The coronavirus pandemic is making everyone a little anxious. But for people already suffering from anxiety and posttraumatic stress disorders, the virus and related uncertainties are a serious and growing threat. "The coronavirus pandemic is pushing America into a mental health crisis," reported the Washington Post on May 4. "Anxiety and depression are rising."

Panic attacks are a common feature of anxiety disorders. These intense episodes can come on at any time and cause extreme physical distress. Symptoms include racing heart rate, trembling, sweating, difficulty breathing and the feeling that the attack will never end. People who suffer panic attacks often say they feel like they're dying; in fact, some of them end up in hospital emergency rooms — an awful experience during normal times, and one that could expose them to COVID-19 today.

Reliably effective treatments for these episodes are scarce. Biofeedback, one promising option, involves charting physiological changes as they happen, but it typically requires medical monitoring. That can be hard to access in the moment — a barrier to treatment, given that panic attacks occur without warning.

In April, researchers at the University of Vermont introduced a new solution: the PanicMechanic smartphone app. Created by Shelburne residents Ellen and Ryan McGinnis, PanicMechanic gives users the ability to measure their body's physiological response to a panic attack while it's happening — using their smartphone. It's available in Apple's App Store for $19.99, roughly the cost of a doctor's visit copay.

Starting May 6, the couple is making it free for all frontline workers (see below).

During an April interview on WCAX-TV, Ellen, a trained clinical psychologist and assistant professor at UVM's Center for Children, Youth and Families, explained the app's appeal: Often during panic attacks, she said, "people are told just to breathe and try to relax. And then, while they're having a panic attack, they think, Man, I can't even relax. I must be failing at this; I have no control over my body."

The app counters that feeling by giving users something to do while they're experiencing one of these episodes. It asks them to measure their body's responses and provide data on what led to the attack.

"By tracking your physiology and understanding the patterns of your body," said Ellen, "you're able to take that control back."

PanicMechanic's origin story

Ellen McGinnis speaks from experience. The Shelburne native used to have panic attacks herself.

She describes them on the PanicMechanic website: "I was in graduate school for clinical psychology, meanwhile, at home I was experiencing a couple of panic attacks a week. I was hyperventilating, my heart was pounding, I felt dizzy. It felt like they were lasting forever."

During a phone interview, she explained that in 2012, during the second year of her PhD program at the University of Michigan, she learned about biofeedback and tried it herself. "I took my own pulse in my living room, graphed it out, then did that during panic attacks for two to three weeks," she said.

It worked. She hasn't had a panic attack since, and she has had success using a similar technique with multiple patients.

Ellen's experience with biofeedback provided the initial spark that led to the app. She worked with her husband, Ryan, an assistant professor of electrical and biomedical engineering, to figure out how to use a smartphone as a measuring tool.

How it works

Like Ellen, Ryan grew up in Vermont — in Charlotte — and graduated from Champlain Valley Union High School in 2005. The two were friends there and started dating after they both landed at Lafayette College in Pennsylvania. After graduation, both earned their doctorates at the University of Michigan. The couple moved back to Vermont in 2017 and are now quarantining with their two young sons.

Ryan explained that the technology is similar to that used by a pulse oximeter, the device that clips onto your finger at the doctor's office and measures heart rate and oxygen saturation. To use PanicMechanic, you put your finger over the camera on your smartphone with the light on, and the app records a video.

You can actually see the blood flowing through your capillaries and watch the color changing, he said. "It's super cool."

The app also asks the user to rate the severity of the attack and record the conditions leading up to it. Different screens ask questions about sleep, exercise, diet and alcohol consumption. This gives the user something to focus on and also provides data that will help them better understand their triggers so they can prevent future attacks.

PanicMechanic's red, white and mauve color scheme validates the sense of alarm users feel while interacting with it, while also holding out the promise of de-escalation. Supportive messages such as "Hang in there!" and "You got this" add to the effect. The couple noted that the app is meant to be used in addition to, not instead of, professional clinical care.

"It's one of the first examples of an app that uses objective measurements of your physiology within a digital mental health framework," Ryan told WCAX. "It's really exciting."

Participants who used the app during a UVM study reported that it helped the duration and severity of their panic attacks. One wrote: "I found it extremely reassuring and validating. Particularly, being able to plot my heart rate and being asked to reflect on my level of anxiety feels like taking some measure of control over a very uncontrollable experience."

A team effort

To produce PanicMechanic, the McGinnises founded a company, Allostatech, that grew out of their academic research at UVM. They got assistance from the school's technology transfer specialists; other faculty collaborators helped them use machine learning to improve the accuracy of the user-collected heart-rate data.

In July 2019, the McGinnises hired Steve DiCristofaro of New York-based Synbrix Software to produce the iPhone app. Burlington-based nonprofit game design studio Rad Magpie is building the Android version, with help from a grant from the Vermont Department of Economic Development. Ellen said it should be available by early June.

PanicMechanic is Allostatech's first project, but the McGinnises are already looking into the next one: an app to help screen preschoolers for signs of anxiety or depression. It would involve assessments of movement and speech, Ellen explained.

James Hudziak, director of the Vermont Center for Children, Youth and Families at the UVM College of Medicine and Medical Center, is excited about the prospect of that project, which will use wearable sensors for early detection of child anxiety. He calls PanicMechanic "a simple and beautiful example of digitally delivered cognitive behavioral therapy."

Hudziak is hopeful that advances in machine learning, artificial intelligence and biomedical engineering can help provide valuable clinical data and possibly aid in mental health treatment.

He has known Ellen since she was in high school, and recruited her to join his team at UVM. He's eager to see what she and Ryan will come up with. "UVM is lucky to have them both," he said.

Info

The PanicMechanic App is available on the App Store; available soon on Android. $19.99, free for frontline workers. panicmechanicapp.com

Frontline Workers Get the App for Free

From the creators of PanicMechanic: We are so thankful for all of the frontline health care professionals, first responders, postal workers and all essential employees. We know that this is an immensely stressful time and we want to show our appreciation and support by gifting you the PanicMechanic App to help you manage your panic attacks. Just tag us in a picture of you at work (or email a pic to [email protected]) to get your free app!

More info

Are you or someone you love in crisis? Access free, 24-7 support through Vermont's Crisis Text Line. Here's how it works:

1. Text "VT" to 741741 from anywhere in the USA, anytime, about any type of crisis.
2. A live, trained crisis counselor receives the text and responds quickly.
3. The volunteer crisis counselor helps you move from a hot moment to a cool moment.

• Learn more at vtcrisistextline.org.
• Reach the National Suicide Prevention Lifeline at 1-800-273-8255, or call Vermont 2-1-1 for information about local services.