-orcid":false,"given":"Jennifer H","family":"Pfeifer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2383-4409","authenticated-orcid":false,"given":"Caroline","family":"FitzGerald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2050-4954","authenticated-orcid":false,"given":"Brittany","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2195-9627","authenticated-orcid":false,"given":"Kevin L","family":"Delucchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1473-5262","authenticated-orcid":false,"given":"Jana","family":"Haritatos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9875-5713","authenticated-orcid":false,"given":"Danielle E","family":"Ramo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"key":"ref1","first-page":"31","author":"Perlman, D","year":"1981","journal-title":"Personal Relationships in Disorder"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2009.06.005"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1177\/0890117119856551"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.paid.2020.110066"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1037\/amp0000690"},{"key":"ref6","unstructured":"Loneliness Research ReportCigna20202020-09-24https:\/\/www.cigna.com\/about-us\/newsroom\/studies-and-reports\/combatting-loneliness\/research-report"},{"key":"ref7","unstructured":"RideoutVFoxSDigital Health Practices, Social Media Use, and Mental Well-Being Among Teens and Young Adults in the U.SHopelab and Well-Being Trust20182020-09-24https:\/\/hopelab.org\/reports\/pdf\/a-national-survey-by-hopelab-and-well-being-trust-2018.pdf"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1111\/soin.12018"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s10802-010-9442-x"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1037\/dev0000719"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291718000788"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1037\/0022-0167.52.4.591"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717000629"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.24.3.297"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1177\/0020764010387551"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12125"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1080\/02699931.2016.1247035"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-018-05377-0"},{"key":"ref19","unstructured":"American College Health Association-National College Health Assessment II: Undergraduate Student Executive Summary Spring 2019American College Health Association20192020-09-24https:\/\/www.acha.org\/documents\/ncha\/NCHA-II_SPRING_2019_US_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1177\/00164402062003009"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.6007\/ijarp\/v3-i2\/2455"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/0191-8869(93)90217-q"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s11218-017-9390-1"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.2190\/a465-356m-7652-783r"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(19)30275-5"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1524360113"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.3102\/0034654311405999"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1177\/0146167298243009"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1207\/s15374424jccp3401_2"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1177\/1088868310377394"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1007\/bf02686933"},{"key":"ref32","unstructured":"GallagherRPNational Survey of Counseling Center Directors 200820092020-09-24The International Association of Counseling Services (IACS)https:\/\/web.archive.org\/web\/20200930214423\/https:\/\/www.immagic.com\/eLibrary\/ARCHIVES\/GENERAL\/ACCA_US\/A081007G.pdf"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1002\/ss.20188"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1177\/1473325011401468"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth.2018.03.02"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7740"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.3.2.e20"},{"key":"ref38","unstructured":"Pew Research CenterMobile Fact Sheet20192020-09-23https:\/\/www.pewresearch.org\/internet\/fact-sheet\/mobile\/"},{"key":"ref39","unstructured":"FoxSDugganMTracking for Health: Main ReportPew Research Center20132020-09-23https:\/\/www.pewresearch.org\/internet\/2013\/01\/28\/main-report-8\/"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1080\/15228835.2017.1368428"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00604"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-019-01681-2"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12389"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-016-0662-3"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa5101_6"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.112.1.155"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1111\/add.14245"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jesp.2018.02.014"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1037\/a0034709"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1080\/01973533.2017.1323638"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.22020"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1080\/10570314.2014.943429"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1080\/10904018.2013.813234"},{"key":"ref54","author":"Burns, D","year":"2006","journal-title":"When panic attacks: the new, drug-free anxiety therapy that can change your life"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1007\/s10902-012-9380-0"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1177\/0146167297234003"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.116.3.457"},{"key":"ref58","author":"Bryant, F","year":"2007","journal-title":"Savoring: A new model of positive experience"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.21923"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1080\/15298860309032"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1037\/a0027600"},{"key":"ref62","author":"Burns, D","year":"1999","journal-title":"The Feeling Good Handbook"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1177\/2167702614548317"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1111\/pere.12250"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2016.09.011"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.2196\/11941"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.3928\/0048-5713-20020901-06"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000550"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2018.04.014"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1080\/07448481.2011.608393"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1002\/da.1055"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.1002\/da.20250"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(89)90047-4"},{"key":"ref75","unstructured":"Student Experience in the Research University Survey: Survey Instrument20202020-09-23https:\/\/seru.umn.edu\/about"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.1007\/s10648-011-9184-5"},{"key":"ref77","unstructured":"National Survey of Student Engagement: Survey Instrument20192020-09-23https:\/\/nsse.indiana.edu\/nsse\/survey-instruments\/us-english.html"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.1080\/00223980.2011.555433"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.1177\/1098214005283748"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1024\/1421-0185\/a000217"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.1037\/0022-0167.32.1.139"},{"key":"ref82","doi-asserted-by":"publisher","DOI":"10.1007\/s10826-015-0274-8"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.1521\/jscp.2018.37.10.751"},{"key":"ref84","doi-asserted-by":"publisher","DOI":"10.1007\/s10615-019-00724-0"}],"container-title":["JMIR Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mental.jmir.org\/2020\/10\/e21496","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:29:29Z","timestamp":1782840569000},"score":1,"resource":{"primary":{"URL":"http:\/\/mental.jmir.org\/2020\/10\/e21496\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,20]]},"references-count":84,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2196\/21496","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.21496","asserted-by":"object"}]},"ISSN":["2368-7959"],"issn-type":[{"value":"2368-7959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,20]]}}}