Time to relax: The biofeedback tech fighting a stress epidemic

Meet the wearables that want to help you de-stress
The biofeedback battle against stress

We've all felt the classic fight-or-flight response when faced with a stressful event – a racing heart, increased blood pressure and a rush of adrenaline as we get ready to move. But when left unchecked, or when we respond strongly to more everyday stressors – like dealing with work, family and life – that kind of response can kill.

Not only can stress ruin your mood and make you feel anxious, angry, depressed or unfocused, prolonged stress has been shown to lead to high blood pressure, cardiovascular disease, hypertension and a compromised immune system. Moreover, stress is costly to the economy. In 2014, the UK alone lost 10.4 million days of work to stress, which equates to roughly £6.5 billion.

Last year, we asked whether a new host of portable, stress busting wearables could make us more calm. Now, we've been talking to the people behind the development of devices and apps hoping to change the way we combat stress with new sensors, algorithms and relaxation techniques.

Empatica brings feedback out of the lab

Biofeedback is a technique of making a patient aware of physiological functions that are normally automatic, so that he or she can control them. The idea is that if you show someone a picture of their heart rate or muscle tension for example, they will learn to control and manipulate it.

Since its roots in the 60s and 70s, biofeedback has been used by psychologists to help treat a variety of issues including post-traumatic stress disorder, attention deficit hyperactivity disorder, headache and hypertension. The problem, though, is that biofeedback devices typically have to be used in a lab setting, with patients being hooked up to electrodes on their hands or head, depending on what they're measuring.

Empatica was one of the first companies to turn the concept of biofeedback into a small, slick wearable. In 2007, one of its co-founders developed a sensor that tracked electrodermal activity (EDA), also known as galvanic skin response (GSR) – a measurement of the amount of electric potential in the skin. Over the course of her team's research at MIT, she serendipitously discovered a correlation between a spike in EDA and seizures.

After a successful crowdfunding campaign in early 2015, Empatica created the Embrace Watch. Still in its beta phase, the Embrace Watch features a lab quality electrodermal sensor that is being tested in clinical trials and will likely be able to detect seizures and alert caretakers via text. There's also the E4 wristband, which has the EDA sensor, in addition to a photoplehysomography sensor that measures blood volume pulse, heart rate and heart rate variability. It's a wearable that can give users real-time feedback, with EDA indicating stress levels.

While it can be used to track stress levels, the device is really designed to be a larger platform for developers and researchers, according to Daniel Bender, a product manager at Empatica. "It's a general purpose device that is already supporting a number of different fields, from gaming and virtual reality analysis to medical applications and clinical trials that get outcome measures and contextual information," he said.

One clinical trial in Boston is looking at serious depression and asymmetries between the electrodermal activity on the left and right wrist and how that might be correlated with depressive episodes, for example. "We are seeing new innovations and less invasive studies," said Bender, "because you can catch measurements constantly as opposed to only in a traditional lab setting."

Getting mindful with Spire

Spire also came out of academia. In a study at Stanford in 2011, Neema Moraveji and his colleagues discovered that students could regulate their breathing to match a pacer in the background of a desktop. "We found that you could be working on something and get subtle feedback on your breathing, and regulate it while focusing on your task," said Moraveji. "You didn't have to stop what you were doing to do a deep breathing exercise and to get the benefit. You could modulate it while you were working."

The research led to the development of Spire, a wearable that clips onto your belt or bra and tracks your respiratory rate and activity. Algorithms identify a baseline average breathing rate for each individual user. When his or her breath becomes faster and erratic, the algorithm detects tension; slow breathing is considered a calm period; and regular and faster breathing indicates the user is focused.

The device comes with a companion app that teaches meditation and deep relaxation, training users to breathe at around six breathes per minute with real-time biofeedback, a rate that's associated with maximum heart rate variability. A vibration or notification can suggest users to take a deep breath if he or she hasn't taken a deep breath in a while, or be mindful of their breathing during a stressful event.

Moraveji doesn't shy away from referring to the Spire as a mindfulness tracker. "We don't like to think of it as if you're broken and need to be fixed," he said. "Instead, it's aspirational and looking at the positive and negative aspects of stress. First off, we need to identify when stress is occurring and acknowledge we're stressed. The second part is welcoming stress and the third is utilising stress.

"If I care about what I'm doing right now, how am I going to use this stress to accomplish something? It's about having control over stress and know what to do with it, rather than just track it."

Real-time training with Pip Stress Manager

Unlike the E4 Wristband and Spire, the Pip Stress Manager by Irish company Galvanic isn't a wearable per se. But it is small enough to fit into the palm of your hand. The Pip Stress Manager is a device that you hold between your fingertips, which measures electrodermal activity as an indicator of stress.

What's cool about Pip is the suite of apps it works with to train you to reduce your stress levels at any given time. Clarity is an app which introduces three different relaxation techniques, including breathing, mantra and body scanning. The idea is that you hold the Pip while you are guided through the technique and then practise in real time. The sound from the app changing as the user's electrodermal activity changes.

In the rain setting, for example, the sound of rain gets quieter as stress levels reduce. As stress levels increase, the rain becomes heavier and includes lightening and thunder. Another app called The Loom gives audio-visual feedback. As you relax and decrease your electrodermal activity, a winter landscape melts into spring and then summer.

The more competitive among us will love Relax Race. In the app the user is depicted as a character in a race that competes against his or her previous best score. As stress levels reduce, the character flies higher and faster.

"By creating an artificially stressful situation – a race – it trains people to control their stress response in a stressful situation," said Marie Clark, the head of marketing for Galvanic. "So when you're in a stressful situation you recognise it and know what to do to reduce your level of stress from your training."

At the end of each session, users get a Pip Score out of 100 to see how they changed over time and as a reward for being to reduce their stress response. "What we're rewarding is your ability to reduce your stress response," said Clark. "It's not just about your previous scores, it rewards your ability to relax in that moment."

Galvanic, which was the first Irish company to raise over $100,000 on Kickstarter and started rolling out the device about a year and a half ago, designed the app as a kind of replacement for or complement to therapeutic biofeedback sessions. They suggest using it for a few minutes, twice a day to incorporate regular biofeedback into daily life.

Future Gazing

Biofeedback has been used by individuals, athletes and in therapeutic sessions for years. The same demand that has driven successful crowdfunding campaigns for the development of stress trackers can also be seen at larger organisations.

While platforms like the E4 Wristband are allowing researchers to understand more about several disorders, including those related to stress, more consumer-friendly gadgets like Spire and Pip may be used on a broader scale. Pip is already being integrated into schools, teaching children who have social and/or behavioral issues to stay calm in stressful situations.

And mindfulness is being encouraged in the corporate environment as well. Just as some companies reward employees who exercise regularly, some are recognising the value in a stress-free workforce and encouraging employees to become more resilient. Google, for instance, has started offering classes to employees on how to manage and reduce stress in recent years.

Some of the biofeedback trackers we have featured are still undergoing research testing their effectiveness. But given their popularity so far, it may only be a matter of time until biofeedback is part of your work benefits package.

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