Designing a Self-help Mobile App to Cope with Avoidance Behavior in Panic Disorder

Panic disorder (PD) is an anxiety disorder that in recent years has spread worldwide. PD is diagnosed when a person has recurring panic attacks, characterized by physical symptoms and disturbing thoughts and feelings that arise rapidly, reach their peak in a few minutes and soon disappear. Panic attacks, despite being harmless and relatively short, are highly distressing and deeply affect the lives of patients, who very often develop agoraphobia, an anxiety disorder that leads to systematic avoidance of places where previous attacks have occurred. PD is often a chronic condition that does not respond well to pharmacological treatment. However, psychotherapeutic approaches such as mindfulness have proved to be quite effective and their delivery through self-care eHealth tools has been encouraged by the World Health Organization. In this paper, we present a self-aid mobile app designed by and for patients affected by PD with mild agoraphobia. The app is aimed at helping users cope with avoidance behavior. Thanks to geolocation, the app automatically detects the proximity of a "critical place (i.e., where a previous attack has occurred) and suggests mindfulness strategies for coping with stress, in order to prevent anxiety escalation and panic. This paper describes the therapeutic background of the proposed application, as well as the mHealth best practices we strove to adopt in the design phase. Preliminary trials conducted with one patient are encouraging; nonetheless, we point out the need for further and more extensive tests to fully assess the effectiveness of our approach.