Changes in Stress, Burnout, and Resilience Associated with an 8-Week Intervention with Relational Agent 'Woebot'

34 Pages Posted: 1 Mar 2023


Background: Research investigating the potential for digital mental health interventions (DMHIs) with integrated relational agents to improve mental health outcomes is in its infancy. By delivering evidence-based mental health interventions through tailored, empathic conversations, relational agents have the potential to help individuals manage their stress and mood, and increase positive mental health.

Aims: The aims of this study were to: 1) assess whether a smartphone app delivering mental health support through a relational agent, Woebot, is associated with changes in stress, burnout, and resilience over 8 weeks, and 2) identify demographic and clinical factors associated with changes in these outcomes.

Method: This exploratory, non-randomized, single-armed, open-labeled trial was conducted from May to July 2022. A total of 256 adults (mean age 39 ± 13.35; 72% females) recruited through social media advertising enrolled in the study. Participants completed an 8-week intervention period during which they were invited to use a smartphone app delivering cognitive behavioral therapy (CBT) through a relational agent called 'Woebot'. Participant-reported measures of stress, burnout, and resilience were collected at Baseline, and Week 8. Changes in these outcomes during the study period were assessed. Bivariate and stepwise multiple regression modeling was used to identify sociodemographic and clinical factors associated with observed changes over the 8-week study period.

Results: Exposure to WB-LIFE was associated with significant reductions in perceived stress and burnout and significantly increased resilience over the 8-week study period. A greater reduction in stress was observed among those with clinically elevated mood symptoms (i.e., Patient Health Questionnaire-8 (PHQ-8) or Generalized Anxiety Disorder 7-item (GAD-7) scores ≥10) at baseline compared to those without; however, the differences in the improvements in resilience scores and burnout between the two groups were not statistically significant. Although a difference in the magnitude of change in stress was observed for participants with and without clinically elevated mood symptoms at baseline, significant improvements in stress, burnout, and resilience over the 8-week study period were observed for both groups. Bivariate analyses showed that race, insurance type, and baseline level of resilience were associated with changes in each of the outcomes, though baseline resilience was the only factor that remained significantly associated with changes in the outcomes in the stepwise multiple regression analyses.

Conclusion: Results of this exploratory study suggest that conversational agent-guided mental health interventions such as WB-LIFE may be associated with reduced stress and burnout and increased resilience in both clinical and non-clinical populations.

Funding declaration: This work was funded by Woebot Health.

Conflicts of Interest: ED, MP, SR, AW, AR, and VH are employees of Woebot Health.

Ethical Approval: WIRB-Copernicus IRB Group (WCG) Institutional Review Board (WCG-IRB) reviewed and approved this study on January 20, 2022. Informed consent was voluntarily given by all participants prior to their participation in the study.

Trial Registration: The trial was retrospectively registered on (#NCT05672745) on January 4, 2023.

Keywords: conversational agents, smartphone applications, Cognitive Behavioral Therapy, stress, burnout, resilience

Suggested Citation

Durden, Emily and Pirner, Maddison C. and Rapoport, Stephanie J. and Williams, Andre and Robinson, Athena and Forman-Hoffman, Valerie L., Changes in Stress, Burnout, and Resilience Associated with an 8-Week Intervention with Relational Agent 'Woebot'. Available at SSRN: or

Maddison C. Pirner

Woebot Health ( email )

Stephanie J. Rapoport

Woebot Health ( email )

Andre Williams

Woebot Health ( email )

Athena Robinson

Woebot Health ( email )

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