Abstract
Anxiety is increasingly becoming a global burden. Although several mobile anxiety assistive technologies have been designed and developed aiming to support the increasing demands, it is not well understood how the design can be improved to aid better regulation outcomes for patients while providing therapists with useful and timely data to make better clinical decisions in assessments and treatments. We explore this area through fifteen interviews with specialist therapists treating anxiety disorders. The uniqueness of this exploration lies in its special attention to therapists’ knowledge on inter-and intra- patient differences in anxiety. This focus enabled the identification of novel therapists-informed, therefore, clinically meaningful customization approaches that could be automated and integrated into the future assistive technologies for anxiety. The therapists’ notion of unintended adverse consequences of envisioned technologies is also revealed and discussed. Overall, this paper contributes to the future design of in-the-moment digital interventions and digital diaries for anxiety, an understudied area in the literature.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Albano, A.M., Barlow, D.H.: Breaking the vicious cycle: cognitive-behavioral group treatment for socially anxious youth. In: Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice, pp. 43–62 (1996)
Alonso, J., et al.: Treatment gap for anxiety disorders is global: results of the world mental health surveys in 21 countries. Depress. Anxiety 35(3), 195–208 (2018)
Aslan, I., Burkhardt, H., Kraus, J., André, E.: Hold my heart and breathe with me: tangible somaesthetic designs. In: Proceedings of the 9th Nordic Conference on Human-Computer Interaction, NordiCHI 2016, pp. 92:1–92:6. ACM, New York (2016)
American Psychiatric Association, et al.: Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing, Arlington (2013)
Bakker, D., Kazantzis, N., Rickwood, D., Rickard, N.: Development and pilot evaluation of smartphone-delivered cognitive behavior therapy strategies for mood-and anxiety-related problems: moodmission. Cogn. Behav. Pract. 25(4), 496–514 (2018)
Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., Wedekind, D.: Efficacy of treatments for anxiety disorders: a meta-analysis. Int. Clin. Psychopharmacol. 30(4), 183–192 (2015)
Barker, M., Van der Linden, J.: Sprite catcher: a handheld self-reflection and mindfulness tool for mental healthcare. In: Proceedings of the Eleventh International Conference on Tangible, Embedded, and Embodied Interaction, TEI 2017, pp. 419–425. ACM, New York (2017)
Beckers, T., Craske, M.G.: Avoidance and decision making in anxiety: an introduction to the special issue. Behav. Res. Ther. 96, 1–2 (2017)
Boukhechba, M., Baglione, A.N., Barnes, L.E.: Leveraging mobile sensing and machine learning for personalized mental health care. Ergon. Des. 28(4), 18–23 (2020)
Brandenburg, A.: Cognitive behavioral therapy for anxiety disorders: predictors of outcome. Master’s thesis, University of Twente (2017)
Chen, C., George, S., Liberzon, I.: 4.13 - stress and anxiety disorders. In: Pfaff, D.W., Joëls, M. (eds.) Hormones, Brain and Behavior, 3rd edn, pp. 251–274. Academic Press, Oxford (2017)
Cuijpers, P., Ebert, D.D., Acarturk, C., Andersson, G., Cristea, I.A.: Personalized psychotherapy for adult depression: a meta-analytic review. Behav. Ther. 47(6), 966–980 (2016)
Fitzpatrick, K.K., Darcy, A., Vierhile, M.: Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR Ment. Health 4(2), e19 (2017)
Frey, J., Grabli, M., Slyper, R., Cauchard, J.R.: Breeze: sharing biofeedback through wearable technologies. In: Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems, pp. 1–12 (2018)
Giannakakis, G., et al.: Stress and anxiety detection using facial cues from videos. Biomed. Sig. Process. Control 31, 89–101 (2017)
Grupe, D.W., Nitschke, J.B.: Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat. Rev. Neurosci. 14(7), 488–501 (2013)
Hobfoll, S.E.: Conservation of resources: a new attempt at conceptualizing stress. Am. Psychol. 44(3), 513 (1989)
Kaczkurkin, A.N., Foa, E.B.: Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin. Neurosci. 17(3), 337–346 (2015)
Kertz, S.J., MacLaren Kelly, J., Stevens, K.T., Schrock, M., Danitz, S.B.: A review of free iPhone applications designed to target anxiety and worry. J. Technol. Behav. Sci. 2(2), 61–70 (2017). https://doi.org/10.1007/s41347-016-0006-y
Kessler, R., Petukhova, M., Sampson, N., Zaslavsky, A., Wittchen, H.: Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int. J. Methods Psychiatr. Res. 21(3), 169–184 (2012)
Liang, R.H., Yu, B., Xue, M., Hu, J., Feijs, L.M.G.: BioFidget: biofeedback for respiration training using an augmented fidget spinner. In: Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems, CHI 2018, pp. 613:1–613:12. ACM, New York (2018)
de Lijster, J.M., et al.: The age of onset of anxiety disorders: a meta-analysis. Can. J. Psychiatry 62(4), 237–246 (2017)
Liu, H., Wen, W., Zhang, J., Liu, G., Yang, Z.: Autonomic nervous pattern of motion interference in real-time anxiety detection. IEEE Access 6, 69763–69768 (2018)
Loerinc, A.G., Meuret, A.E., Twohig, M.P., Rosenfield, D., Bluett, E.J., Craske, M.G.: Response rates for CBT for anxiety disorders: need for standardized criteria. Clin. Psychol. Rev. 42(C), 72–82 (2015)
Macik, M., et al.: Breathing friend: tackling stress through portable tangible breathing artifact. In: Bernhaupt, R., Dalvi, G., Joshi, A., K. Balkrishan, D., O’Neill, J., Winckler, M. (eds.) INTERACT 2017. LNCS, vol. 10516, pp. 106–115. Springer, Cham (2017). https://doi.org/10.1007/978-3-319-68059-0_6
Martinez, H., Bengio, Y., Yannakakis, G.: Learning deep physiological models of affect. IEEE Comput. Intell. Mag. 8(2), 20–33 (2013)
Martinez, S.G., Badillo-Urquiola, K.A., Leis, R.A., Chavez, J., Green, T., Clements, T.: Investigation of multimodal mobile applications for improving mental health. In: Schmorrow, D.D.D., Fidopiastis, C.M.M. (eds.) AC 2016. LNCS (LNAI), vol. 9744, pp. 333–343. Springer, Cham (2016). https://doi.org/10.1007/978-3-319-39952-2_32
Meuret, A.E., et al.: Do unexpected panic attacks occur spontaneously? Biol. Psychiatry 70(10), 985–991 (2011)
Mohammedali, M., Phung, D., Adams, B., Venkatesh, S.: A context-sensitive device to help people with autism cope with anxiety. In: CHI 2011 Extended Abstracts on Human Factors in Computing Systems, CHI EA 2011, pp. 1201–1206. Association for Computing Machinery, New York (2011)
Mood tracker (2020). https://www.moodtracker.com
Morrison, A.S., et al.: Anxiety trajectories in response to a speech task in social anxiety disorder: evidence from a randomized controlled trial of CBT. J. Anxiety Disord. 38, 21–30 (2016)
Nezu, C.M., Nezu, A.M., Bullis, J.R., Hofmann, S.G.: Adult anxiety and related disorders. In: The Oxford Handbook of Cognitive and Behavioral Therapies, 1 edn. Oxford University Press (2015)
Niles, A.N., et al.: Advancing personalized medicine: application of a novel statistical method to identify treatment moderators in the coordinated anxiety learning and management study. Behav. Ther. 48(4), 490–500 (2017)
Nowell, L.S., Norris, J.M., White, D.E., Moules, N.J.: Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods 16(1), 1–13 (2017)
Özseven, T., Düğenci, M., Doruk, A., Kahraman, H.İ.: Voice traces of anxiety: acoustic parameters affected by anxiety disorder. Arch. Acoust. 43(4), 625–636 (2018)
Parette, P., Scherer, M.: Assistive technology use and stigma. Educ. Train. Dev. Disabil. 39(3), 217–226 (2004)
Poon, S.K.: Pacifica: stressed or worried? An app to help yourself (mobile app user guide). Br. J. Sports Med. 50(3), 191–192 (2016)
Qu, C., Sas, C., Doherty, G.: Exploring and designing for memory impairments in depression. In: Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems, CHI 2019, pp. 510:1–510:15. ACM, New York (2019)
Rennert, K., Karapanos, E.: Faceit: supporting reflection upon social anxiety events with lifelogging. In: CHI 2013 Extended Abstracts on Human Factors in Computing Systems, CHI EA 2013, pp. 457–462. ACM, New York (2013)
Richter, J., Hamm, A.O., Pané-Farré, C.A., et al.: Dynamics of defensive reactivity in patients with panic disorder and agoraphobia: implications for the etiology of panic disorder. Biol. Psychiatry 72(6), 512–520 (2012)
Rosenfield, D., Zhou, E., Wilhelm, F.H., Conrad, A., Roth, W.T., Meuret, A.E.: Change point analysis for longitudinal physiological data: detection of cardio-respiratory changes preceding panic attacks. Biol. Psychol. 84(1), 112–120 (2010)
Rubin, J., Abreu, R., Ahern, S., Eldardiry, H., Bobrow, D.G.: Time, frequency & complexity analysis for recognizing panic states from physiologic time-series. In: Proceedings of the 10th EAI International Conference on Pervasive Computing Technologies for Healthcare, PervasiveHealth 2016, pp. 81–88. ICST (Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering), Brussels (2016)
Sanchez, A.Y.R., Kunze, K.: Flair: towards a therapeutic serious game for social anxiety disorder. In: Proceedings of the 2018 ACM International Joint Conference and 2018 International Symposium on Pervasive and Ubiquitous Computing and Wearable Computers, UbiComp 2018, pp. 239–242. ACM, New York (2018)
Schneider, R.L., Arch, J.J., Wolitzky-Taylor, K.B.: The state of personalized treatment for anxiety disorders: a systematic review of treatment moderators. Clin. Psychol. Rev. 38(C), 39–54 (2015)
Schroeder, J., et al.: Pocket skills: a conversational mobile web app to support dialectical behavioral therapy. In: Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems, CHI 2018, pp. 398:1–398:15. ACM, New York (2018)
Senaratne, H., Ellis, K., Oviatt, S., Melvin, G.: Designing efficacious mobile technologies for anxiety self-regulation. In: Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems, CHI EA 2019, pp. 1–6. ACM, New York (2019)
Senaratne, H., Kuhlmann, L., Ellis, K., Melvin, G., Oviatt, S.: A multimodal dataset and evaluation for feature estimators of temporal phases of anxiety. In: Proceedings of the 2021 International Conference on Multimodal Interaction, ICMI 2021, pp. 52–61. Association for Computing Machinery, New York (2021)
Silfvernagel, K., Wassermann, C., Andersson, G.: Individually tailored internet-based cognitive behavioural therapy for young adults with anxiety disorders: a pilot effectiveness study. Internet Interv. 8, 48–52 (2017)
Simm, W., Ferrario, M.A., Gradinar, A., Whittle, J.: Prototyping ‘clasp’: implications for designing digital technology for and with adults with autism. In: Proceedings of the 2014 Conference on Designing Interactive Systems, DIS 2014, pp. 345–354. ACM, New York (2014)
Steimer, T.: The biology of fear-and anxiety-related behaviors. Dialogues Clin. Neurosci. 4, 231–249 (2002)
Summerfeldt, L.J., Kloosterman, P.H., Antony, M.M., McCabe, R.E., Parker, J.D.: Emotional intelligence in social phobia and other anxiety disorders. J. Psychopathol. Behav. Assess. 33(1), 69–78 (2011)
Thieme, A., et al.: Challenges for designing new technology for health and wellbeing in a complex mental healthcare context. In: Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems, CHI 2016, pp. 2136–2149. ACM, New York (2016)
Topham, P., Caleb-Solly, P., Matthews, P., Farmer, A., Mash, C.: Mental health app design: a journey from concept to completion. In: Proceedings of the 17th International Conference on Human-Computer Interaction with Mobile Devices and Services Adjunct, MobileHCI 2015, pp. 582–591. ACM, New York (2015)
Torous, J., Wolters, M.K., Wadley, G., Calvo, R.A.: 4th symposium on computing and mental health: designing ethical emental health services. In: Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems, CHI EA 2019, pp. Sym05:1–Sym05:9. ACM, New York (2019)
Watt, M.C., Stewart, S.H., Conrod, P.J., Schmidt, N.B.: Personality-based approaches to treatment of co-morbid anxiety and substance use disorder. In: Stewart, S.H., Conrod, P.J. (eds.) Anxiety and Substance Use Disorders. SARD, pp. 201–219. Springer, Boston (2008). https://doi.org/10.1007/978-0-387-74290-8_11
Wehbe, R.R., et al.: Above water: an educational game for anxiety. In: Proceedings of the 2016 Annual Symposium on Computer-Human Interaction in Play Companion Extended Abstracts, CHI PLAY Companion 2016, pp. 79–84. ACM, New York (2016)
Williams, C., Garland, A.: Identifying and challenging unhelpful thinking. Adv. Psychiatr. Treat. 8(5), 377–386 (2002)
Wilson, C., Draper, S., Brereton, M., Johnson, D.: Towards thriving: extending computerised cognitive behavioural therapy. In: Proceedings of the 29th Australian Conference on Computer-Human Interaction, OZCHI 2017, pp. 285–295. ACM, New York (2017)
Winkler, P., et al.: Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys. Epidemiol. Psychiatr. Sci. 29(e173), 1–8 (2020)
World Health Organization: Depression and other common mental disorders: global health estimates (2017). Licence: CC BY-NC-SA 3.0 IGO
Acknowledgments
We thank our participants for their time and valuable insights. We also thank Swamy Ananthanarayan, Jarrod Knibbe, Patrick Olivier and Kim Marriott for providing feedback at different stages to improve this manuscript.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering
About this paper
Cite this paper
Senaratne, H., Melvin, G., Oviatt, S., Ellis, K. (2022). Therapist-Informed Design Directions for Mobile Assistive Technologies for Anxiety. In: Lewy, H., Barkan, R. (eds) Pervasive Computing Technologies for Healthcare. PH 2021. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, vol 431. Springer, Cham. https://doi.org/10.1007/978-3-030-99194-4_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-99194-4_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-99193-7
Online ISBN: 978-3-030-99194-4
eBook Packages: Computer ScienceComputer Science (R0)