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eMPower digital program reduced HADS total scores by 2.6 to 2.9 points over waitlist controlDigital program reduces anxiety and depression in people with chronic conditions

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Key Takeaway
Consider eMPower as an effective digital intervention for reducing anxiety and depression in patients with chronic illnesses.

This randomized controlled trial evaluated the efficacy of eMPower, a multi-component self-directed digital program, in adults aged 18 and older who reported chronic medical conditions and had internet access. The study was conducted across 13 countries in an online setting. A total of 825 participants were initially allocated to different study arms, with 695 completing the 12-week assessment. The intervention included video-guided movement, breathwork, meditation, psychology-based coping skills, and disease education.

The study compared three delivery models: eMPower with human support (weekly telephone check-ins from trained nonclinicians), self-directed eMPower, and a waitlist control group. This design allowed researchers to assess whether the addition of human interaction provided incremental benefits over a purely digital platform for patients managing chronic conditions.

The primary outcome was the change in Hospital Anxiety and Depression Scale (HADS) total scores from baseline to 12 weeks. Participants receiving eMPower with human support showed an improvement of 2.9 points compared to the waitlist control (n=222 in the intervention group, n=259 in the control group; 95% CI [2.0, 3.8]; p < 0.001). Participants using self-directed eMPower showed an improvement of 2.6 points compared to the waitlist control (n=214 in the intervention group, n=259 in the control group; 95% CI [1.8, 3.5]; p < 0.001).

Secondary outcomes included HADS anxiety and depression subscales, fatigue measured by the Modified Fatigue Impact Scale, and health-related quality of life (HRQoL) assessed via SF-12 mental/physical scores and EQ-5D-5L index scores. When comparing the intervention arms directly, no significant differences were observed for any outcome (all p > 0.05). This suggests that while both digital formats were effective compared to a waitlist, the addition of human support did not provide statistically superior outcomes over the self-directed version in this specific study.

Safety and tolerability data indicated that no adverse events were reported in any arm during the 12-week period. Specific rates for serious adverse events or discontinuation rates were not reported. The program appeared well-tolerated by the participants across all delivery modes.

These results align with broader evidence suggesting digital interventions can be effective for managing psychological distress. However, the study has several limitations that should be considered when interpreting the data. The use of a waitlist control means the study does not account for nonspecific intervention effects or the 'Hawthorne effect.' Additionally, the sample was predominantly female and highly educated, which may limit the generalizability of the findings to broader populations. The reliance on self-reported diagnoses and the relatively short 12-week follow-up period also limit long-term conclusions.

For clinical practice, these results suggest that multi-component digital interventions like eMPower are viable tools for reducing anxiety and depression in patients with chronic conditions. Because both self-directed and human-supported models yielded similar improvements, clinicians can consider digital platforms as scalable options for patient management. However, questions remain regarding the long-term sustainability of these improvements beyond 12 weeks and how these results apply to less educated or more diverse demographic groups.

How this fits prior evidence

How this fits prior evidence This finding extends previous evidence that digital interventions can outperform waitlist controls for specific anxiety conditions. It also complements findings regarding the use of stepped-care models to reduce anxiety and depression scores, as it demonstrates a scalable digital approach for patients with chronic medical conditions.

Living with a chronic medical condition can be exhausting. Beyond the physical symptoms of an illness, many people struggle with the heavy emotional toll of constant worry and low mood. For these individuals, finding ways to manage mental health that fit into a busy life is essential for improving their daily quality of life.

To see if technology could help, researchers conducted a study involving 825 adults who reported having chronic medical conditions. These participants were split into different groups to test an online program called eMPower. This program was not just a simple app; it combined several tools including video-guided movement, breathing exercises, meditation, and education about their illnesses. Some people used the program entirely on their own, while others received extra support through weekly phone calls from trained staff who were not doctors.

After 12 weeks, the results showed that both groups using the eMPower program saw significant improvements in their anxiety and depression scores compared to a group that did not use the program. Interestingly, the study found no real difference between those who used the app alone and those who had the extra phone calls. Both methods worked well to lower stress levels. The researchers also looked at other factors like fatigue and general quality of life, though the primary focus was on reducing the mental burden of their conditions.

Safety was a key part of the study, and no adverse events were reported by any participants in any group. However, it is important to keep some things in mind before jumping to conclusions. The study only lasted 12 weeks, which is a short time to see long-term changes. Also, most of the people in the study were women with high levels of education, so the results might not apply perfectly to everyone. Because the group that did not use the program was on a waitlist, it is harder to tell if the improvement was only from the app or from other factors.

For patients today, this means that digital tools can be a very effective way to manage mental health. Whether you prefer to work through a program alone or with a little extra human support, these types of multi-tool programs offer a practical way to tackle anxiety and depression. While it is not a replacement for clinical treatment, it shows that technology can provide meaningful relief for those managing long-term illnesses.

What this means for you:
A digital program combining movement and meditation significantly reduced anxiety and depression in people with chronic illness.

Study Details

Study typeRct
Sample sizen = 695
EvidenceLevel 2
Follow-up2.8 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Anxiety, depression, and fatigue affect >50% of adults across a range of chronic medical conditions, leading to reductions in quality of life. Digital symptom management interventions may address this burden, but clinical trial evidence across diverse conditions is limited, and the added value of human support remains uncertain. This study aimed to determine whether a multicomponent digital intervention, delivered with or without human support, reduces anxiety and depression compared with usual care at 12 weeks in adults with chronic medical conditions, and whether human-supported delivery outperforms self-directed delivery. METHODS AND FINDINGS: A three-arm parallel-group open-label randomized controlled trial was conducted from February 2023 to December 2024, with online recruitment and delivery across 13 countries. 825 adults (≥18 years) with self-reported chronic medical conditions and internet access were allocated by computer-generated stratified block randomization (1:1:1) to: (i) waitlist control (n = 274); (ii) eMPower, a self-directed digital program integrating video-guided movement, breathwork, and meditation practices, a psychology-based coping skills curriculum, and disease education (n = 275); or (iii) eMPower + human support consisting of weekly telephone check-ins (≤15 min) from trained nonclinicians (n = 276). The primary outcome was change in Hospital Anxiety and Depression Scale (HADS) total score from baseline to 12 weeks in the eMPower + human support arm compared with the control arm, adjusted for baseline score, chronic condition type, age, and sex. Secondary outcomes included HADS anxiety and depression subscales, fatigue (Modified Fatigue Impact Scale [MFIS]), and health-related quality of life (Short Form-12 [SF-12] mental and physical component scores and EQ-5D-5L index score). Twelve-week assessments were completed by 695 participants (84.2%). Primary outcome data were available for 222 participants in the eMPower + human support arm, 214 in the self-directed eMPower arm, and 259 in the control arm. Analyses followed the intention-to-treat principle. In the prespecified primary comparison, eMPower + human support improved HADS total score by 2.9 points (95% CI [2.0, 3.8]; p < 0.001). In prespecified exploratory analyses, the self-directed eMPower arm also significantly improved HADS total score, compared with control (mean difference 2.6 points; 95% CI [1.8, 3.5]; p < 0.001). No significant differences were observed between intervention arms for any outcome (all p > 0.05). Both intervention arms were associated with improvements across prespecified secondary outcomes compared with control. No intervention-related adverse events were reported in any arm. Key limitations include the use of a waitlist control design, which does not control for nonspecific intervention effects; reliance on self-reported diagnoses for most participants; the 12-week follow-up period; and a predominantly female and highly educated sample, which may limit generalizability. Additional registered process-oriented secondary outcomes and exploratory outcomes will be reported in companion publications. CONCLUSIONS: A multicomponent digital intervention with human support significantly reduced anxiety and depression symptoms compared with usual care in adults with chronic medical conditions. Comparable effects between self-directed and human-supported delivery in exploratory analyses highlight potential for scalable, low-resource implementation. Longer-term follow-up and cost-effectiveness analyses are warranted. Trial registration: ClinicalTrials.gov: NCT05786482.
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