Digital Wellness Intervention Improved Mental Health and Quality of Life for Patients with Chronic Liver Disease

Individuals living with chronic liver disease experience fatigue, anxiety, and depression, which diminish their quality of life and increase their risk for frailty. However, mental health issues are often underrecognized and undertreated in this population, partly due to the challenges involved in prescribing pharmacotherapy to individuals with liver dysfunction. 

Nonpharmacologic interventions that integrate therapy, movement, and mindfulness components have shown promise in addressing these multidimensional symptoms (Watt M et al. Hepatol Commun 2023;7:e0316). Given the limited information about the use and efficacy of such interventions in real-world settings, a liver-specific subgroup analysis of 255 people enrolled in the eMPower randomized controlled trial was conducted to assess whether the 12-week online wellness program could improve mental health, fatigue, and quality of life in adults with chronic liver disease compared with the standard of care. Lead author Emily Johnson, a research fellow in the division of gastroenterology at the University of Alberta in Edmonton, Canada, presented the findings in a poster session at The Liver Meeting 2025. 

The three-arm eMPower trial evaluated a 12-week online mind-body wellness intervention combining acceptance-and-commitment therapy skills, guided meditations, mindful movement, and disease-specific education. Validated baseline surveys were used to assess fatigue, mental health, demoralization, frailty, and quality of life. A vast majority of the participants (72%) had primary biliary cholangitis (PBC), while the rest had either cirrhosis (20%) or primary sclerosing cholangitis (8%). Most participants were women (88%), with a mean age of 59 years. 

The analysis revealed that fatigue and mental health symptoms were common across the spectrum of chronic liver disease. Moderate-to-severe physical fatigue emerged as the most predominant symptom, which was also closely connected to psychological distress and reduced quality of life. Anxiety and depression were also common, as was moderate distress, reflected in the demoralization scores. Fried Frailty scores indicated that many participants were in the pre-frail to mildly frail range, showing increased vulnerability to physical and functional decline. 

Overall, the eMPower intervention achieved greater symptom reductions than the standard of care. Qualitative interviews revealed that the intervention taught participants how to pace themselves and be more self-aware, which led to improvements in physical fatigue, overall mental health, demoralization, and quality of life. Improvements in cognitive and psychosocial fatigue and frailty domains were also observed. The participants reported that, although fatigue remained a significant symptom, the emotional regulation they had learned through the breathing, movement, and mindfulness practices embedded in the online intervention improved their quality of life. “I’m not pushing through the exhaustion anymore,” a patient with PBC remarked in an interview. “I take breaks. That makes a big difference.” 

The findings suggest that low-intensity digital programs have the potential to reduce symptom burden and enhance wellbeing in hepatology care, Johnson and colleagues concluded. Interventions that target fatigue, anxiety, psychological distress, and frailty could better address the complex needs of patients with chronic liver disease by combining liver care with mental health support.