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SPEAKEASY-A MOBILE ASSISTANT FOR THE MANAGEMENT OF

SOCIAL ANXIETY IN SPEECH SITUATIONS
Kuderna-Iulian BENA

Marcel CREMENE

Technical University of Cluj-Napoca, Faculty of Electronics, Telecommunications and Information Technology, 26-28
G. Bariiu Street, 400027 Cluj-Napoca, Romania, Phone +40264401913 Email: {benta, cremene}@com.utcluj.ro

Silviu-Andrei MATU
Babes-Bolyai University, Departament of Clinical Psychology and Psychotherapy, No. 37, Republicii St., 400015, ClujNapoca, Romania, Phone + 40264434141, Email: silviu.matu@ubbcluj.ro

Ioana Roxana PODINA

Babes-Bolyai University, Departament of Clinical Psychology and Psychotherapy
and University of Bucharest, Department of Psychology
No. 37, Republicii St., 400015, Cluj-Napoca, Romania, Phone +40746367186, Email: ioana.r.podina@gmail.com

First A.
Abstract: In the context of the exponential growth of portable devices, mobile applications ease the access to psychological
interventions anytime and everywhere. SpeakEasy is a mobile assistant for the management of social anxiety in public speech
situations, a highly distressing psychological disorder and targets the most investigated mechanisms underlying corresponding to it.
It includes self-evaluation and gradual exposure to feared situations via dedicated guidelines and in situ interventions in various
mobile environments. The graphical interface, progress and reward user feedback mechanisms are design features implementing
the SpeakEasy model. Each mobile phone database records user evaluations and sends reports to the core database where
psychologists can analyse them in a web-based interface.

Keywords: Mobile Application, Affective Computing, Pervasive Computing, Social Anxiety.

I. INTRODUCTION
Mental health problems are becoming an increasing burden
to modern society [1]. However, only a small number of
those that require professional care are receiving it [2]. One
approach to overcome this issue is to facilitate a remote
access to psychological treatments via internet/computer and
mobile devices. These means for providing care are thought
to be easy to disseminate and constitute a less costly
alternative to classical approaches. Mobile devices, such as
smartphones and tablets, have the additional advantage of
being portable and easily accessible. While for computerbased interventions there is already evidence to state their
efficacy for various forms of psychopathology [3, 4], the
literature reporting on the empirical status of mobile
intervention is quite spares [5]. This is all the more
concerning as there is a large number of mental health
applications now available on the market, however without a
prior efficacy testing [6].
To offer a response to these challenges, we developed a
mobile application focused on one of the most prevalent and
impairing mental health problems, namely social anxiety.
This paper describes the principles and the development of
the application, while ongoing efforts are made to
empirically test its clinical utility in terms of efficacy and/or
effectiveness.
Social anxiety disorder or social phobia is one of the
most common anxiety disorders, affecting up to 12.1 % of
the population across lifetime [7]. Life with social anxiety is
strongly impaired by this condition, individuals reporting

high levels of distress and difficulties in social and

professional interactions [8]. In other words, social anxiety
is described as a marked fear of social situations [9] which
impairs even individuals who do not meet the diagnostic
criteria for this disorder [10]. The impairments brought on
by social anxiety are probably best seen in public speech
situations [11].
As a result, the current application (i.e., SpeakEasy)
focuses on addressing social anxiety in public speech
situations. Its main purpose is to help individuals with social
anxiety that have to deliver a speech to better manage their
reactions to the feared/anxiogene situation and, therefore,
perform better in such settings. As such, SpeakEasy is
intended to be a self-help mobile assistant.
Blended self-help with therapist assistance can increase
acceptance and efficiency in the treatment when
implemented on a mobile smart device to facilitate in situ
interventions. In this approach the technical challenge is
how to design a distributed mobile application to support
self-help in a structured way following a comprehensive
psychological model and also to allow for a communication
with the therapist in a simple manner.
Adding affective awareness can make a personal device
react to the users emotional situation according to a certain
strategy. In our approach a structured GUI facilitates selfevaluation of anxiety, different kind of emotions and
thoughts and is the basis for a set of exercises and
recommendations.

Manuscript received February 29, 2010; revised April 17, 2010

1

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link between the patient and the therapist, and that engage
the patients in a variety of intervention exercises targeting
the specific mechanisms involved in social anxiety. This is
the purpose of the current SpeakEasy application.
As such, SpeakEasy is similar to other applications
analysing users emotions and thoughts so as to extract
behavioural patterns, but it is also designed to increase selfawareness and to master social anxiety in a self-help
manner. However, when needed, the patient could receive
remote assistance from his therapist.

II. RELATED WORK

There is a wide spectrum of mobile applications aiming for
increasing the efficiency and well-being of the user by
monitoring mental or emotional reactions in real life
situations and teaching them techniques that they could use
to overcome possible cognitive, emotional and behavioural
problems.
Emotional responses, such as the stress level, are
extracted [12] from the users daily activities and associated
with various other features (sleep quality, health, mood,
alertness, tiredness) via a mobile phone GUI. A multimodal
in situ detection is proposed in [13] where an emotional
journal was recorded by each user for a week through a GUI
allowing annotation on a continuous emotion 2D space and
discrete basic emotions. Another emotion-aware mobile
application is described in [14] where autistic children are
learning about their emotions by using a set of emotion
labelled images containing children faces. The students
emotions, mental, behaviour trends and performances are
monitored using smartphones in [15] to learn more about
students life. Self-reports (i.e. mood and stress), automatic
continuous sensing and classifications are performed on
mobile phones and then correlated to mental health,
academic performances, etc. All these are similar affectiveaware mobile applications allowing the user to self-assess
their affective states and, in some cases, mental health is
also considered [15].
Despite the obvious evolution of user friendly mobile
applications, in relation to social anxiety in speech
situations, which is the focus of our work, existing mobile
applications are limited in several ways. First, most of the
currently marketed mental health applications (including
anxiety management) are not evidence-based [5], and thus
raise serious questions over their clinical utility. Second,
existing mental health applications are focused on providing
support to patients, but do not allow an integration with
classic psychotherapeutic process (i.e., face to face
individual or group sessions). Allowing the therapist to
monitor the progress of a patient through the mobile
application or using it as a platform for homework
assignment might turn out to be useful for both patient and
therapist, allowing more time to discuss about what has been
learned from different exercises rather than teaching the
patient how an exercise should be performed. Third, the few
current available apps developed specifically for social
anxiety (e.g., Overcoming Social Phobia by KoolAppz [16],
Social Anxiety Disorder by Afradad Media [17]) are focused
on providing information on the causes and the treatments of
this problem in a textbook fashion. Although these
applications keep their mobile attribute, they lose the
interactive and engaging capabilities that current technology
can offer on a smartphone. Last, there is a larger number of
applications that target anxiety symptoms in a transdiagnostic approach [6]. Despite the fact that at least some
of them include a large variety of cognitive, behavioural and
relaxation exercises (e.g., Pacifica - Stress & Anxiety, by
Pacifica Labs [18], Self-help Anxiety Management, by the
University of the West of England [19]) they lack key
intervention components that are relevant for social anxiety
in particular, such as managing self-focused attention or
targeting specific dysfunctional beliefs that these patients
endorse.
To sum up, there is a need for social anxiety management
applications that are evidence-based, that could facilitate the

III. UNDERYLING PSYCHOLOGICAL

FRAMEWORK
SpeakEasy is rooted in the evidence-based techniques of
cognitive behavioural therapy (CBT), which is currently the
most effective psychological treatment for social anxiety
[20]. It uses a cocktail of exercises that are scientifically
documented to be effective for the management of social
anxiety.
A. Psychopathological mechanisms targeted by
SpeakEasy
The techniques extracted from CBT are built on the
theoretical models of the factors involved in triggering and
maintaining social anxiety in speech situations. Although
there are slight variations between cognitive-behavioural
models, all contain a number of common factors that were
targeted by our appplication, as detailed below.
First, it is believed and documented that the onset and
maintenance of anxiety symptoms is mediated by cognitive
variables [21]. In other words anxiety is mediated by how
people perceive a social situation (e.g., a public speech).
Some may see it as a challenge and others as a threat,
thereby the difference between people in anxiety responses.
Second, people with social anxiety resort to avoidance to
prevent them from confronting (i.e. being exposed) a social
stressor or go to large extents to prevent any unexpected
complications (e.g., over study for an exam). As various
studies indicate, avoidance and engagement in
overcompensating behaviours only amplify or maintain
anxiety [22, 23].
Third, focusing on the negative aspects of a social
situation only worsens the anxiety experienced in speech
situations. In fact there are several studies which indicate
idea that negatively focusing on ones reaction during a
speech - either by (a) expressing a belief (e.g., I blush too
much, it will be awful) or (b) by paying excessive attention
to ones physiological responses (e.g., heartbeat, breathing,
sweating, etc.) - only amplifies anxiety [24, 25]. More
importantly, these anxiety responses begin before the speech
itself, making the management of social anxiety in speech
situations all the more important.
B. Overview of the SpeakEasy Application
SpeakEasy is designed to be used on mobile platforms so as
to ease the access to anxiety management exercises at all
times, especially in times of crisis. As such, SpeakEasy
targets the most investigated mechanism underlying social
anxiety in speech related situations. These are maladaptive
cognitions, behavioural avoidance, and negative attentional
biases, as detailed below.
Maladaptive Cognitions. In order to modify how people
with social anxiety view public speech situations, we have

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implemented the psychological pills component1. These pills
suggest alternative ways of perceiving a stressful event (e.g.,
as less awful or even challenging). Its benefits in terms of
emotional distress reduction, such as anxiety, have been
reported in a number of experimental studies [27, 28].
Bio-Behavioural Avoidance. The behavioural component
of the application was addressed via exposure exercises to
public speech situations. Exposure is paramount for the
management of social anxiety [29]. Similarly, the
physiological component of anxiety was addressed via
relaxation exercises that are to be used before when
confronting with a speech situation or in crisis (e.g., panic
attack).
Self-focused attention. The attention re-training module
of the application dealt with excessive self-monitoring
situations (e.g., I am blushing and my heart is pounding) that
amplify anxiety in speech situations [30]. Subsequently, this
module will be useful in exposure exercises, aiming to
control inwards attention in favour of outwards task/speech
oriented attention.
To sum up, the generic model guiding the SpeakEasy app
is the following2:
A (Antecedent) stressful events (i.e., public speech
situation)
B (Belief or cognitive factor) - psychological factors that
mediate (maladaptive beliefs, attentional biases)
C (Consequences) symptoms (anxiety, avoidance).

The next sections describe in details each module of

SpeakEasy architecture.
B. THE MOBILE CLIENT
The mobile client is implemented in Java and runs on
Android mobile phones and tablets. The minimal Android
version required by the application is 4.0. This version was
chosen due to the fact that about 85% of existing Android
mobile devices support it (at the time being).
The mobile application is intended to be used by the
patient while the therapist uses a stand-alone application that
operates like an interface to users data store on server.
Mobile client
GUI

SQLite DB

Figure 2. SpeakEasy Mobile client inner architecture

The mobile client is mainly composed by three
components depicted in Figure 2: the user interface (GUI)
interacts with the patient, the HTTP connector is used to
communicate with the server and the local SQLite database
stores the persistent data collected from the patient.
The patient user-interface, designed with fragments, is
based on regular graphical components such as: menus (see
Figure 3), text boxes, sliders, radio buttons and check boxes.
Images and sounds are also used for the specific relaxation
procedures that are included in the application.

IV. SPEAK_EASY-IMPLEMENTATION
SpeakEasy is implemented as a distributed software
application. Its main components are described in this
section.
A. GENERAL ARCHITECTURE
The SpeakEasy architecture, illustrated in Figure1, is
composed of four core modules: the mobile client
implemented in Java for Android, the server implemented in
PHP, the database installed inside a MySQL server and the
therapist interface (UI) running as a Java stand alone
application. The mobile client application operates also
offline but the gathered data are updated when internet
connection becomes available.
Patient

HTTP
Connector

Mobile client
Therapist GUI
Server
MySQL DB

Figure 1. SpeakEasy application general architecture

1

Psychological Pills are registered under the Romanian Office for

Intellectual Property (ORDA) by Daniel David, Ph.D. [26] and
was previously integrated in a mobile application called
Psychological Pills Virtual Agent PsyPills for iOS operating
systems https://itunes.apple.com/app/id589004229. We used the
Psychological Pills concept with the express consent of the
intellectual property rights owner.
2
The A-B-C model underlies the CBT paradigm.

Figure 3. SpeakEasy application main menu

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The anxiety scores, computed by the application, are
graphically displayed in a chart-like manner. The patient
may be notified (i.e. to do a self evaluation or an exposure
exercise) using different types of alerts.
Communication with the therapist is possible using a
dedicated e-mail address. Data collected from the patient is
stored locally in the SQLite database and also, with the
patients consent, it is sent to the server through the HTTP
connector and stored in a centralized MySQL database
hosted on the server.
The graphic user interface (colours, fonts, component
sizes and positions) resulted from user feedback on a series
of prototypes. It was a laborious process aiming to find the
best suitable interaction elements and information flow for
the targeted users (mainly teenagers and young adults).
The mobile client application offers the following
features:
Application description and patient consent form,
Anxiety and mood assessments, as well as other several
psychological tests (e.g., degree of inward attention,
level of maladaptive beliefs) see Figure 4,
Stimulation module that prepares and exposes the
patient to a feared situation see Figure 5,
Psychological software (virtual) pills,
An attention training module,
Relaxation procedures.
The following part of this section depicts examples of the
most important functions of the user interface.
The interface described in Figure 4 enables the user to
self-evaluate his/her affective state. The user evaluates
his/her emotions and use sliders to specify the emotions
intensity. Several categories are considered: optimism,
tension, sadness, and melancholy.

All collected data has a periodic nature (recurrent

evaluations are schedulled) and the evolution is persistently
stored in a local SQLite database in order to be able to
provide a persistent history.

Figure 5. SpeakEasy - Exposure exercises menu

The local database (see Figure 2) contains 9 tables where
test results, event, and interventions are stored along with
the time at which the data are recorded. For instance, the
psychological pills are put in relation with test results and
events that may cause stress.
C. THE SERVER
In order to have the possibility to observe the progress of
each subject, the therapist should be able to analyse data
concerning each user if he/she consents to share these data.
The therapist GUI (see Figure 6) is a Java and MySQLbased application that is secured, accessible and provides
searchable information about the SpeakEasy subscribers,
based on a certain criteria (i.e. user, date).
Data stored locally in each mobile devices SQLite
database is sent to the server via HTTP and stored remotely
on the server side MySQL database. The information update
is based on a set of dedicated PHP scripts. Each user is
identified by a user ID and an associated e-mail address,
both in server and local databases.
Several tables are defined for: users, events, states,
emotions, emotion scales, thoughts, symptoms, attention
exercises, and pills result.
The therapist can access the thoughts, emotions,
attentional control, symptoms, and pills used, as well as
filter the results according to their research or clinical
observation target (i.e. by using a period of time or a certain
feature value or range for a designated user, if willing; see
Figure 6).

Figure 4. Emotion evaluation interface part of the

evaluation user interface module

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acceptable threshold. Open comments indicated that
graphical elements (such as colours, buttons in the menu,
type fonts) should be improved. However, it is important to
have in mind that developing a commercially ready
application with an attractive design is beyond the scope of
the research endeavour described here. All other dimensions
that targeted the psychological content of the application
received good ratings, which indicate that the
implementation can be kept under the current form and to be
used for clinical testing. The reviewers indicated that the
application fits the cognitive-behavioural model of social
anxiety and the exercises address the psychological
mechanisms that are thought to be involved in this mental
health problem.
The overall rating of the application was acceptable,
although it is likely that it was affected by problems related
to the attention control exercises. Once this issue is solved,
we expect an increase of the overall rating.
Summarizing the reviews coming from the group of
experts (practitioners in clinical psychology and
psychotherapy), we can state that the application is close to
being finalized. The application follows the theoretical
approach upon which it was built and makes use of exercises
that are relevant for the specific mental health problem that
it targets. Integrating the suggestions that were received
from the reviewers could bring a better acceptance from
patients (the final end-users) and might increase its
attractiveness to them.
SpeakEasy comes as a solution to increase the access to
professional care for patients suffering from one of the most
prevalent mental disorders. Experts review showed that is
built on solid theoretical grounds and that the exercises it
incorporates should help the targeted populations. Technical
testing showed that the application is performing well in
portable conditions and thus would offer the users the
flexibility that is expected. However, beyond offering a
mobile application that works well, SpeakEasy is
theoretically sound. In the future, it is important to test the
clinical efficacy of the SpeakEasy application. This would
offer us an important advantage over most of the existing
mobile mental health applications, making SpeakEasy one of
the first evidence-based apps for psychological problems in
social anxiety.

Figure 6. The server the therapist GUI

V. RESULTS
Before testing the clinical efficacy and effectiveness of the
SpeakEasy application an expert evaluation with a group of
clinicians and/or cognitive-behavioural psychotherapists was
performed. Five experts reviewed the application and
provided feedback regarding content of the application and
the degree to which it is appropriate to be used for the
targeted problem. All expert reviewers (three women and
two men; aged between 23 and 29 years old) have at least a
bachelors degree in psychology and are certified by the
Romanian College of Psychologists in clinical psychology
and/or psychotherapy. Three of them have also a masters
degree in clinical psychology and one has a doctoral degree
in the same field. All of them make daily use of smartphones
and mobile applications. The application was tested on their
personal mobile phones. The group of experts has tested and
analysed the application for at least three days. After
reviewing it, they were asked to fill in an online
questionnaire which assessed the adequacy of the
application on 11 dimensions (see Figure 7). The
questionnaire investigated their opinion regarding
SpeakEasys fit with the cognitive-behavioural model of
social anxiety, as well as whether the designed exercises
would be useful for social anxiety in speech situations. Some
other question assessed the design and how well the
exercises were integrated in the application. The
questionnaire asked the reviewers to perform quantitative
ratings on each dimension, using a visual analogue scale
(VAS; the VAS scale that we used required the respondents
to give their answer on a continuum, with no intermediate
values, relying on the visual position of a slider) from 0 to
10 (higher scores meant a higher suitability of the
application for that dimension). Also, they were given the
option to comment and offer qualitative suggestion to
improve the application on each of the 11 dimensions.
Expert evaluations are synthesized in Figure 7. The
dimension that received the lowest evaluation (bellow the
mean level of the scale, which we considered to indicate an
inadequate level) was related to attention control exercises.
Qualitative comments suggested that these exercises are not
yet well integrated in the application and require important
improvements. The first version of the application design
also received a low score, which was just above the

Figure 7. The evaluation of the SpeakEasy application over

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[6] Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C.,
and Reger, G. M., mHealth for mental health: Integrating
smartphone technology in behavioral healthcare, Professional
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[15] R. Wang, F. Chen, Z. Chen, T. Li, G. Harari, S. Tignor, X.
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[16] KoolAppz, Overcoming Social Phobia, [Online]. Available:

11 dimensions. The indicated values are the average of

users responses and are considered acceptable when they
pass over 5.
Given that intense psychophysiological responses in
social situations are common in people with social anxiety,
and also taking into account that mobile sensors for
monitoring peripheral bio signals are becoming more and
more available, an innovative development that we target is
the integration of psychophysiological monitoring into
SpeakEasy. Electro-dermal activity (EDA) in social
situations could be used as an objective measure for
quantifying the users level of emotional distress, and thus
achieve a better understating of their progress in the
treatment. This enhancement of SpeakEasy would also have
an important research potential.
VI. CONCLUSIONS AND FUTURE WORK
We developed a client-server application that underlies
mobile self-help platform for the management of social
anxiety in speech situations. The server centralizes the users
evaluations and his progress throughout the intervention
modules in order to allow the therapist to study the
efficiency of the applied treatment.
The SpeakEasy design, referring here to the underlying
psychological model and its implementation, is promising
considering the early user trials. A long-term use of the
application will benefit from the users feedback to refine
the model and polish the rough edges of the technical parts
to meet the expectances for a commercial and, more
important, useful product.
Monitoring multimodal affective states while using the
mobile device [31] could be useful for the real-time emotion
assessment of anxiety and associated emotions.
ACKNOWLEDGMENT
This paper was supported by the Post-Doctoral Programme
POSDRU/159/1.5/S/137516, project co-funded from
European Social Fund through the Human Resources
Sectorial Operational Program 2007-2013.
We thank M.Sc. Eng. Gabriela Bnic and M.Sc. Eng.
Cristina Filipan for their contributions to this paper.

https://play.google.com/store/apps/details?id=com.koolappz.EP77900900001,

[Accessed: 10.07.2015]
[17] Afradad Media, Social Anxiety Disorder, [Online]. Available:
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[Accessed: 10.07.2015]
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Available: https://play.google.com/store/apps/details?id=com.pacificalabs.pacifica
[Accessed: 10.07.2015]
[19] Self-help Anxiety Management, by the University of the
West
of
England,
[Online].
Available:
https://play.google.com/store/apps/details?id=com.uwe.myoxygen
[Accessed: 10.07.2015]
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treatment, pp. 6993, New York: Guildford Press, 1995.
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R., Noel, S., Fleming, J. E., & Antony, M. M., Safety Behaviors
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Volume 51, Number 1, 2010

ACTA TECHNICA NAPOCENSIS

Electronics and Telecommunications
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