News release

From: PLOS

Digital wellness program eases anxiety and depression in adults with chronic health conditions

A controlled trial across 13 countries found that a self-guided digital program and a version paired with telephone support both outperformed usual care for anxiety and depression

A digital program combining guided movement, breathing and meditation exercises, and coping-skills training reduced anxiety and depression symptoms in adults with chronic medical conditions, according to a new study published August 20^th in the open access journal PLOS Medicine by Puneeta Tandon of the University of Alberta, Canada, and colleagues.

More than half of adults living with chronic physical conditions experience anxiety, depression, or fatigue, which can significantly reduce quality of life. Access to effective symptom management support is limited by mobility barriers, geography, cost, and shortages of trained clinicians. Digital programs may offer a scalable way to address this burden, but clinical trial evidence backing these interventions has been limited, and the role of human support in their efficacy is unclear.

Researchers conducted a fully remote, three-arm randomized controlled trial across 13 countries, involving 825 adults with self-reported chronic medical conditions including Primary Biliary Cholangitis, chronic digestive diseases, cirrhosis, and heart failure. Participants were assigned to a waitlist control group, a self-directed digital program (eMPower), or the same program supplemented with weekly telephone check-ins from trained non-clinicians. The program included movement, breathwork/meditation, coping skills, and disease education. Anxiety and depression symptoms were measured using a standard symptom scale ranging from 0 to 42.

At 12 weeks, participants receiving the digital program with telephone support showed significantly greater improvement in anxiety and depression scores than the control group (2.9-point greater improvement; 95% CI, 2.0–3.8). They also reported improved quality of life and less fatigue. In exploratory analyses, the self-directed program alone also significantly improved symptoms compared with control (2.6-point greater improvement; 95% CI, 1.8–3.5), and no significant difference was found between the two program formats, although the trial was not designed or powered to directly compare them.

The study primarily included women with higher education and only measured outcomes for 12 weeks, so longer-term impact and generalizability to other populations remain unclear. However, the authors say the data suggest a path forward for digital mental health interventions.

“Taken together, the eMPower clinical trial provides robust evidence that a fully digital, multicomponent intervention reduced anxiety and depression symptoms and was associated with improvements in fatigue, and quality of life across a range of chronic disease populations,” the authors say. “Rather than developing separate digital programs for each condition, a single cross-condition approach with tailoring for disease-specific education is effective in addressing shared symptoms.”

Corresponding author Dr. Puneeta Tandon states, “As clinicians, we are good at treating organ-specific problems, but the whole-person burden of chronic illness - the anxiety, low mood and exhaustion - that is often where patients have fewer practical options. People often leave the clinic without much they can try, but it doesn’t need to be that way. While these skills don’t replace medication or mental health care when those are needed, they do give people a practical place to start at home.

“What was surprising was that, in an exploratory analysis, we did not find a significant difference between the fully self-directed program and the program with brief weekly check-ins from a trained team member. This does not prove that the two approaches are equal, but it suggests that a program like this may be able to reach far more people without requiring one-to-one support for everyone. Support could then be focused on those who need it most.

“Because the study was entirely online, people could take part from home. The average age was 56, almost one in four participants was over 65, and 84% completed the 12-week follow-up – a strong result for a fully online study. We’re very grateful to the patient partners and organizations representing heart, kidney, liver, transplant and digestive communities who helped shape the program from the beginning. Their involvement was an important part of the study’s success.”

“The 12-Week eMPower program has demonstrated meaningful improvements in quality of life for people living with primary biliary cholangitis (PBC), the largest group enrolled in the eMPower study,” said Gail Wright, a PBC patient and President of the Canadian PBC Society. “Participants living with a significant symptom burden reported clinically meaningful improvements in fatigue and overall quality of life. The success of this program represents an important milestone for the PBC community, providing clinicians with evidence to support more personalized care that combines pharmaceutical treatment with an evidence-based self-management program for people living with PBC.”

First author Emily Johnson, MD/PhD Candidate, notes, “Running the trial entirely online meant we could reach people who are often left out of research – including people managing severe fatigue or mobility limitations, people living far from a specialist centre, and people who can't add another appointment to their week. What struck me most was that they stayed. Patient partners shaped this program from the first draft, and I think that's why it held people's attention for 12 weeks. I look forward to continuing with this work and helping even more people.”