Mobile CBI App Beneficial for Anxiety and Depression in Patients With Functional Gastrointestinal Disorders

Investigators assessed the efficacy of a digital cognitive behavioral intervention for treating emotional distress in patients with functional gastrointestinal disorders.

Use of digital cognitive behavioral intervention (dCBI) was associated with statistically and clinically significant improvement in anxiety and depression for up to 4 months in adult patients with functional gastrointestinal disorders (FGIDs), according to a study in Clinical and Translational Gastroenterology.

Patients who were seen during routine care at an integrated behavioral neurogastroenterology clinic with symptoms of anxiety or depression were offered access to a health coach-enhanced dCBI app (RxWell); the app provides users with a brief skill-building intervention with techniques such as relaxation and cognitive reframing.

The participants also completed the General Anxiety Disorder-7 (GAD-7) and Personal Health Questionnaire Depression Scale (PHQ-8) tools in RxWell. The primary outcomes were a reduction in anxiety and depressive severity in a 4-month period after dCBI use was initiated.

A total of 364 patients with FGIDs were prescribed RxWell, of whom 176 (48.4%; mean age, 42.3 [SD, 15.8] years; 73.9% women; 92.1% White) were enrolled and completed the baseline GAD-7 or PHQ-8 measures. The app users were categorized into the anxiety (n=126 [71.6%]) and depression tracks (n=50 [28.4%]). The participants used a median of 3 techniques (IQR, 1-14), with 100 RxWell users (56.8%) completing 3 or more techniques.

Use of the RxWell app was associated with statistically and clinically significant differences between baseline anxiety scores and the scores at the first assessment and up to 4 months of follow-up. For depression, the differences between baseline scores and follow-up scores were not statistically different at the first assessment but were statistically and clinically different at up to 4 months.

In users who had sufficient follow-up data for analysis, about 70% (41/59 anxiety track users) had a reduction in anxiety scores, with 44% (26/59) having clinically significant reductions of 3 points or more in the GAD-7 scores. About 65% (30/46 depression track users) had a reduction in depression scores, with 52% (24/46) having clinically significant reductions of 3 points or more in PHQ-8 scores.

At 4 months, patients had a mean change in GAD-7 scores of 2.71 (SD, 5.68) and a mean change in PHQ-8 scores of 2.85 (SD, 4.58).

Anxiety scores improved in all RxWell users, regardless of whether they engaged with their digital health coach, but depression scores improved only in users who engaged with their digital health coach.

The investigators noted that their study was an open, nonrandomized implementation trial conducted primarily under a quality assurance framework. Additionally, the study did not restrict RxWell access to patients who met diagnostic criteria for anxiety disorder or clinical depression but was based on the patients’ reporting of anxiety or depression symptoms in a real-time clinic visit. Further, the researchers were limited in assessing the app’s effects on health care outcomes and gastrointestinal symptom improvements.

“These initial findings strongly argue for the further development of coached dCBI applications for broad application in gastroenterology care,” the investigators concluded.

Disclosure: One of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.


Szigethy E, Tansel A, Pavlick AN, et al. A coached digital cognitive behavioral intervention reduces anxiety and depression in adults with functional gastrointestinal disorders. Clin Transl Gastroenterol. 2021;12(12):e00436. doi: 10.14309/ctg.0000000000000436