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Clinical Research

PsycApps, the company behind eQuoo the Emotional Fitness Game, is aware of the great responsibility that comes along with designing and distributing mental wellbeing and mental health products. Everything we develop is based on studies published in peer-reviewed journals and we have conducted multiple clinical trials with eQuoo and our other product, PsycApps. All studies conducted by Psychologist Silja Litvin, have been approved through the Ethics Committee of Ludwig Maximilian University, and will be published in open-source peer-reviewed journals for all to read.


  1. We tested the effects of eQuoo on well-being -IT WORKS!
  2. We tested the following well-being metrics: Psychological Well-Being (Ryff's Scale) - Positive Relationships with others, Resilience (ARS), Personal Growth (PGIS), a One Item Anxiety Likert Scale
  3. It was a 5-week, 3-arm randomized controlled trial with 358 participants


Young adults 18 - 28 years old are the most vulnerable population to mental health issues of which 29% are living with a diagnosed mental illness. With less than 35% having access to therapy and psychological care, it is pressing to develop therapeutic tools that are cost-efficient, effective and 'sticky'. The broad distribution of smartphones offers a compelling platform in the form of applications, but evidence-based apps struggle with high attrition. Additionally, prevention programs have attrition rates of up to 99%, making them difficult to implement. Research suggests gamification to be a valid strategy to intrinsically motivate patients to adhere to prevention and early-stage mobile interventions.


A game named eQuoo, teaching psychological concepts such as emotional bids, generalization, and reciprocity through psychoeducation, storytelling, and gamification was developed and published on all application platforms. A hypothesis was postulated that using the app over a period of 5 weeks would significantly boost Resilience, Personal Growth.

Psychological well-being: Positive Relations With Others and Anxiety as well as heighten adherence. 358 participants partook in a 5-week, 3-armed randomized controlled trial, of which a third used eQuoo, a third used a 'Treatment as Usual' CBT Journal app and a third was on a waitlist with no intervention. All 3 groups filled out the following questionnaires at 3 time-points: The Adult Resilience Scale, The Personal Growth Inventory Scale, the Psychological well-being: Positive Relations With Others Scale by Ryff and a 1 Item Anxiety Likert scale.


Results of repeated measures of ANOVAs showed statistically significant increases in the well-being metrics and a significant decrease in anxiety when using the app over a timeframe of 5 weeks. The app significantly increased resilience as measured with the ARS by d .37, personal growth as measured by PGIS by d .67, positive relations with others as measured by Ryff's PWB by d .42 and anxiety as measured with a 1 Item Ankiety Likert Scale lowered by d .20. With 90% adherence, eQuoo was able to retain 21% more participants than the control or waitlist group.


eQuoo is a mental health game that significantly raises mental well-being and lowers anxiety as well as maintains high adherence. This allows a deduction that smartphones are a valuable and effective platform - for those who adhere to the intended therapy process - to offer mental health interventions within an app. Using gamification could be the key to achieving the attention and motivation needed to generate higher retention rates and reduce attrition for a certain age group. Future research would benefit from measuring eQuoo's effect on anxiety with a more sensitive tool GAD 7 as well as other widespread mental illness like depression.


  1. Mobile interventions work.
  2. We developed an EVIDENCE-BASED app called PsycAppsE and trialled it in a 2-arm RCT over 4 weeks.
  3. Depression levels were significantly lowered, anxiety levels were lowered.
  4. Attrition rates led me to abandon customary mood-tracking and CBT app-delivery and into developing eQuoo.


  1. A brief review of existing evidence-based mental health apps
  2. The evolution from PsycAppsE to eQuoo and why PsycApps moved towards gaming
  3. An outlook on the two upcoming trials with eQuoo