A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study

Background: Panic attacks (PAs) are an impairing mental health problem that affects >11% of adults every year. PAs are episodic, and it is difficult to predict when or where they may occur; thus, they are challenging to study and treat. Objective: The aim of this study is to present PanicMechanic, a novel mobile health app that captures heart rate-based data and delivers biofeedback during PAs. Methods: In our first analysis, we leveraged this tool to capture profiles of real-world PAs in the largest sample to date (148 attacks from 50 users). In our second analysis, we present the results from a pilot study to assess the usefulness of PanicMechanic as a PA intervention (N=18). Results: The results demonstrate that heart rate fluctuates by about 15 beats per minute during a PA and takes approximately 30 seconds to return to baseline from peak, cycling approximately 4 times during each attack despite the consistently decreasing anxiety ratings. Thoughts about health were the most common trigger and potential lifestyle contributors include slightly worse stress, sleep, and eating habits and slightly less exercise and drug or alcohol consumption than typical. Conclusions: The pilot study revealed that PanicMechanic is largely feasible to use but would be made more so with modifications to the app and the integration of consumer wearables. Similarly, participants found PanicMechanic useful, with 94% (15/16) indicating that they would recommend PanicMechanic to others who have PAs. These results highlight the need for future development and a controlled trial to establish the effectiveness of this digital therapeutic for preventing PAs.