Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) for anxiety in chronic breathlessness: a qualitative exploration of feasibility, usability, and acceptability

Abstract

Background: Anxiety is common in people living with chronic breathlessness. Cranial Electrotherapy Stimulation (CES) with the Alpha-Stim Anxiety, Insomnia, Depression (AID) has evidence of effectiveness in the treatment of anxiety disorders, but little is known about its feasibility, usability, and acceptability for people living with anxiety associated with chronic breathlessness. Aim: To explore individuals’ experiences of using Alpha-Stim AID to manage their anxiety associated with their breathlessness. Methods: Participants were recruited from two hospices, with advanced chronic respiratory disease and breathlessness and anxiety, and followed either a Set Dose Regime (SDR) or a Personalised Dose Regime (PDR). Semi-structured interview with 15 participants who had used Alpha-Stim AID (SDR and/or PDR) daily for eight weeks were analysed thematically using the predefined domains of feasibility, usability, and acceptability. Results: Feasibility: the Alpha-Stim AID was readily integrated into daily routines, providing a valued hour of calmness and fostering adherence to Alpha-Stim AID use. Usability: most participants reported benefits including reduced anxiety, improved mood, better sleep, and subtle mindset shifts such as cognitive reframing, although a minority reported limited impact. Acceptability: The device was perceived as simple to use and intuitive and associated with no or mild transient side effects, with PDR enhancing comfort, perceived control, and engagement. Conclusions: Alpha-Stim AID is a low-burden, well-tolerated adjunctive intervention for anxiety in people with breathlessness, with potential benefits extending beyond symptom relief. Future research should explore long-term effects, the mechanisms underpinning mindset change, and strategies for optimisingpersonalizing dosing regimens.