A multicomponent digital intervention with human support significantly reduced anxiety and depression symptoms compared with usual care in adults with chronic medical conditions, with comparable effects observed for self-directed delivery in exploratory analyses.
Key Findings
Results
eMPower with human support significantly improved HADS total score compared with waitlist control at 12 weeks.
Mean difference of 2.9 points improvement in HADS total score (95% CI [2.0, 3.8]; p < 0.001) in the primary prespecified comparison
276 participants were allocated to the eMPower + human support arm; 222 completed 12-week assessments
Human support consisted of weekly telephone check-ins of ≤15 minutes from trained nonclinicians
Analysis followed intention-to-treat principle, adjusted for baseline score, chronic condition type, age, and sex
Results
Self-directed eMPower also significantly improved HADS total score compared with waitlist control in prespecified exploratory analyses.
Mean difference of 2.6 points improvement in HADS total score (95% CI [1.8, 3.5]; p < 0.001)
275 participants were allocated to the self-directed eMPower arm; 214 completed 12-week assessments
This comparison was prespecified but described as exploratory in the study
Results highlight potential for scalable, low-resource implementation
Results
No significant differences were observed between the human-supported and self-directed intervention arms for any outcome.
All between-intervention comparisons yielded p > 0.05
This finding applied across both the primary outcome (HADS total) and all secondary outcomes
The lack of added benefit from human support was consistent across anxiety subscale, depression subscale, fatigue, and quality of life measures
The comparable effects between arms were noted as highlighting potential for scalable, low-resource implementation
Results
Both intervention arms were associated with improvements across all prespecified secondary outcomes compared with control.
Secondary outcomes included HADS anxiety and depression subscales, fatigue (Modified Fatigue Impact Scale [MFIS]), and health-related quality of life (SF-12 mental and physical component scores and EQ-5D-5L index score)
Improvements were observed in both the eMPower + human support and self-directed eMPower arms relative to waitlist control
No intervention-related adverse events were reported in any arm
12-week assessments were completed by 695 of 825 participants (84.2%)
Methods
The trial enrolled 825 adults with chronic medical conditions across 13 countries using online recruitment and delivery.
Participants were ≥18 years with self-reported chronic medical conditions and internet access
Allocation was by computer-generated stratified block randomization (1:1:1): control (n = 274), self-directed eMPower (n = 275), eMPower + human support (n = 276)
Trial was conducted from February 2023 to December 2024
The sample was predominantly female and highly educated, which the authors note may limit generalizability
Methods
The eMPower intervention is a multicomponent digital program integrating movement, breathwork, meditation, psychology-based coping skills, and disease education.
Components included video-guided movement, breathwork, and meditation practices
A psychology-based coping skills curriculum and disease education were also included
The program was designed to address anxiety, depression, and fatigue, which affect >50% of adults across a range of chronic medical conditions
The intervention was delivered entirely online, enabling reach across 13 countries
Discussion
The study has several key limitations that may affect interpretation and generalizability of findings.
A waitlist control design was used, which does not control for nonspecific intervention effects
Most participants provided self-reported rather than clinically verified diagnoses
Follow-up was limited to 12 weeks; longer-term effects are unknown
The sample was predominantly female and highly educated, limiting generalizability to broader populations
What This Means
This research suggests that a digital program called eMPower — which combines guided movement, breathwork, meditation, coping skills training, and health education — can meaningfully reduce anxiety and depression symptoms in adults living with chronic medical conditions. In a large clinical trial with over 800 participants across 13 countries, people who used the program showed roughly 2.6 to 2.9 points greater improvement on a standard anxiety and depression scale compared to those who received usual care alone, after just 12 weeks. Improvements were also seen in fatigue and quality of life measures. Importantly, no safety concerns were identified in either intervention group.
One of the most notable findings is that adding weekly phone check-ins from trained (but non-clinical) supporters did not produce significantly better outcomes than using the digital program alone. This suggests that a fully self-directed digital version of the program may be just as effective as one with human coaching — a finding with important implications for how such programs could be scaled up broadly and at lower cost, particularly in settings where trained human support is limited or expensive.
This research matters because anxiety, depression, and fatigue are extremely common in people managing chronic illnesses, yet access to mental health support remains limited for many. Digital programs like eMPower could offer a widely accessible, low-resource option. However, the study authors caution that the results may not apply equally to all groups — the sample was largely female and highly educated — and that the 12-week timeframe means longer-term benefits remain unknown. Future research on cost-effectiveness and sustained effects would help clarify how these tools could best be integrated into care for people with chronic conditions.
Johnson E, Hyde A, Corrick S, Isley S, Wright G, Ezekowitz J, et al.. (2026). Effect of a digital intervention on mental health symptoms in adults with chronic conditions: A three-arm randomized controlled trial.. PLoS medicine. https://doi.org/10.1371/journal.pmed.1005198