Review: Anxiety Coach App by the Mayo Clinic

"Anxiety Coach" is an app published by the Mayo Clinic
The Mayo Clinic publishes an app call "Anxiety Coach". Getty / Danita Dellimont

Anxiety Coach by Mayo Clinic is a self-help app designed to reduce anxiety, fear and worry common to social anxiety disorder (SAD) and other anxiety disorders. Anxiety Coach was designed by clinical psychologists Stephen Whiteside (Director of the Pediatric Anxiety Disorders Program at Mayo Clinic) and Jonathan Abramowitz (University of North Carolina).

Exercises are based on exposure training commonly practiced as part of cognitive-behavioral therapy (CBT).

The app also includes learning material so that users can learn more about how and why these techniques work.

Overview

The Anxiety Coach app is designed to be used over a period of several weeks to months as a tool to gradually face feared situations and reduce anxiety. The Anxiety Coach app consists of the following components:

  • General instructions
  • Self-tests
  • Anxiety ratings
  • Learning series
  • To-do lists

The app easily guides you through these different sections with a mailbox icon that indicates how many items you still have left to complete. Much like an email inbox, this is helpful when first starting the app so that you know what to do next.

After reading through general instructions for the app, users are asked to answer a series of questions as part of self-tests for various anxiety symptoms. From there, you are asked to make a rating of your current anxiety level on a scale from 0 to 100. Both of these results (scores from 0 to 100 on the self-tests and current anxiety ratings) are then plotted on graphs to be tracked over time.

In addition to the self-tests and anxiety ratings, users are directed to a series of readings to learn more about anxiety (what it is, how it affects you, when it is a problem and why it doesn't go away) as well as treatment (how to break the cycle, CBT, other resources and strategies to avoid).

Finally, the user is asked to create a "To-Do List," which is essentially a list of items on a fear hierarchy.

Users create this list by choosing amongst a list of problem areas and specific tasks. You are also able to enter your own user-generated hierarchy items. Once the list is created, you are asked to select an item that you are ready to perform: for example giving a compliment to a stranger on an elevator.

You are then asked to rate your anxiety (on a scale from 0 to 100) prior to the event, as well as in two minute intervals throughout. The goal is to stay in the situation until you have a 50% reduction in anxiety, at which point the item can be checked off your list or kept for additional exposure practice.

Pros

  • This app makes cognitive-behavioral techniques accessible to the general public through a self-help program that is cost-effective and widely available.
  • This app has valuable content, including learning sections, a list of hierarchy items for browsing, and recommendations for finding a therapist.
  • The developers of the app have incorporated tracking over time through daily anxiety ratings and self-tests as needed. The "To-do list" easily introduces exposure training into daily life.
  • In general, the app sections are well organized and the initial "mailbox" icon guides you through the different components.

    Cons

    • People who avoid most social situations might have difficulty answering questions about situations that they do not encounter.
    • In the "Learning about treatment" section, muscle relaxation and breathing exercises are listed as strategies to avoid when trying to improve anxiety. A more complete description might include the reasons why these strategies don't work, or how they might be incorporated within a larger treatment framework (such as progressive muscle relaxation used in tandem with exposure hierarchies).
    • A feature to prevent users from adding the same fear item to their "To-do list" more than once would be helpful.
    • Creating the "To-do list" using the library of items is a little confusing and cumbersome. 
    • In general, navigating backwards and forwards in the app is confusing, as is editing your list once it is created.
    • Users may find it cumbersome to use the app while completing exposures. Checking your iPhone every couple of minutes and making ratings while in a social or performance situation could be distracting both to you and to those around you.
    • For some exposures, the two-minute interval between rates seems like a long time. In addition, it might be hard to extend some exposures long enough for a reduction in anxiety of 50% to occur; for example, giving a compliment to a stranger in an elevator is not likely to last even the two minutes required to make a second rating.
    • When asked to indicate your initial level of anxiety, users are given a warning if they choose a rating that is very high (e.g., 85 out of 100). It is suggested that this level of anxiety or fear might be out of proportion to the situation. However, those with social anxiety disorder quite often have fears that are out of proportion to the situation but are still extreme and severe.
    • Separate "To-do lists" for different fears might be a better way to organize the hierarchy items and make things less confusing.

    The Bottom Line

    While this app doesn't provide evidence of effectiveness or validation through controlled studies, it offers the advantage of involving real-life exposures and tracking progress over time. It's a bit clunky to use as an app, and may be better suited to a computer software program. However, it's use "in the moment" eclipses some of these difficulties to make it a practical tool that you may wish to consider.

    A Word From Verywell

    As technology advances, it is inevitable that apps and software programs will be used to help individuals make progress with regard to their mental health. There is no reason not to try out this new technology, as long as you are also receiving traditional treatment in the form of cognitive-behavioral therapy (CBT) or medication if you live with severe social anxiety.

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