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One in four university students face mental health challenges, underscoring the need for effective support systems. Within Erasmus University Rotterdam student wellbeing initiative, we developed a mobile intervention providing universal and targeted preventive support, focusing on emotion regulation to address common issues like depression and anxiety. This study reports a superiority Randomized Controlled Trial evaluating intervention impact and uptake among students with elevated stress.

(N = 202) were randomized to immediate ROOM app access (n = 101) or a 3 month waitlist control (n = 101); 171 (85%) completed the trial. Questionnaires were completed at baseline and weeks 3, 8, and 12, alongside continuous in-app activity logs. Primary outcomes were perceived stress and emotion regulation; secondary outcomes included depressive and anxiety symptoms, resilience, and objective and subjective engagement. Analyses followed an intent-to-treat approach, with exploratory subgroup analyses assessing differences by engagement level.

The intervention showed no statistically significant impact on any outcomes. Exploratory analyses suggested that higher engagement with the intervention was associated with greater reductions in stress. Engagement was initially high but declined sharply after week 1, stabilizing by week 6. More than half of participants still used the intervention at day 30. Breathing and relaxation exercises were favoured, whereas transfer-elements and self-assessments were used less than expected.

ROOM did not demonstrate significant effects at the sample level, although greater engagement was associated with reduced stress. Future research is needed to better understand what drives engagement with the intervention, strengthen real-world skill application, and evaluate its preventive potential in larger and more representative student samples.