Overview
Anxiety contracts the Perception Box. Worry, the central cognitive feature of generalized anxiety disorder, is a negatively reinforced avoidant behavior that narrows attentional scope and forecloses curiosity. In previous trials of our reinforcement learning (RL) based digital therapeutic, individuals with Generalized Anxiety Disorder showed 67% reductions in anxiety versus 14% in treatment as usual, with emotional non-reactivity mediating reductions in worry. Missing in the literature is a way to measure perceptual expansion directly.
First, we will develop and validate the Perception Box Lexical Index (PBLI), a continuous, behaviorally derived measure of expanded versus contracted states computed from language. PBLI is a session-level ratio, PB_Expanded / (PB_Expanded + PB_Contracted), bounded from 0 (contracted) to 1 (expanded). We will develop it from our corpus of conversational messages from individuals in our Going Beyond Anxiety program, using LLM pre-classification followed by expert annotation, validated on a participant-level held-out partition fixed in advance. Pre-specified benchmarks are weighted κ ≥ 0.80 between automated and expert classification, a positive mean slope in a latent growth curve model across sessions, and PBLI at month 1 predicting GAD-7 at month 2. That is what makes PBLI deployable as a mechanistic outcome in the trial that follows, and usable wherever conversational data are collected.
Second, we will conduct a one-month feasibility and usability study of Your Life the Game (n=30), a game-based RL intervention for adolescents and young adults (ages 18 to 22) with anxiety (GAD-7 ≥ 8). Our primary population will be high school seniors. Benchmarks are System Usability Scale ≥ 60 and ≥ 80% of participants engaging three times weekly. Change in anxiety is exploratory. Together these define primary outcomes for a subsequent fully-powered randomized controlled trial to assess efficacy in anxiety reduction.