Using apps to help with anxiety

This post was created by PGCert participants as part of their assessment for Unit 1 of the course. The brief was to choose two specific learning needs and evaluate technologies that could help students with these needs to learn more effectively.

Spielberger (1983) defines anxiety as a subjective feeling of tension, apprehension, nervousness, and worry associated with arousal of the nervous system. The right kind and level of anxiety encourages us toward change and growth. On the other hand, social anxiety is a disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations (Ruffins, 2007), where normal anxiety morphs into distress, making day-to-day functioning difficult (Schmidt et al. 2009).

Social anxiety is one of the major predictors of academic performance among university students (McCraty, 2007). It may cause a lack of interest in learning, and poor performance in exams and assignments (Ozturk and Mutlu, 2010). High levels of social anxiety can decrease working memory and increase distraction in students (Aronen et al. 2005).  Grant (2010) states that while all university students face anxiety, art students face a particularly intense kind. This may be due to the sheer amount of work and less free time they have, or the expectation to produce something that is original from day one which triggers the amount of anxiety (Chronicle.com, 2019).

For this PGCert task, we studied many anxiety apps and distilled them into five distinct types based on the approach used to tackle anxiety: mindfulness, meditation, breath-work, distraction and journaling. We have concentrated our work on journaling for we believed it can be extremely useful for students. Control is the key word for preventing and dealing with undesirable levels of anxiety, for if students feel like they are in control they will have better mental health whatever life throws at them (Remes, 2017).

A good example for jounaling apps is Moodpath, which is a personalised mental health companion. The app itself is free to use, but a subscription is needed to access exercises and other useful content (£48 per year with free 7 day trial). What we loved about Moodpath is that, with the help of its users, it offers an open research platform through their website (https://mymoodpath.com/en/science/). Prof. Zimmermann of Universität Kassel, who is the creator of Moodpath, notes that the platform has two aims: to provide scientists with new insights into individual causes of depression, and to help them in finding solid connections between experienced situations, emotions, and symptoms.

Moodpath has three functions:

  1.     You can assess your mental health by answering 3 daily questions: getting bi-weekly assessments, and sharing them with mental health professionals.
  2.   You can track and reflect on your mental state by creating mood journals: having daily reference of your emotional states, reflecting on your thoughts, feelings, and experiences, and understanding patterns and triggers.
  3.   Finally, you can improve your mental state by choosing from a large library of exercises: improving your sleep, reducing brooding, practising mindfulness techniques, and acquiring skills in self-compassion.

At a peak stress moment, calming breathing techniques (breath work) are key. It has been proven that exhaling longer than inhaling breathing exercises decrease anxiety immediately (Ma et al. 2017). The only downside of the Moodpath app is that it does not offer a quick access to breathing work, although it does offer breathing exercises in its library.

Whilst browsing through UCA recommended apps for anxiety, we also came across the Student Health App (SHA)/ Although it is not specifically designed for anxiety, we decided to include it as a reference app. SHA is a free-to-download app for general health. It doesn’t provide space for recording or reflecting on feelings, neither does it provide calming methods for immediate relief. Its main function is to teach students when it’s safe to manage self-treatable mental and physical health problems themselves, spot warning signs, and help them know when they need to seek professional advice. It is created and regularly updated by NHS doctors and experts in student health. It can be used offline. It also offers the possibility to create branded pages to Universities, staff and/or parents through customisation. The app has been certified by NHS England Information Standard, listed on the NHS Apps Library, reviewed and approved by the Organisation for the Review of Care and Health Applications (ORCHA).

There is a considerable amount of research which indicates that internet-based cognitive behavioural therapy is effective in the treatment of anxiety (Firth et al. 2018). However, research into the effectiveness of mental health apps is lacking, and the majority have no evidence of efficacy. Teaching and support staff at universities need to be aware of what apps are supported by such evidence, and should exercise caution when recommending apps to students (Marshall et al.2019). The majority of mental health apps present a popular and ubiquitous method of intervention delivery, although the evidence base supporting these newer approaches drastically falls behind the extensive marketing and commercialisation efforts currently driving their development (Powel et al.2019). Until there is evidence that these apps work, we should be cautious about saying they are the answer to anxiety and recommending them (Alyami et al. 2017).

References

Alyami, M. ,Giri, B., Alyami, H., & Sundram, F. (2017). Social anxiety apps: a systemic review and assessment of app descriptors across mobile store platforms’ In: Evid Based Mental Health Vol 20 No 3 pp 65 – 70 At:https://www.researchgate.net/publication/318058900_Social_anxiety_apps_A_systematic_review_and_assessment_of_app_descriptors_across_mobile_store_platforms [Accessed: 30 November 2019]
Aronen, E.T., Vuontela, V., Steenari, M.R., Salmi, J. and Carlson, S. (2005) Working memory, pyschiatric symptoms, and academic performance at school. Neurobiology of Learning and Memory, 83(1), 33-42, doi: 10.1016/j.nlm.2004.06.010 [Accessed: 30 November 2019]
Cronical.com  (2019) Art Students mental health: A complicated Picture, Anon, https://www.chronicle.com/blogs/arts/art-students-mental-health-a-complicated-picture/27923?fbclid=IwAR1U2yXmRfGe2dzU-mNyWGab_dl7FY7P9lGl3RXu4_H0eLM4tFG_gA_4zn8. [Accessed: 30 November 2019]
Ma, X., Yue, Z.Q., Gong, Z.Q. et al. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front Psychol.;8:874. Published 2017 Jun 6. doi:10.3389/fpsyg.2017.00874 [Accessed: 30 November 2019]
Marshall, J. M., Dunstan, D. A,. and Bartik, W. (2019). Clinical or gimmickal: The use and effectiveness of mobile mental health apps for treating anxiety and depression. Australian & New Zealand Journal of Psychiatry.  https://doi.org/10.1177/0004867419876700[Accessed: 30 November 2019]
McCraty, R. (2007). When Anxiety Causes Your Brain to Jam, use Your Heart. Institute of Heart Math. HeartMath Research Center, Institute of HeartMath, Boulder Creek, CA.
Firth J., Torous J., Carney, R., Newby J., D. Cosco T., Christensen H., and Sarris J. (2018). Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions. Current Psychiatry Reports · June 2018 DOI: 10.1007/s11920-018-0910-2 [Accessed 30 November 2019]
Grant, D. (2010). Art Students’ Mental Health: A Complicated Picture [online]: https://www.chronicle.com/blogs/arts/art-students-mental-health-a-complicated-picture/27923?fbclid=IwAR1U2yXmRfGe2dzUmNyWGab_dl7FY7P9lGl3RXu4_H0eLM4tFG_gA_4zn8 [Accessed 30 November 2019]
Ozturk, A. and Mutlu, T., (2010). The relationship between attachment style, subjective well-being, happiness and social anxiety among university students.  Procedia Social and Behavioral Sciences (9): 1772–1776
Powell, A.C., Yue, Z., Shan, C., et al. (2019). The Monetization Strategies of Apps for Anxiety Management: an International Comparison, Journal of Technology in Behavioral Science. 4: 67. https://doi.org/10.1007/s41347-019-00093-y[Accessed: 30 November 2019]
Remes, O. (2017). How to cope with anxiety, TEDx UHasselt [online video]  https://www.ted.com/talks/olivia_remes_how_to_cope_with_anxiety[Accessed: 30 November 2019]
Ruffin, P. (2007). A Real Fear: It’s More Than Stage Fright, Math Anxiety can Derail Academic or Professional Success, But Some Scholars are Working to Help Students Get over It. Diverse Issues in Higher Education. Findarticle.com (online) http://findarticles.com/p/articles/mi_m0WMX/is_2_24/ai_n18744928/[Accessed: 30 November 2019]
Schmidt, N. B., Richey, J. A., Buckner, J. D., & Timpano, K. R. (2009). Attention training for generalized social anxiety disorder. Journal of Abnormal Psychology, 118(1), 5–1. https://doi.org/10.1037/a0013643[Accessed 30 November 2019]
Sommer, A. (2019). Anxiety Disorders and Panic Attacks: TEDxCarletonCollege. [DVD] Directed by A. Sommer. https://www.youtube.com/watch?v=bl8_81JF3b8: Youtube. [Accessed: 30 November 2019]
Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory STAI. Palo Alto, CA: Mind Garden.
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