On the date of each intervention group's last session and 6 weeks later, intervention and paired waitlist participants were sent emails to complete trial measures online. They could complete measures up to 14 days post-invitation. Email, text, or phone reminders were sent 3, 8, and 11 days after initial invitations, if measures were not completed. Detailed information on outcome measures is available in the appendix (pp 5–10).

For the primary outcome analysis, the 4-item PROMIS Anxiety 4a version 1.014 was used to measure anxiety symptoms at immediately post-intervention. Raw scores are converted into T scores standardised in the US adult general population (mean=50, SD=10). Higher scores represent more anxiety. Estimates of minimal clinically important difference (MCID) range from 2·4 points to 4·0 T-score points;17, 18 we conservatively used 4 points.

Secondary outcomes were anxiety symptoms 6 weeks post-intervention and other outcomes post-intervention and 6 weeks later, including depression symptoms (Patient Health Questionnaire-8; PHQ-8);19 fear (COVID-19 Fears Questionnaire for Chronic Medical Conditions);9 loneliness (6-item version of UCLA Loneliness Scale; ULS-6);20 boredom (8-item version of Multidimensional State Boredom Scale; MSBS-8);21 physical activity (International Physical Activity Questionnaire – elderly; IPAQ-E);22 and, among intervention participants, the Client Satisfaction Questionnaire (CSQ-8; post-intervention only).23

The eight-item PHQ-8 measures depression symptoms19 over the last 2 weeks; higher scores (range 0–24) reflect more depressive symptoms. The ten-item COVID-19 Fears Questionnaire for Chronic Medical Conditions9 assesses fears in the last week; total scores range from ten to 50 with higher scores reflecting greater fear. The six-item ULS-6 assesses feelings of loneliness and social isolation.20 Total scores range from 0 to 18 with higher scores indicating greater loneliness. The eight-item MSBS measures state boredom.21 Total scores range from 8 to 56 with higher scores reflecting greater boredom. The four-item IPAQ-E assesses physical activity22 over the last week, including time spent sitting, walking, and in moderate and vigorous physical activity. The eight-item CSQ-8 assesses satisfaction with health services23 and was adapted for SPIN-CHAT. Total scores range from 8 to 32 with higher scores reflecting greater satisfaction. Adverse events were assessed by ongoing monitoring and post-intervention inquiry.

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