Tech to take the stress out of stress

By Padraig Belton

Image source, Thinkstock
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Stress and anxiety stop us functioning as we should - instead of medication, what if a simple smartphone app could banish the "Blue Meanies" forever?

Mairin Philips (not her real name) suffered from anxiety, so much so that it made the pain from a stomach ulcer far worse.

Then a friend suggested a handheld anti-anxiety device."I was keen to give it a try, but was not convinced it would be of benefit to me," she says.

The biosensor device, called Pip, is gripped between the thumb and forefinger, looks a bit like a small iPod, and measures sweat and electrodermal activity associated with stress levels.

People working to manage their anxiety can then play a number of games like Relax & Race, where relaxing confers a competitive advantage.

"After a couple of days," says Miss Philips, "I had stopped taking relaxing medication, which I had been relying on due to anxiety.

"This was a surprise to me. It was a great tool for helping to slow down your body and mind, a great substitution for relaxing medicine."

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The Pip is a biosensor that communicates with a smartphone app

Pip is among a batch of new stress-management gadgets. It is produced by a Dublin start-up called Galvanic, with Trinity College Dublin psychology professor Ian Robertson as chair of its scientific advisory board.

The device, which connects by Bluetooth with smart devices, was originally researched and patented in 2007, but the company did not survive Ireland's downturn.

Mindfulness goes digital

Some 10.4 million days are lost annually to work-related stress in the UK, according to the Health and Safety Executive.

The World Health Organization says it costs businesses in the US $300bn (£187bn; €237bn) a year.

Mindfulness - meditation practices found to have an impact on anxiety, by focusing on the present moment - is newly in vogue, with an all-party parliamentary group last month recommending all new NHS medical and teaching staff be given training in it.

A higher-tech take on mindfulness, Pip is designed for users to pick up and make an effort at managing their stress, through instant biofeedback to learn what techniques work best, says Galvanic's chief executive David Ingram.

Another approach is wearable technology - such as Insight, part of the redLoop project and designed at Middlesex University.

Image source, Redloop
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The Insight kit bag - using wearable technology rather than handheld sensors

Project director Dr Andy Bardill says, "[Anxiety has] various different parameters to it, some of which are measurable and can be indicated by reliable biomarkers, while others are more qualitative, more patient dependent."

Skin conductivity - tied to how much you sweat - is a biomarker of stress, part of the fight-or-flight response, but also goes down when there is high humidity, or up when you go up stairs.

"Getting baseline data is important: it could be it's gone down because you've done exercise or you're unwell, not because you're anxious,' says Dr Bardill.

Insight features wristbands, heartbeat monitors, and an iPhone app. With a log of when and where every heartbeat of a person takes place, Dr Bardill says analysing the data requires "episodic analysis, essentially data analytics used in the intelligence community".

Another wearable device, designed in Canada, is a headband called Muse.

"It's clinical grade EEG (electroencephalography, recording brain electrical activity) in this slim, sleek little consumer form factor," says Ariel Garten, a psychotherapist and chief executive of InteraXon, which developed the device.

With it, a person can track their brain activity in real time on a smartphone or tablet, and practise focused attention.

"It's like mindfulness on hyperdrive," she says.

Image source, Muse
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The company behind the Muse headband claims the device can measure brain activity, to help you focus

Blocking anxiety

Stress tech has been bolstered by the ready availability of smart devices, to which devices like Pip, Insight and Muse can connect by Bluetooth.

A different approach invokes another recent trend, social networking.

Jennifer Hyatt founded Big White Wall, an anonymous social network to support people in managing mental health. Half its members use the site to relieve anxiety.

Image source, Big White Wall
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Big White Wall is a social network for managing mental health issues

She began the website after the suicide of a friend's partner, believing technology offered support and recovery tools, carrying no shame or stigma.

At the top tier, the website provides a secure Skype-like platform, where a member can deal with an issue directly with a clinician.

In middle levels, there is a course on Cognitive Behavioural Therapy for managing anxiety. At lower levels, members may write on "bricks", set up groups, anonymously befriend others, and track themselves against measures such as GAD 7, a self-administered Generalised Anxiety Disorder assessment.

Ms Hyatt says Big White Wall has 4,500 active users in any month. Initially, 40% were under 25; now, the largest group is 35 to 44-year-olds, with over 55s increasing fast.

A Buddy story

Syed Abrar is the man behind Buddy, a mobile phone-based platform.

"It can be a £10 supermarket throwaway - as long as it sends texts, you can use Buddy," he says.

Texting is discreet, says Mr Abrar. People may not have pens to hand and might need to explain keeping a physical diary, but texting "allows soldiers to keep their game face on, or you can be sat in a pub, or with parents, and can send stuff and capture feelings in a contemporaneous way".

Image source, Sidekick Studios
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Buddy can be accessed online through a tablet or smartphone - but texts can be received by an ordinary phone
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Syed Abrar is the man behind Buddy

Users receive texts from Buddy asking how they feel and what they are doing, and later can see links between what they were doing and how they felt - and "manage their own journey of recovery".

One challenge in evaluating new stress tech devices is the different speed of private technology development versus publicly funded research.

Dr Lisa Marzano, senior psychology lecturer at Middlesex University, says, "Academia, funding bodies, and research councils work at a very different, much slower pace than the field of computing."

Accordingly, researchers still know relatively little about the effectiveness of new stress tech, or users' experiences in everyday life, or integrating into existing mental health interventions.

"When you have something that's evolving so quickly, it's really hard to measure its impact before it evolves yet again," adds Sarah Amani from the Oxford Academic Health Science Network.

A related challenge is identifying good developers.

There is a conference next month on frameworks to evaluate mental health apps, shy of large clinical trials, hosted by MindTech, a technology co-operative founded by the Nottinghamshire NHS Trust and University of Nottingham.

Dr Jen Martin, MindTech project manager, counts roughly 5,000 apps aimed at mental health and wellbeing, and says, "A lot of those, while they might not be particularly damaging, might not be particularly helpful."

But experts also recognise the potential for stress tech to reach people in need at a time of cutbacks and waiting lists.

The availability of devices, a rapid increase in scope and evolution, it's enough to give you a headache.

Or maybe, perhaps, make it feel a bit better.

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