Currently submitted to: JMIR Formative Research
Date Submitted: Mar 17, 2026
Open Peer Review Period: Mar 17, 2026 - May 12, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Pilot Prospective Study of a Conversational Agent–Based CBT Self-Help Intervention for Anxiety and Depression Among Medical Students
ABSTRACT
Background:
Medical students experience high rates of anxiety and depression, yet stigma, time constraints, and limited access to support often delay help-seeking. Digital self-help interventions may provide an accessible and low-threshold approach to supporting student wellbeing.
Objective:
To evaluate the feasibility, acceptability, and preliminary effectiveness of a conversational agent–based cognitive behavioral therapy (CBT) self-help intervention for anxiety and depression among medical students
Methods:
A two-week multinational, unblinded, pilot prospective study was conducted with 138 medical students enrolled at an Indian and Bulgarian university. Participants scoring ≥10 on the Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9) were randomized to either a conversational agent–based CBT self-help intervention (Woebot; n=69) or a self-help psychoeducational leaflet control (n=69). Anxiety and depression were assessed at baseline and post-intervention. Feasibility outcomes included recruitment, adherence, and engagement metrics. All data were collected in de-identified form following electronic informed consent.
Results:
Recruitment and retention were feasible, with 138 participants completing baseline and post-intervention measures. The intervention group demonstrated significantly greater reductions in anxiety and depression scores compared with controls (GAD-7 and PHQ-9, p<0.001). Engagement with the conversational agent was high, with participants completing most assigned interactions, and the intervention was rated as acceptable and user-friendly.
Conclusions:
A conversational agent–based CBT self-help intervention is feasible, acceptable, and shows preliminary effectiveness in reducing anxiety and depression among medical students. Larger and longer-term studies are warranted to confirm these findings and inform implementation in educational settings. Clinical Trial: Vardhman Mahavir Medical College & Safdarjung hospital, New Delhi – S. No. IEC/VMMC/SJH/Thesis/06/2022/CC-68
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