PhD Research

Anxiety is a feeling experienced by everyone at some point in their lives – it is a natural function which alters us to potential danger, heightening our state of readiness so that we can assess and respond to the perceived threat. However, for some people their anxiety response is disproportionate to the perceived danger, leading to persistent and unpleasant symptoms. When these symptoms interfere with a person’s ability to function and they have difficulty controlling their responses to situations, then a diagnosis of an anxiety disorder is usually made [1].

Anxiety disorders are one of the most common mental health disorders in the UK [2]. In 2013, it was estimated that 18% of the adult population meet the diagnostic criteria of an anxiety disorder [3]. This number is likely an underestimation of the true number of people who suffer with anxiety.

There are several types of anxiety disorders including generalised anxiety disorder (GAD), panic disorder, phobias, and separation anxiety [4]. Even though each of these conditions have their own unique set of symptoms there are a number of symptoms which they all share, such as: tense muscles, trembling, increased breathing, having poor concentration, struggling with memory, and having poor problem-solving skills [5-7]. 

Commonly anxiety does not present itself in isolation, there are often co-morbid conditions involved. These co-morbid conditions can be other metal health conditions, such as depression, or could be physical conditions such as chronic pain [8, 9]. 

Chronic pain is defined as pain that persist for longer than 12 weeks despite the use of medication or treatment to try to alleviate the symptoms [10]. In 2016 it was estimated that 43% of the British population experienced chronic pain, with 14.3% living with pain that is moderately or severely disabling [11]. Of those with chronic pain it is estimated that 35% also suffer with anxiety [12, 13]. However, this is likely to be an underestimation of the prevalence of anxiety in people suffering from chronic pain as the values do not consider people who have sub-threshold levels of impairment and duration to warrant a formal diagnosis, even though they suffer greatly from anxiety [14]. 

The co-occurrence of anxiety and chronic pain can have a detrimental impact on a person’s quality of life (Bair et al., 2008). The presence of both anxiety and pain has been shown to  contribute to higher levels of reported pain, higher levels of self-reported disability, higher levels of avoidance of activities, lower levels of physical ability and lower levels of perceived ability to cope [15, 16].

Due to the high level of impact comorbid anxiety and chronic pain has on sufferers, and circular relationship they have, it is necessary to find effective treatments to break this cycle and help to alleviate symptoms. The most used treatments for anxiety are cognitive behavioural therapy and mindfulness techniques – they are also popular techniques used to treat people with chronic pain [17-21].

Cognitive behavioural therapy is a skills-based therapy which aims to help sufferers break the negative cycle of negative thoughts effecting feelings which effect behaviours which in turn effect thoughts [5, 22, 23]. 

Mindfulness techniques are often used alongside cognitive behavioural therapy to equip people with ways in which they can consciously attend to in the moment experiences, helping them to break the vicious cycle which only serves to perpetuate feelings of anxiety [24, 25]. 

In recent years, interest has grown in how to better support people with mental health and physical conditions. An area of focus has been on the use of mobile applications on smartphones. In 2019 it was estimated that there were over 40,000 health-related apps on both the Apple and Google Play app stores [26, 27]. 

The use of apps for mental health treatment in particular is a rapidly growing area and offers the potential for successful, cost-effective, wide-reaching treatment. Mental health apps are being recognised as a new frontier for delivering mental health treatment [28]. These apps have already been shown to have a positive effect on a range of issues including depression, stress, anxiety, bulimia nervosa, post-traumatic stress disorder, bipolar disorder, and schizophrenia [29-31].

However, what is lacking in current research is the consideration of the four areas mentioned above coming together – anxiety, chronic pain, CBT/Mindfulness, and mobile apps. This therefore raises the question: can existing techniques in CBT/Mindfulness be embedded into an app that can be seen to be useful to people with anxiety and chronic pain?

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31. Neary, M. and S.M. Schueller, State of the Field of Mental Health Apps. Cognitive and Behavioral Practice, 2018. 25(4): p. 531-537.

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