Anxiety: A Big Challenge

Life has its ups and downs and it is normal to feel anxious (worried or scared) sometimes. Feeling anxious is your body’s way of helping you deal with difficult experiences. If feelings of anxiety become too strong or last a long time, they can make you unwell. At this point, anxiety can become a problem and make it difficult to do the day-to-day activities you like. This is called an anxiety disorder and it is a type of illness. Unfortunately, anxiety disorders are quite common. A recent study estimates that one-third of all the people in the world will experience an anxiety disorder at some time in their life [1]. That is a lot of people! Luckily, there are medicines and therapies to help, but every person has different needs. Therefore, it is important that scientists keep exploring ways to help people with anxiety. We started our project to find new, non-medical ways to help people with anxiety.

Early Design Of the Robotic Cushion

Our project involved working as a team made up of a designer, an engineer, a psychologist (someone who studies the brain and behavior) and a roboticist (a person who makes robots). We wanted to make a device to help people with anxiety. In the beginning, we did not know what the device should do or look like. So, we used a method called iterative design, which is a process of creating something, testing it with people, then creating a new version based on their feedback, and testing it again. We kept repeating (iterating) this process until we came up with a good final design. In our project, we went through three design iterations.

The first iteration was the most difficult because we did not know what a good design might be, so we had to try something out to see if it worked. Just as importantly, if our design did not work, we wanted to find out why.

Using the various skills of our team members, we started by creating early attempts at our device, called prototypes. These prototypes took the form of cushions (Figure 1) with robotic parts inside. Each one was designed to create a different calming experience, taking inspiration from existing research and our personal experiences. We ran focus groups (groups of people outside of the project team who provide feedback on ideas) to ask people which cushions were their favorite and why. We also showed them different fabrics and colors, and asked them which they would like best on a calming cushion device. The results helped us improve the prototypes. We made five cushion prototypes (Figure 2), which did different things:

• Cushion 1 had a balloon inside that inflated and deflated to create a feeling like breathing, inspired by the feeling of cuddling a person or pet.

• Cushion 2 had a moving part inside that created the feeling of a heartbeat, inspired by feeling someone’s heartbeat when hugging them.

• Cushion 3 vibrated gently to create a feeling of purring, inspired by the feeling of stroking a purring cat.

• Cushion 4 combined the purring and breathing ideas in one cushion.

• Cushion 5 had rainbow-colored lights inside that slowly rotated and could be made brighter and clearer by pressing your fingers on them.

For our second iteration, we ran another focus group asking people which cushion would be best for helping with anxiety. Cushion 1 (the one that feels like it is breathing) received the most positive comments. On average, people gave the breathing-feeling cushion a score of 8 out of 10 for how pleasant it felt, on a scale from 0 (unpleasant) to 10 (pleasant). They also described this cushion as “calming”, “soothing”, and “relaxing”, which suggested that it could be helpful for reducing anxiety. Therefore, we choose the breathing cushion to explore further.

Final Design: The Breathing Cushion

For our final design, we made a better version of the breathing cushion based on the feedback we got from the focus groups. For example, we made the cushion larger to be more huggable and used soft, blue fabric (Figure 3).

We made a robotic device that could push air in and out of a balloon inside the cushion, to control the “breathing”. Because slower breathing is more relaxing, we used a slow breathing rate of 10 breaths per minute. Ten breaths per minute means breathing in slowly for 3 s and breathing out for 3 s—try it for a couple of breaths and see how you feel!

Does the Breathing Cushion Help With Anxiety?

Now that we had our final prototype, we wanted to test whether the cushion could reduce anxiety, so we needed to run an experiment. This experiment needed to do three things. It needed to make people anxious, measure their anxiety levels, and compare the effect of the cushion to something else, so we could see if the cushion reduced anxiety levels.

We made people anxious by making them do a really hard maths test in front of other people. How would you feel if your teacher asked you to stand up in class and answer maths questions?!? Measuring anxiety is difficult and there are lots of ways to do it. We used a measure of anxiety that asked participants to rate how true the following statements were for them: “I feel calm”, “I am tense”, “I feel upset”, “I am relaxed”, “I feel content”, and “I am worried” [2]. To compare how effective the cushion was at reducing anxiety, we split people into three groups (called conditions). Condition A experienced the breathing cushion, Condition B experienced a guided breathing meditation (a slow breathing technique that can help reduce anxiety), and Condition C sat in silence without any method to help their anxiety (a control condition).

Our experiment had 129 participants. The steps of the experiment were:

• Step 1: We measured the anxiety levels of all participants (we called this measurement Time1 and it was a baseline that allowed us to see if people got more or less anxious than normal).

• Step 2: We made the participants feel anxious by telling them about the maths test they would do in 10 min.

• Step 3: The participants then experienced either the cushion, the meditation, or did nothing, depending on what condition they were in.

• Step 4: After 10 min, we measured anxiety levels again (measurement Time2).

• Step 5: We brought the participants together for the maths test. We expected this to make them very anxious!

• Step 6: After the test, we measured their anxiety levels (measurement Time3).

• Step 7: The participants then experienced the same condition as before: the cushion, the meditation, or nothing, for 10 min.

• Step 8: Afterwards, we measured anxiety levels for the last time (measurement Time4).

• Step 9: We thanked the participants for taking part and told them about our research.

Results of the Experiment

At that point we had lots of data! First, we checked that the participants in the three conditions all started with similar levels of anxiety (measurement Time1). They did, which meant we could compare their other anxiety measurements. We also checked that the maths test made participants feel anxious, to make sure that our method worked. It did—participants anxiety levels were much higher after the maths test (Time3) compared to the baseline (Time1).

Then we came to the main findings. We checked measurement Time2 and found an exciting result: the people who hugged the breathing cushion had much less anxiety than the people who sat in silence. This means that the breathing cushion helped people to feel less anxious when they were about to do the maths test! We checked the measurements for the people who did the meditation and found that it also helped reduce their anxiety.

These findings suggested that the breathing cushion can help when someone is feeling anxious.

How Can We Help More People With Anxiety?

Our experiment showed that the breathing cushion could be a useful tool for helping people when they feel anxious. Not everyone wants to take medicines, and meditation can be difficult because it takes focus and practice. But hugging a cushion is easy! And it is possible that a person could use the cushion while doing other things [3]. By continuing to do more research like this, we can help people who have different needs or preferences for treatment. We hope that the breathing cushion can help many people when they feel anxious. What do you think—would you like to have a breathing cushion to hug when you feel worried about something?

Glossary

Anxiety: ↑ A feeling of worry, nervousness, or unease, which can be mild or strong.

Anxiety Disorder: ↑ When normal feelings of anxiety get stronger and uncontrolled, we can feel it in our bodies, and it often stops us doing what we want to.

Iterative Design: ↑ A method for designing new objects or devices. The process involves multiple iterations (or cycles) of design and testing.

Prototype: ↑ A first version of a device, to test if the idea works.

Focus Group: ↑ A group of people who give feedback about a device or product.

Control Condition: ↑ In experiments a control condition is used to compare a treatment (the experimental condition, e.g. breathing cushion) to a baseline where the treatment is absent (sitting in silence).

Baseline: ↑ An early measurement used before an intervention or treatment to check for a change due to the intervention or treatment at a later time.

Conflict of Interest

AL was employed by Bonnie Binary Ltd.

The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The prototype development was funded by a seedcorn grant from the Brigstow Institute, University of Bristol, UK which also supported author AL in the form of consultation fees. AH was supported through the EPSRC Doctoral Training Partnership (EP/N509619/1) and now by Saarland University, Germany. JR was supported by the Royal Academy of Engineering as a Chair in Emerging Technologies and by the EPSRC (grants EP/M020460/1, EP/R02961X/1, EP/S026096/1 and EP/T020792/1). AL received a salary from Bonnie Binary during the timeframe of this project. The specific role of the author is articulated in the “author contributions” section. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.