Biobehavioral assessment of the anxiety disorders: Current progress and future directions

Abstract

It is difficult to accurately assess and differentially diagnose the anxiety disorders. The current system of assessment relies heavily on the subjective measures of client self-report, clinical observation, and clinical judgment. Fortunately, recent technological advances may enable practitioners to utilize objective, biobehavioral measures of assessment in a clinical setting. The current body of literature on two of these biobehavioral tools (eye-tracking and electrocardiogram devices) is promising, but more validation and standardization research is needed to maximize the utility of these devices. Eye-tracking devices are uniquely capable of providing data that can be used to differentially diagnose anxiety disorders from both other commonly comorbid and misdiagnosed disorders. Both eye-tracking and electrocardiogram devices are able to provide change-sensitive assessment information. This objective, real-time feedback can assist clinicians and researchers in assessing treatment efficacy and symptom fluctuation. Recently developed wearable and highly portable electrocardiogram devices, like the wearable fitness and behavior tracking devices used by many consumers, may be particularly suited for providing this feedback to clinicians. Utilizing these biobehavioral devices would supply an objective, dimensional component to the current categorical diagnostic assessment system. We posit that if adequate funding and attention are directed at this area of research, it could revolutionize diagnostic and on-going assessment practices and, in doing so, bring the field of diagnosis out of the 20th century.

Keywords: Biobehavioral; Assessment; Diagnosis; Anxiety; Electrocardiogram; Electrocardiogram; Eye-tracker

Core tip: Anxiety disorders are some of the most commonly comorbidly- and mis-diagnosed disorders in the DSM-5. The current system of assessment and diagnosis depends on clinician and client report measures, which are subjective and prone to bias. Recent technological advances make it possible to utilize the biobehavioral measures from eye-tracking and electrocardiogram devices in clinical settings. These devices can provide a much needed dimensional, objective, and change-sensitive component to current diagnostic and treatment-efficacy assessment protocols. This article summarizes the status of and outlines future directions for research on this important topic.