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Mental Health on the Go

Severe, debilitating anxiety has afflicted Scott Stossel his entire life, a life he describes in his morbidly fascinating new memoir,. His case may be especially tormenting, but he is far from alone in this plight.
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Journalist Scott Stossel was so anxious at his own wedding that he had to hold on to his new bride in order to steady himself at the altar. His clothes were by then soaked through by torrential sweat. At the birth of his first child, with his wife in the throes of labor, the nurses had to turn their attention to the expectant father, who had gone pale and keeled over. He has also had breakdowns in the middle of job interviews, dates and plane flights. Even ordinary activities like talking on the phone can trigger pervasive dread, accompanied by nausea, shaking, and vertigo.

Severe, debilitating anxiety has afflicted Stossel his entire life, a life he describes in his morbidly fascinating new memoir, My Age of Anxiety. His case may be especially tormenting, but he is far from alone in this plight. Nearly three in ten people experience a serious anxiety disorder at some point in their life, making it the most common form of mental illness. That's 90 million sufferers in the United States alone.

Yet half of these people fail to get any treatment, and instead continue to struggle with their crippling fears. The cost, the stigma of mental illness, the time commitment, accessibility -- all of these conspire to keep people from seeking or receiving help.

This disconnect is troubling to mental health professionals, who have been searching for alternative ways to get help to this anxious population. Some have recently become interested in exploring the potential of computerized and mobile devices, mostly because they are everywhere now. Nine in ten American adults now have a cell phone, and most use these phones for mobile applications or internet access. Could this technological advance offer a unique opportunity to broaden the reach of mental health services?

Two psychological scientists at the City University of New York have started to investigate this possibility. Tracy Dennis of Hunter College and Laura O'Toole of CUNY's Graduate Center are especially interested in translating psychological interventions into games, complete with gaming interfaces, animated graphics and competition for points and rewards. These enticements, they believe, could help engage otherwise reluctant people into treatment and also boost compliance -- and perhaps even prevent anxiety disorders from starting in the first place.

Dennis and O'Toole are in the early stages of testing such a therapeutic game for use with anxiety. The theory is that anxiety disorders are rooted in a dysfunctional cognitive bias -- an exaggerated tendency to focus attention on danger and threat, and to ignore signs of safety and pleasure. This cognitive bias is believed to emerge in childhood, creating a fearful state of mind that unfolds into persistent and pervasive adult anxiety.

To combat anxiety at its cognitive root, the scientists try to modify the skewed attention, to train it away from threat cues. They do this by creating non-threatening competition for the threat cues, and repeatedly directing attention to these competing cues. Here's how the scientists have incorporated this psychological intervention into a simple game:

Two animated sprites appear on the game screen, one with an angry expression and one with a neutral expression. The sprites simultaneously burrow into the grass field, but only one of them causes a visible path of rustled grass to appear. Gamers are instructed to trace this burrowed trail with their finger. They are told to do this as quickly and accurately as possible, and they earn points and colored "jewels" based on performance. But here's the therapeutic part: For some players, the controls, the grass trail is just as likely to follow the angry or the neutral sprite. But for those in the therapy group, all trails lead to the non-threatening sprite. This idea is that this movement -- in the guise of game playing -- actually retrains the players' attention away from threat and toward something non-threatening.

Dennis and O'Toole recruited a group of subjects, from 18 to 50 years old, who all scored high on anxiety. Before the game began, they took a number of measurements: anxiety -- as a trait and also observed nervous behavior -- threat bias, stress reactivity, and mood. Some of them played the game for 25 minutes, and others for 45 minutes. Then the scientists repeated the measurements, to see if the intervention app had any therapeutic effect.

It did, clearly. As described in an article to appear in the journal Clinical Psychological Science, a single session of the therapeutic version of the game, compared to the control version, reduced subjective anxiety and signs of stress reactivity. Importantly, only the 45-minute gaming experience -- not the shorter one -- reduced threat bias, the core cognitive component implicated in anxiety.

Dennis and O'Toole believe that this app, and others like it, might have potential as "cognitive vaccines" to prevent or disrupt the trajectory of psychopathology. And notably, the therapy is mobile and entertaining -- perfect for the young people who may be feeling the first ominous stirrings of a full-blown anxiety disorder.