Decoding anxiety: A scoping review of observable cues

Background: While anxiety disorders are one of the most prevalent mental diseases, they are often overlooked due to shortcom-
ings of the existing diagnostic procedures, which predominantly rely on self-reporting. Due to recent technological advances, this
source of information could be complemented by the so-called observable cues – indicators that are displayed spontaneously
through individuals’ physiological responses or behaviour and can be detected by modern devices. However, while there are sev-
eral individual studies on such cues, this research area lacks a synthesis. In line with this, our scoping review aimed to identify
observable cues that offer meaningful insight into individuals’ anxiety and to determine how these cues can be measured.
Methods: We followed the PRISMA guidelines for scoping reviews. The search string containing terms related to anxiety and
observable cues was entered into four databases (Web of Science, MEDLINE, ERIC, IEEE). While the search – limited to
English peer-reviewed records published from 2012 onwards – initially yielded 2311 records, only 33 articles fit our selection
criteria and were included in the final synthesis.
Results: The scoping review unravelled various categories of observable cues of anxiety, specifically those related to facial
expressions, speech and language, breathing, skin, heart, cognitive control, sleep, activity and motion, location data and
smartphone use. Moreover, we identified various approaches for measuring these cues, including wearable devices, and
analysing smartphone usage and social media activity.
Conclusions: Our scoping review points to several physiological and behavioural cues associated with anxiety and highlights
how these can be measured. These novel insights may be helpful for healthcare practitioners and fuel future research and
technology development. However, as many cues were investigated only in a single study, more evidence is needed to gen-
eralise these findings and implement them into practice with greater confidence.