Pathways to Anxiety Reduction in Neurodivergent and Neurotypical Students Using Digital Support Tool Brain in Hand: A Mixed-Methods Evaluation

Purpose: Student anxiety in UK higher education has risen in recent years, straining university services. This study examined whether, and how, Brain in Hand (BiH)—a hybrid human–digital support tool—is associated with reduced anxiety in neurodivergent and neurotypical students. Design/methodology/approach: Seventy-two university students (60 autistic and/or with ADHD) completed baseline and 6-month surveys assessing anxiety and hypothesised pathways: coping (ability to manage overwhelm; ability to cope with day-to-day stressors), cognitive challenges, and social participation. Within-person change in anxiety was modelled as a function of change in these candidate mechanisms. Reflexive thematic analysis of 6-month semi-structured interviews elaborated pathways and the perceived contribution of BiH. Findings: Across the sample, anxiety and all candidate mechanisms improved over six months. Greater improvements in coping, reductions in cognitive challenges, and reduced participation-related difficulties were each associated with greater anxiety improvement. Qualitative themes clarified these pathways: (1) reactive in-the-moment coping and developing awareness of long-term patterns; (2) planning/structuring daily life and scaffolding anxiety management (e.g., reminders, solution prompts); and (3) increased participation/reduced isolation and earlier, more effective help-seeking.Practical implications: Findings support integrating guided digital supports like BiH as scalable complements to university provision, particularly where designs reduce cognitive burden, scaffold participation, and are responsive to neurodivergent needs. Originality/value: In a largely neurodivergent cohort, BiH use was associated with anxiety improvement, and mixed-methods integration illuminated plausible emotional, cognitive, and social mechanisms of change. The study advances a mechanism-focused, neuroinclusive evaluation of hybrid digital support in higher education.