Instillness : Assistive Technology for the use of Anxiety and Panic Disorders

Emeri Audra Yarnoff

Although the benefits of assistive technology for people with physical disabilities are extensively recognized, the study and implementation of assistive technology in the mental health field have been relatively discounted. In an effort to address this situation directly, my thesis project examines the possibilities for developing effective and affordable assistive technology for emotional regulation and other mental behavior issues.


Socio-Economic context of anxiety disorders

Anxiety disorders are the most common mental illness in the U.S., with 19.1 million (13.3%) of the adult U.S. population (ages 18-54) affected.

According to “The Economic Burden of Anxiety Disorders,” a study commissioned by the ADAA and based on data gathered by the association and published in the Journal of Clinical Psychiatry, anxiety disorders cost the U.S. more than $42 billion a year, almost one third of the $148 billion total mental health bill for the U.S.
More than $22.84 billion of those costs are associated with the repeated use of healthcare services, as those with anxiety disorders seek relief for symptoms that mimic physical illnesses.
People with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers.

Mental illness affects virtually everyone in our society. Most of us will be personally touched by it, whether it is due to our own illness, or someone very close to us. And everyone is impacted to varying degrees by stress - from family, relationship and work difficulties, and from losses and other difficult life experiences. Yet there continues to be a profound stigma surrounding these problems, which often prevents those affected from seeking treatment.

Anxiety disorders include panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and phobias. About 40 million American adults have anxiety disorders, which frequently occur with depressive disorders or substance abuse. Most people with one anxiety disorder also have another anxiety disorder and typically have their first episode by age 22.

Panic Disorder: Nearly six million American adults have panic disorder. It typically develops in early adulthood (median age at onset is 24), but the age at onset extends throughout adulthood. About 33% of people with panic disorder develop agoraphobia--fear of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.

Generalized Anxiety Disorder: Nearly 6.8 million American adults have GAD. It can begin at any age, although the median age at onset is 31.

The Psychological Nature of PTSD

Posttraumatic stress disorder (PTSD) is an emotional illness that usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyper arousal). Although this condition has likely existed since human beings have endured trauma, PTSD has only been recognized as a formal diagnosis since 1980.
PTSD is a lasting consequence of traumatic ordeals that cause intense fear, helplessness, or horror, such as a sexual or physical assault, the unexpected death of a loved one, an accident, war, or natural disaster. Families of victims can also develop post-traumatic stress disorder, as can emergency personnel and rescue workers.
Statistics regarding this illness indicate that approximately 7%-8% of people in the United States will likely develop PTSD in their lifetime, with the lifetime occurrence (prevalence) in combat veterans and rape victims ranging from 10% to as high as 30%. Other important facts about PTSD include the estimate of 5 million people who suffer from PTSD at any one time in the United States and the fact that women are twice as likely as men to develop PTSD.
Economically, PTSD can have significant consequences as well. As of 2005, more than 200,000 veterans were receiving disability compensation for this illness, for a cost of $4.3 billion. This represents an 80% increase in the number of military people receiving disability benefits for PTSD and an increase of 149% in the amount of disability benefits paid compared to those numbers five years earlier.
Available Psychotherapeutic Treatments for PTSD

Currently, there are a number of psychotherapeutic treatments available for PTSD:
 Cognitive-behavior therapy, which involves learning to recognize and change, thought patterns that lead to troublesome emotions, feelings, and behavior.
 Exposure therapy, Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the practitioner guides the person with PTSD in talking about the trauma suffered and the negative feelings associated with the events, while focusing on the professional's rapidly moving finger. While some research indicates this treatment may be effective, it is unclear if this is any more effective than cognitive therapy that is done without the use of rapid eye movement.
 Psychodynamic therapy focuses on helping the person examine personal values and the emotional conflicts caused by the traumatic event.

Technology-enhanced Treatments for PTSD
PTSD is common in soldiers returning from combat duty and may also result from sexual or physical assault, imprisonment or hostage situations, terrorism, surviving an accident or disaster, or diagnosis of a life-threatening illness.
Conventional approaches to treatment, including antidepressant medication and psychotherapy, yield unacceptable recovery rates.
Exposure therapy has been recognized as a highly promising method for treating patients with PTSD. Exposure therapy is also known as virtual therapy.
Rather than relying on patients’ visualization skills to “relive” the traumatic experience, technological strategies such as virtual reality (VR) provide a controlled environment in which patients can experience a situation or scenario while learning to cope with their emotional responses.

(, 23 Nov. 2010.)

The T2 Mood Tracker, a free smart phone application the Defense Department released last week to help service members and veterans monitor their emotions with a few strokes on a touchpad. Though it does not diagnose mental health issues, it can help gauge feelings that may come with depression or post-traumatic stress. It was developed at the Department of Defense’s National Center for Telehealth & Technology at Joint Base Lewis-McChord. The program is only available for soldiers and on the android platform smartphones/
(, 04 Dec. 2010.)
After extensive research for current technology-enhanced applications accessible at this time, I was surprised at how little information was actually available. I found about half a dozen relevant programs, but my assumption is that they are more targeted for general anxiety and stress.

Developing an application for the relief and management of anxiety and panic disorders, called Instillness. Using this application, individuals and medical professionals can create customizable tools that will be beneficial for all classifications and disciplines of anxiety disorders, panic disorders, and Post Traumatic Stress Disorder. This application has mobile phone and Internet components and interfaces. There are many promising features such as the ability for individuals to have one-button instant access to multiple emergency contacts on their mobile phone. Use of this application will provide quantified self-knowledge by analyzing patterns of use during times of anxiety and panic. The information and data provided will collect and create visualized data to help evaluate triggers of distress and other ailments. Other features such as light therapy, sound therapy, and relaxation therapy will also be implemented into this application. The key goal of this application is to “instill” individuals with the tools to live a productive and healthy life.