Mindable: App support for anxiety disorders during the therapy waiting period

People with an anxiety disorder often feel restricted in their everyday lives. However, even when they are at the point of wanting help, finding a therapy place involves a long wait. During this challenging time, the Mindable app can help.

In an interview with MEDICA-tradefair.com, Prof. Thomas Lang explains how those affected can benefit from the app's content while waiting for a place on a treatment program.

Prof. Lang, why did you decide to develop an app for the treatment of anxiety disorders?

Prof. Thomas Lang: Anxiety disorders in general are very widespread. Every year, this disorder affects around 6 million people in Germany alone. Panic disorder with agoraphobia, which is the subject of the app, can be treated relatively well. We already know from previous studies that it can also be treated with the help of books. It was therefore to be expected that treating this panic disorder with an app would also be successful.

How does the app work in detail?

Lang: Once you have installed the app, you have three main areas to choose from. One of them is psychoeducation. Here, affected people can find out and learn what a panic disorder is and how to proceed with treatment.

Then there are two more exercise-related areas. One is about the fear of physical symptoms associated with the panic disorder. This is because during the panic attacks, those affected also feel the changes in their body. To this end, the app guides users through interoceptive exposure. This is a special form of confrontation therapy that aims to confront the person affected with anxiety-inducing body symptoms and thus help them to cope.

Thirdly, there is the section for agoraphobia, meaning fear in certain situations. Here too, the app provides guidance on how to behave in these situations and teaches you how to face the fear without avoiding it.

Patients can work through these three main areas and use questionnaires to give constant feedback on how it is helping them. The questionnaires are aimed at assessing the condition, especially in exposure situations. This can encourage perseverance and help to assess how much the body symptoms are causing anxiety and where more exercises would be useful. The app is designed in such a way that it can respond individually to the symptoms of the person concerned.

How exactly can the app help with the waiting time for a place on a treatment program?

Lang: Unfortunately, the waiting time for a place in therapy is relatively long. On average, patients with an anxiety disorder need seven to eight years from the onset of the disorder until they receive adequate treatment. The app can provide psychoeducation in advance. Patients who are unsettled by the anxiety disorder are thus given support in classifying this uncertainty. It can sometimes lead to a significant improvement in symptoms when they finally understand what is happening. The app can of course also be used to do exercises during the waiting period.

Is it possible to extend the app to other anxiety disorders or other mental illnesses in general?

Lang: This version of the Mindable app is focused on this particular anxiety disorder, with specially designed content. However, Mindable is currently working on an app for dealing with social phobia. However, this will be a different app, which makes more sense as the content for the clinical pictures is very different.

Now that the app has been approved by the health insurance companies as a DiGA, what would be your ideal scenario for how it should be used?

Lang: For me, the ideal scenario would be for patients to actually use the app during the waiting period and then perhaps go into treatment having already improved.

It would also be desirable for us to create a link between those affected and those treating them to ensure that the app is used in therapy. That is already possible. But it would be nice if the treating therapists could access the data from the app as well. As things are at present, those affected can do the exercises but not be supervised. If this were possible, the app would provide a good insight into what happens when people find themselves in problematic situations. A supplementary therapist dashboard, where medical professionals can log in and see how patients are doing the exercises, would be helpful. This could also motivate patients.

As a stand-alone application, the app is perfectly adequate for bridging the waiting time, but we know from research that it improves usage further if there is someone else in the background who reminds the patient of the exercises and with whom they can talk about them. It would therefore be a good idea to share it with the therapists.

It would be interesting to investigate whether this actually leads to an improvement. Whether patients ultimately feel as improved as after therapy or less so.