There is an increasing shortage of mental health professionals, with poor and rural areas in many countries left without coverage. Digital technology and wearables, in part, offer real hope to people in need of tools for biofeedback, mental health monitoring and other services.
While wearables can’t substitute actual medical treatment, portable devices can assess activity, gather information, and evaluate biomarkers. According to experts, their potential can be tremendous. At the same time, this type of digital technology is constantly undergoing rapid development and is far from perfect.
There are several types of wearables available on the market. We'll explore a selection below.
Mood wearables
Wearables for mood can measure skin conductance, temperature, and heart rate variability. These devices can draw conclusions about the mood based on the measurements. Patients can also monitor changes within those. The user gets feedback about the correlation between their mood and these parameters and how the latter are affected by activities like mindfulness meditation or applying breathing techniques.
Sleep wearables
Quality and quantity of sleep are equally important for mental health and well-being. More and more wearables are being created to monitor sleep. They are equipped with sensors to identify and remember sleeping patterns. This information is retained and can be used to improve sleep quality and reduce the risk of accidents caused by sleep deficiency.
Sleep wearables can also track how often someone wakes up at night, when they fall asleep, when they wake up, and if they snore. This data helps people identify issues that disturb their sleep. Basically, early detection of sleeping pattern changes can help prevent sleep disorders. The challenge lies in figuring out how to use them for beneficial intervention.
One cannot understand their health, nor make changes and see how those changes make a difference, unless the measuring tool is of acceptable accuracy, and consistently accurate.
Dr. Matthew Walker, PhD
Beyond Fitbit
It is estimated that Fitbit, the popular activity tracker, had 31 million active users in 2020. Typically, these wearables retrieve high-quality data. Devices in this niche that are designed specifically for mental health care include Lief, Abilify MyCite, Muse, TouchPoints, Oura Ring, and Thync. This article will have a closer look at them.
Lief
Lief by Lief Therapeutics is a clinical-grade ECG device that continuously measures breathing, heart rate and heart rate variability (HRV). Over time, the Lief adapts to the user's body, using vibration feedback to alert wearers when HRV is relatively low.
The Lief uses reusable ECG stickers that snap into the patch and stick to the body (on or around the torso) in order to accurately capture heart data. These stickers can be replaced every 2-5 days to maintain their adhesive properties.
Inclusion of a smartphone and diagnostic platform provides users and healthcare providers with valuable insights into patient well-being.
We interviewed Lief founder, Rohan Dixit, on the Resilience Podcast.
Oura Ring
The Oura ring is a feature-rich device that centers on sleep’s effect on mental health and readiness. More specifically, it’s designed to demonstrate how rest can elevate performance and alleviate mental health challenges. Oura is used to “maximize users’ mental states” and improve their sleeping patterns. You can also use it to collect a set of data, which can then assist professionals in monitoring and treating mental health concerns. This functionality has also been successfully deployed across several high-performance sports teams.
Resilience Institute partner, Brad Hook, has been wearing an Oura ring for two years. His feedback is that the wearable has provided excellent quality and fascinating insights into how his habits affect his readiness.
Brad said, “The Oura ring guides me towards both high performance and care by adjusting daily movement targets based on my readiness. Understanding how certain evening patterns impact HRV during the night has been instrumental in guiding implementation of better habits and practices.”
Brad asked Oura CEO, Tom Hale, how else a tool such as the Oura Ring can support business leadership.
Mr. Hale replied, “For leaders, it can be difficult to practice what they preach. Much like the airplane example of putting on your mask before helping others, it’s imperative that leaders are recovering as efficiently as possible in order to perform for their people and their business.
Much like the airplane example of putting on your mask before helping others, it’s imperative that leaders are recovering as efficiently as possible in order to perform for their people and their business.
Tom Hale, CEO Oura
In fact, a survey of Fortune 500 CEOs reveals that the majority of them get around 6 hours of sleep per night, well below the recommended range of 7-9.
I’ve been guilty of it too! But I always notice that I am not as effective as a leader when I have let my own self-care become deprioritized.
We find that awareness can be the catalyst for changing behaviors. Many people that are underslept get so used to it that they don’t even realize that they are underperforming but once they use something like the Oura Ring and begin to see the negative health impacts of too little sleep, they can more easily begin to make lifestyle changes to improve it."
Asked whether, in the workplace of the future, wearables are part of health and safety, Mr Hale replied, "Absolutely. Inadequate sleep has been proven to increase the likelihood of a workplace accident by 70% and make an individual 3x more likely to develop a cold. These are risks and costs that no company should be willing to compromise on.
One of the key trends coming out of the pandemic is the renewed focus on health and overall wellness. With a majority of employees returning to the office, we’re seeing a resurgence of corporate offerings, particularly ones that go above and beyond things like free lunches.
Employers and employees alike are seeking solutions that provide a holistic approach and Oura’s Employee Wellness solution does just that - driving best-in-class adoption, engagement, and outcomes.”
Abilify MyCite: Depression, bipolar, schizophrenia
Abilify MyCite was developed by Proteus Digital Health and Otsuka America Pharmaceutical. It helps people cope with depression and is used to treat schizophrenia and bipolar disorder. It is worn on the torso and includes a patch containing a sensor, which shows when the person has taken their pill.
It is estimated that as many as 75% of people with schizophrenia do not take their medication as prescribed. Adherence to treatment plans causes adverse life events and poorly managed symptoms. While the device’s effect on adherence has not been established, Otsuka hopes to achieve more clarity about patient behavior, so doctors and their patients are “better informed.”
Abilify MyCite transfers the data it retrieves to an app on the patient’s smartphone, which is then sent to their doctor.
Muse
Muse might not be new to you. This brain-sensing headband applies the same EEG technology that is used by neuroscientists globally. The device interprets mental activity using advanced signals. It sounds quite vague, admittedly. The app uses the signals your brain sends to guide your thoughts to productive, healthy, and safe spaces.
Meditation is where the Muse device truly excels. Weather is used to denote different states of mind. When you’re calm, it displays peaceful weather. When you’re not, the weather is turbulent.
TouchPoints
TouchPoints is a touch-based alternating stimulation system developed by Amy Serin, a neuropsychologist from Arizona. The system comprises a pair of wireless devices you put in your pockets or wrists when you experience anxiety. According to its creator, the device can “change the brain’s response to stress to a great degree.”
The technology and the concept behind the system are not new. Serin simply improved the stimulation by adding a portable wireless component.
Thync
Thync uses a non-invasive approach involving electricity to improve brain function. The device stimulates nerves, targeting specific brain areas to increase energy. There have been experiments to test how effective it is. In one of them, the device was used on an experimental group, and a placebo was used on the control group. The effect on the experimental group’s energy levels was calculated at 33% improvement based on the median value of the subjects’ self-reports. You can place Thync’s proprietary energy patch device, FeelZing, on your body when you need an energy boost.
Apollo Neuro
The creators of Apollo Neuro market it as a stress relief bracelet, so it’s a mental health aid and a piece of jewelry at the same time. It was created to alleviate anxiety, depression, and related mental health disorders by targeting specific emotions and addressing sleep patterns directly.
You can wear the Apollo Neuro on your wrist or your ankle. It works by transmitting vibrations along the ankle or wrist. They are gentle and soothing and intend to calm people down. Apollo does more than track body functions; evidence suggests it positively affects mental health.
An app by Awake Labs and Community Living Windsor
Canadian-based company Awake Labs is working on an app on a Samsung smartwatch to enable caregivers in facilities to track the emotional states of patients with developmental and intellectual disabilities and respond as needed. The company partnered with care facility Community Living Windsor for the project, which is financed by the Ontario Brain Institute.
Finally, two apps have been approved by the US Food and Drug Administration: reSET and reSET-O, both developed and brought to market by Pear Pharmaceuticals. reSET helps with withdrawal symptoms for alcohol and drug addiction, more specifically, stimulants like cocaine, and marijuana withdrawal. The O helps accelerate abstinence from opioids.
Wearables are lagging behind smartphones
The smartphone remains the most promising device when it comes to mental health apps. The current number of smartphone users in the world is 6.567 billion. Smartphones show great promise for mental health. They feature fast processors, geolocation and sensors like accelerometers, which measure the force of acceleration caused by gravity or movement. Mental health apps for smartphones are abundant and many have proven to be of low quality. However, many apps do prove to be highly beneficial, with Headspace and Calm leading the way in stress reduction and meditation. Sleep Cycle is a non-wearable app designed to improve sleep, using the phone's microphone to track movement during the night.
At present, wearable devices are generally lagging where practical mental health applications are concerned. This fact is mainly due to the prohibitive cost and the complexity of the devices, where intuitiveness is often not at focus. Another factor is their novelty, which provokes distrust among potential users.
Wearables are not for everyone
People with very serious symptoms may not benefit from such wearables, at least not as they are now. Another issue with wearable devices relates to privacy.
The questions remain: what data is being collected, and who has the right to access it? The answers are far from obvious. According to a recent study published by the American Medical Association, the majority of best-ranked apps to stop smoking and alleviate depression shared data with Facebook and Google with the potential to compromise people’s privacy. The study covered 36 apps, just 12 of which included information about the possibility of such data release in their terms and conditions.
Caution is imperative among consumers as well as clinicians. The FDA announced plans to make changes to its oversight role in the realm of digital health technology.
Potential disadvantages of mental health wearables
Apart from the privacy issue, the quality of the devices comes into question. According to Stephen Schueller, Ph.D., executive editor of online library PsyberGuide and assistant professor of psychological science at the University of California, there are currently more than 10,000 such devices on the market. According to him, most of them are “pretty bad; some are even potentially harmful.”
There is always a risk when choosing any app or device, especially one that you’ll be relying on for health-related help. Some devices do not accurately track sleep, medication, and other crucial information. Others bypass the basic principles of psychoeducation.
Assessing mood based on movement and phone use
The most common consumer wearable is the smartwatch, but around half of all smartwatch owners lose interest soon after acquiring one. This is not the case with smartphones, which tend to be on the user’s person all the time unless the user is asleep or showering.
According to David Mohr, Ph.D., professor of preventive medicine, the uptake is ingrained in people’s day-to-day activity. Mohr’s team has assessed and developed an app suite, IntelliCare, which provides interventions for depression and anxiety. The apps are now available on iPhone and Android.
Mohr also led a team using smartphone features like GPS to assess mood based on the person’s phone use and level of movement. Phone use was measured by duration and frequency.
An auxiliary benefit of the study was to reveal clinical opportunities offered by the smartphone, including “just-in-time” intervention and support and constant monitoring of high-risk populations with a low patient burden.
However, it has emerged that the findings of these studies are hard to replicate. Mohr has brought attention to the problem of variability. Activity levels are bound to differ based on age, location, time of year, and other factors.
Final thoughts
The products described in this article have their advantages, but some may have downsides. Mental health wearables are not always accurate, leading to frustration at best and symptom exacerbation at worst. They can be limited in terms of evaluating subjective symptoms, and the feedback the user gets from them isn’t necessarily actionable.
For mental health support always consult a trained healthcare professional. For improving your own mental health there are many options, starting with foundations such as sleep, movement, time in nature and connection to others. To monitor and track your readiness, many of the wearables listed above can provide critical insights and guidance to help you shape your mental fitness and stay resilient.
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