Home›Psychiatry› RELAX digital intervention reduces anxiety and repetitive negative thinking in pregnant individuals
RELAX digital intervention reduces anxiety and repetitive negative thinking in pregnant individualsDigital tool helps pregnant people manage anxiety and worry
JAMA network openPublished November 5, 2026Study authors: Hirsch Colette R, Volkmer Brittannia, Sawjani Yogini, Towner Nathalie, Newburn Mary, Bennett Jo, Bri…PubMed ↗DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Consider the RELAX digital intervention to reduce anxiety and repetitive negative thinking in pregnant individuals.
This Phase 2b randomized clinical trial enrolled 268 pregnant individuals in the UK between 16 and 28 weeks' gestation who presented with high repetitive negative thinking (RNT) and up to moderate anxiety. Participants were randomized to receive either the RELX digital intervention, consisting of twelve 17-minute sessions over 4 weeks, or usual maternity care (UC).
At the T2 follow-up, the RELAX group showed significantly lower anxiety (GAD-7) scores compared to the UC group (95% CI, -2.4 to -0.6; P =.001). Other significant reductions at T2 included lower scores for repetitive negative thinking (RTQ-10) (95% CI, -4.5 to -0.9), worry (PSWQ) (95% CI, -5.9 to -1.3), and perinatal anxiety (PASS) (95% CI, -8.2 to -2.8). Depression scores on the PHQ-9 and EPDS scales were also significantly lower in the RELAX group at T2.
At the T3 follow-up (12-24 weeks post-birth), the reductions in anxiety (GAD-7), repetitive negative thinking (RTQ-10), and postpartum depression (EPDS) were sustained compared to usual care. However, no significant differences were found between groups for functioning (WSAS), perinatal anxiety (PASS) at T3, or general depression (PHQ-9) at T3. Safety and tolerability data were not reported. A limitation noted was that interpretation bias did not mediate the effects on GAD-7 at T2.
How this fits prior evidence
How this fits prior evidence: This finding extends the evidence for non-pharmacological interventions in pregnancy. It specifically builds upon the finding that a Web-Based Mindfulness Program Lowers Depression Relapse in Pregnant Women, by providing a digital intervention that specifically targets repetitive negative thinking in addition to anxiety and depression.
Pregnancy is a time of huge change, but it can also bring heavy feelings of anxiety and constant worry. For many, this involves repetitive negative thinking, where the mind gets stuck on distressing thoughts. A study of 268 pregnant people in the UK looked at a digital program called RELAX to see if it could help manage these feelings.
The RELAX program consisted of twelve 17-minute sessions over four weeks. Compared to standard care, those who used the digital tool showed significantly lower levels of anxiety, depression, and worry during pregnancy. These improvements were also seen in their scores for repetitive negative thinking. These positive results were sustained through the first few months after giving birth.
While the program helped with specific feelings of anxiety and depression, it did not show a significant difference in overall daily functioning or general depression scores after birth. The study also found that the program helped participants view situations more positively. Because this was a Phase 2b trial, more research is needed to see how it works for everyone.
What this means for you:
A 4-week digital program can significantly lower anxiety and repetitive negative thinking during and after pregnancy.
Common questions
What is the RELAX program?
RELAX is a self-led digital intervention. It consists of twelve 17-minute sessions delivered over a period of 4 weeks. It was designed to help people manage anxiety and repetitive negative thinking during pregnancy.
How does it help with anxiety and worry?
Participants using the RELAX program showed significantly lower levels of anxiety and worry compared to those receiving standard care. These improvements were sustained through the 36-week follow-up period, which occurred about 12 to 24 weeks after birth.
Does it help with depression?
The study found that participants using the RELAX program had significantly lower scores for depression during pregnancy. However, for general depression scores measured after birth, there was no significant difference compared to standard care.
IMPORTANCE: Anxiety disorders affect 1 in 5 pregnant women and birthing people. Cognitive bias modification for interpretation reduces anxiety and repetitive negative thinking (RNT; a risk factor for anxiety) among nonpregnant samples.
OBJECTIVE: To evaluate whether adding pregnancy-tailored cognitive bias modification for interpretation to usual maternity care (UC) prevents increased anxiety during pregnancy; reduces anxiety, depression, and RNT before and after birth; and improves functioning before and after birth compared with UC.
DESIGN, SETTING, AND PARTICIPANTS: The RELAX (Reducing Levels of Anxiety) 2-arm, parallel-group, multisite, superiority, phase 2b randomized clinical trial recruited participants from June 2023 to July 2024, with final assessment in April 2025. Participants included pregnant individuals in the UK at 16 to 28 weeks' gestation, with high RNT and up to moderate anxiety, recruited via antenatal clinics or self-referral.
INTERVENTION: Participants were randomized to the self-led digital intervention (RELAX plus UC), involving twelve 17-minute sessions over 4 weeks, or to UC.
MAIN OUTCOMES AND MEASURES: Assessments took place at baseline before randomization (T0) and 4 weeks (T1), 8 weeks (T2), and 36 weeks (T3; 12-24 weeks after birth) after randomization. The primary outcome was anxiety, as assessed by the 7-item Generalized Anxiety Disorder scale (GAD-7) at T2 and as a secondary outcome at T3. Secondary outcomes included RNT (assessed by the 10-item trait version of the Repetitive Thinking Questionnaire [RTQ-10]), depression (general and perinatal, assessed by the Patient Health Questionnaire-9 [PHQ-9] and Edinburgh Postnatal Depression Scale [EPDS]), perinatal anxiety (assessed by the Perinatal Anxiety Screening Scale [PASS]), worry (assessed by the Penn State Worry Questionnaire [PSWQ]), and functioning (assessed by the Work and Social Adjustment Scale [WSAS]). Interpretation bias at T1 was the hypothesized mechanism. Analysis was performed using a modified intention-to-treat approach.
RESULTS: A total of 268 participants were randomized (mean [SD] age 33.7 [3.9] years; 174 [64.9%] married). Anxiety was significantly lower for RELAX participants vs UC (mean GAD-7 difference, -1.5; 95% CI, -2.4 to -0.6; P = .001). Depression (mean PHQ-9 difference, -0.8; 95% CI -1.5 to -0.1; and mean EPDS difference, -1.1; 95% CI, -2.0 to -0.2), RNT (mean RTQ-10 difference, -2.7; 95% CI, -4.5 to -0.9), worry (mean PSWQ difference, -3.6; 95% CI, -5.9 to -1.3), and perinatal anxiety (mean PASS difference, -5.5; 95% CI, -8.2 to -2.8) were significantly lower at T2. Effects on general anxiety (mean GAD-7 difference, -1.0; 95% CI, -1.9 to -0.1), postnatal depression (mean EPDS difference, -1.3; 95% CI, -2.4 to -0.2), and RNT (mean RTQ-10 difference, -2.4; 95% CI, -4.6 to -0.2) were sustained at T3. RELAX promoted more positive interpretations vs UC (mean difference, 2.1; 95% CI, 1.8-2.3) that did not mediate effects at T2 (indirect effect on GAD-7, -0.2; percentile bootstrap 95% CI, -0.4 to 0.1). Functioning did not differ at T2 (mean WSAS difference, -1.0; 95% CI, -2.5 to 0.5) or T3 (mean WSAS difference, -0.8; 95% CI, -2.7 to 1.2), nor did perinatal anxiety (mean PASS difference, -2.1; 95% CI, -5.5 to 1.4), general depression (mean PHQ-9 difference, -0.2; 95% CI, -1.2 to 0.9), or worry (mean PSWQ difference, -1.4; 95% CI, -4.1 to 1.3) at T3.
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, anxiety was lower during pregnancy and postnatally for RELAX plus UC participants compared with those receiving UC. Integrating RELAX into maternity care for those at risk of increased anxiety has potential to improve maternal mental health.
TRIAL REGISTRATION: https://www.isrctn.com/ISRCTN12754931.
