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Updated March 07, 2014.

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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.

What I Like

I like the concept of this app, in that it attempts to make cognitive-behavioral techniques accessible to the general public through a self-help program that is cost-effective and widely available.

I also like much of the content of this app, including the learning sections, the list of hierarchy items for browsing, and the recommendations for finding a therapist.

I like that the developers have tried to incorporate tracking over time by including daily anxiety ratings and self-tests as needed. The concept of the "To-Do List" is also a great way to introduce the idea of exposure training as something that can be incorporated into daily life.

In general, I found the app sections to be well organized as the initial "mailbox" icon that helps guide you through the different components was useful.

Criticisms

My list of criticisms includes both navigational problems as well as content-specific issues.

• In terms of the self-test, I felt as though more specific questions could have been asked. I responded as a person with mild social anxiety, but was not asked questions about public speaking fears or other specific social or performance situations. People who avoid most social situations might also have difficulty answering questions about situations that they do not encounter.
   
• When I made my daily rating of anxiety and the app plotted my rating on the progress chart, it seemed to be placed at the one year mark rather than at the starting point.
   
• 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).
   
• When creating my "To-Do List" I accidentally added the same fear items several times, not realizing that they were being included in the list. I then had to go in and delete these items one by one. A feature that prevents adding the same fear item more than once would be helpful; or a way to delete multiple hierarchy items at the same time.
   
• I also found creating the "To-Do List" using the library of items a little confusing and cumbersome. There appeared to be two levels of choices: an overall fear and a list of items to be practiced for that fear, but this did not become clear to me until several tries back and forth between the To-Do List and the library list.
   
• In general I found it confusing knowing how to navigate backwards and forwards in the app, and how to edit my list once it was created.
   
• As an iPad user, I would have liked to see a version that used the full screen capability instead of the small iPhone app.
   
• 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. I found this to be a strange indication for those with SAD; quite often fears are very much out of proportion to the situation but are still extreme and severe.
   
• It seemed at times that the items on my hierarchy list were being marked as done when I had not checked them off as completed. At other times it seemed liked items that had been marked done were being placed back on my list.
   
• 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

Since I did not use the app over an extended period of time, I can't comment on the effectiveness of the program for working on specific social fears. It would be nice to know if the app has been used and validated in controlled studies.

At times I felt as though the design might have been better suited to a software program that would be easier to navigate and understand. I do like that the app can be used in real-life exposures and that it tracks progress over time.

I believe the developers need to work out some of the bugs in this app and make it more user-friendly before the true value of the program can be evaluated. I do hope that some of the navigational clunkiness can be resolved to create a better user experience.

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