A web of anxiety: accessibility for people with anxiety and panic disorders [Part 2]

Section of an insurance broker website form that asks users to 'Tell us if you don’t want to hear from us' and provides a series of checkboxes for users to opt-out of communications about products and promotions.“Unethical”, “misleading” and “exploitative” are the words used by the Norwegian Consumer Council to describe the use of dark patterns and privacy-intrusive default settings by Facebook, Google and Microsoft. The council’s report, titled Deceived by Design (PDF, 3.2MB), documents the “deceptive” and “manipulative” techniques that companies use to nudge users towards disclosing as much information as possible.

Yet despite protestations and renewed commitments to data privacy from the companies named in the report, nefarious design practices are unlikely to go away. Dark patterns (at least in the short term) are simply too profitable. The truth is: many companies care little about how anxious or stressed their websites make you feel. In fact, companies may well be counting on your being anxious.

But that’s not to say that there’s nothing we can do.

In my previous post, I talked with several people with anxiety and panic disorders about aspects of user interface (UI) and user experience (UX) design that contribute to feelings of anxiety and panic. In this next post in the series, I offer some practical guidance on how to improve accessibility for people with anxiety and panic disorders.

Designing for anxiety

Designing for users with anxiety poster from the Home Office: Do give users enough time to complete an action; Don't rush users or set impractical time limits; Do explain what will happen after completing a service; Don’t leave users confused about next steps or timeframes; Do make important information clear; Don’t leave users uncertain about the consequences of their actions; Do give users the support they need to complete a service; Don’t make support or help hard to access; Do let users check their answers before they submit them; Don’t leave users questioning what answers they gave.Anxiety and panic disorders are well documented in medical and academic literature, yet there is a notable lack of guidance and research on their relation to web accessibility.

Recent efforts by the Web Accessibility Initiative’s Cognitive and Learning Disabilities Accessibility Task Force aim to address this research gap to better support users with stress, anxiety and depression. In his recent Inclusive Design 24 talk—Addressing Trauma- and Stressor-Related Disorders—Thaddeus Cambron describes how he hopes to bring additional visibility to anxiety and trauma disorders through his position on the World Wide Web Consortium’s Personalization Accessibility Task Force.

But despite not explicitly mentioning anxiety and panic disorders, the Web Content Accessibility Guidelines (WCAG) 2.1 still include a number of success criteria that can help people with these disabilities. Similarly, a number of TPGi’s Inclusive Design Principles are relevant to people with anxiety and panic disorders.

The UK Home Office Digital, Data and Technology team maintains a series of dos and don’ts posters that highlight research-driven inclusive-design best practices for different user groups. While the posters focus on accessible service design in government, much of their advice can be applied generally. A recent addition to the series is a poster on designing for users with anxiety (PDF, 1.0MB).

The following pointers can help address the concerns that were raised by people with anxiety and panic disorders:

Stop the clock

Programme details on the BBC iPlayer, which include the option to 'Turn Autoplay off'.One way to avoid the anxiety-inducing sense of urgency that certain websites and apps provoke is to remove unnecessary time limits and countdown timers, and give users enough time to comfortably complete their tasks. Both Netflix and BBC iPlayer provide options to disable the next episode countdown timer. The Home Office poster warns designers not to “rush users or set impractical time limits” and recommends giving users “enough time to complete an action”. Similarly, WCAG 2.1 success criterion 2.2.1: Timing Adjustable requires sites to let users turn off, adjust or extend time limits, while 2.2.6: Timeouts ensures that users are made aware of timeouts.

We might also take this advice a step further to actively create more peaceful user experiences. One respondent, who found chat room platforms frenetic and overbearing, praised a recent change to Skype that eschewed intrusive and demanding alerts in favor of more subtle notifications. They described how Skype “now has an icon that glows red with a new message, as opposed to making noises. I like this feature. It’s rather less nagging than the bwerps, flashing and cavorting that made it an irritating program to use in past.”

Manage expectations

In my previous post, respondents cited the unpredictable nature of certain websites and apps as another source of apprehension. This is particularly the case for online forms, where ambiguous labels and vague instructions can make anxious users rightly reluctant to trudge through the form. One respondent described feeling overwhelmed when there’s too much information or when something starts to feel too involved or complex. They added that this discomfort can be avoided by “simplifying forms, keeping them nice and clear, using easy to understand terms, and not having too much happening on the page.”

The Home Office poster offers advice along these lines, including recommendations to make important information clear, and explain what will happen after completing a form. It warns sites that they shouldn’t leave users “confused about next steps or timeframes” or “uncertain about the consequences of their actions”. A number of WCAG 2.1 success criteria, such as 3.3.2 Labels or Instructions and 1.3.5: Identify Input Purpose, encourage clarity in forms, while others, such as 3.2.3 Consistent Navigation and 3.2.4 Consistent Identification, promote a predictable and more familiar user experience. The inclusive design principle Be consistent also advocates for using well-established patterns and familiar conventions.

Remove (or apply) friction

Friction in UX design refers to anything that prevents users from accomplishing a task. The sense of powerlessness that websites and apps can provoke can often stem from unnecessary friction, such as making the option to cancel your subscription or deactivate your account just a little too hard to find. According to one respondent who finds speaking on the phone stressful, companies deliberately make it difficult to contact them through email because “it’s much harder to make an upsell when you have less opportunity to control the conversation.” They argue that companies should instead “make the customer comfortable however they wish to give you their money.”

Certainly, putting important information up front and making it easy for users to make contact in a way that suits them will avoid unnecessary anxiety. This is emphasized in the Home Office team’s advice to “give users the support they need to complete a service” and not to “make support or help hard to access”. The inclusive design principle Prioritise content also recommends prioritizing core tasks, features and information within the content and layout, while Give control encourages the notion that “people should be able to access and interact with content in their preferred way.”

Yet empowering users and giving control may be as much about applying friction as removing it. The Home Office poster also recommends letting users “check their answers before they submit them” so as not to “leave users questioning what answers they gave”. Similarly, the WCAG 2.1 success criteria 3.3.4: Error Prevention (Legal, Financial, Data) and 3.3.6 Error Prevention (All) require sites to let users review, confirm and correct their information before finalizing their submission. These recommendations introduce minor speed bumps to user journeys but ones that are arguably offset by the reassurance and comfort they provide to anxious users.

Notification from the Monzo app prototype that says 'You spent £308.53 online last night after 10pm. Would you like to review these purchases?'Designers at the UK online bank Monzo have thought about deliberately applying “positive friction” to financial transactions to better support customers with mental illnesses. Research conducted on the bank’s behalf found that people with bipolar disorder sometimes make unnecessary frivolous purchases late at night, during manic episodes. The following morning, they are confronted with the reality and consequences of their actions, which may trigger depression. To try to avert this situation by allowing time for users to reflect on their purchases, Monzo designers prototyped a method of delaying transactions until the following morning—an application of “positive friction” to improve the user experience.

Keep it real

NHS Behind the Headlines website displaying a list of medical headlines. One headline in particular, 'Lavender scent may help with anxiety in mice' is highlighted. The final theme in my previous post related not to UI design but to content by shifting responsibility from designers and developers to journalists, copywriters and content creators. Respondents frequently cited clickbait headlines and sensationalist reporting, particularly in coverage of health and medical issues, as a common source of anxiety.

Delivering accurate and timely medical information without causing unnecessary panic and anxiety is a difficult balancing act. Although journalistic practices are beyond the scope of resources such as WCAG, there are numerous media guidelines that encourage balanced and responsible reporting of medical issues. For instance, HealthNewsReview.org provides tips and case studies for journalists writing about health care and complex medical topics. Similarly, the UK mental-health charity Mind provides a guide to reporting on mental-health issues that highlights the role of overly dramatic headlines and sensationalist terms in promoting fear and anxiety. And if you’re ever unsure whether a medical headline is true, NHS Choices: Behind the Headlines offers an unbiased evidence-based analysis of health stories that make the news.

Sadly, the perverse profit-making potential of clickbait headlines and sensationalist reporting means that they’re unlikely to go away soon. As developers and UI/UX designers, we need to be cognizant of dark patterns, and we need to do our best to avoid them. As users, there’s unfortunately not a lot that we can do—but we can vote with our wallets. There’s the old saying that ”if you’re not paying for it, you’re not the customer; you’re the product being sold” and that applies here too. So whether a site may be free or not free, if they make use of dark patterns with abandon, one may be able to send a message by not using that site anymore or by taking one’s business elsewhere.

Out of darkness

The advice in this post can help you avoid or reduce anxiety and panic triggers on the web. Helpfully, a team led by Sarah Drummond of design agency We Are Snook is also assembling a public-domain pattern library that aims to improve the design of online mental-health products and services. Essentially, it’s a set of evidence-based positive design practices that are designed to counteract the web’s dark patterns. These efforts will help make the web more usable for people with anxiety or panic disorders, and they’ll ultimately benefit everyone.

Note: Anxiety is a complex psychological condition. Treatment of clinically-diagnosed anxiety may take various forms, and we do not attempt to present these recommendations as a cure for anxiety. Rather, we offer them as a way to help you improve user experience by identifying and reducing unnecessarily anxiety-inducing situations.

Categories: Technical, User Experience (UX)

About David Swallow

David is a Principal UX Consultant at TPGi. He joined the company in 2016, and before that, he was an academic researcher in human-computer interaction at the University of York in the UK, where he specialized in designing, developing, and evaluating usable and accessible interfaces. There he gained a PhD in computer science by investigating how to integrate accessibility web development into the existing workflows of professional web developers.


Isabel Holdsworth says:

Accessibility can be a minefield at times. The accommodation applied by Skype, that causes a new message alert to glow red rather than make a noise, could render this info inaccessible to blind users if not implemented correctly.

AJ says:

Sensationalist reporting is very common in America. It’s sad to see this becoming the norm in both TV and print.

Santina Croniser says:

Thank you for highlighting how WCAG 2.1 helps to address invisible illnesses. It’s a topic I hope will be is addressed more often.