Wearable technology and therapy

The future of therapy on your fingertips

Imagine one day that you go in for your therapy session and your therapist pulls up your weekly biodata and uses it to suggest adjustments to your therapy practices, similar to how your physician might look at your blood work and adjust your medications. That day is today (although to be fair, it’s still relatively uncommon).

The use of technology has been rapidly implemented in the field of mental health and “wearables” are no exception. Wearables are non-invasive electronic devices that individuals wear to track and analyze real-time physiological and behavioral parameters. It can allow for immediate feedback and early identification of warning signs, as well as helping to personalize and enhance treatment from a holistic perspective.

While some people understandably have concerns about who has access to their biodata, when proper safeguards are in place and the data is used appropriately, wearables have immense potential benefit in the context of therapy.

Gadgets to game-changers

In the past decade, the landscape of wearable technology has advanced considerably, especially with the integration of features aimed at improving mental health management (Hernando et al. 2018). It has evolved from simple gadgets designed to track steps, into sophisticated tools that can collect heart rate variability, indices of sleep quality, and much more. 

Today, medical-grade devices, smartwatches, and smart rings with integrated artificial intelligence are widely used in research and application to track a broad spectrum of physiological and psychological data. 

Moreover, wearables help summarize this data in a way that is easy to interpret by mental health professionals (Vijayan et al., 2021), and reduces load on the patients to accurately report measures that are subjected to memory or reporting bias (Debard et al., 2020). 

For instance, the Muse smart headband utilizes EEG sensors to track brain activity, provide sleep stage analysis, and give detailed reports on sleep hygiene (Avagyan, 2024). It converts the data into visual snapshots that represent the brain signals in a simplified interface intended to be user-friendly (Krigolson et al., 2021).

What are the applications of wearable technology in the field of mental health? 

1. Providing insight: First, wearables can be used to collect and monitor psychological and physiological data that are extremely intertwined with one another. In therapy, while self-report assessments present a picture about people’s symptoms, mood, and behavioral changes, our mental health is inextricably linked with our physiology and mental health providers and individuals rarely have access to that information. It can also be difficult for patients to recall informationabout emotional statesafter the fact (e.g., studies have found that individuals with depression can overestimate experiencing negative emotions in hindsight) (Urban et al., 2018). This is where wearables assist to address the interconnectedness of the mind and body, and help to more accurately represent patterns over time. The combination of wearable and self-report data can then be used to provide insight into common triggers or antecedents of mood or anxiety symptoms, and subsequently suggest Just In Time Interventions.
   
   
2. Instant feedback: Immediate feedback is one of the best ways to enhance learning. In the field of mental health, patients often do not have immediate feedback on whether a given technique is working (for instance it may be difficult to tell if one cognitive restructuring exercise is more or less helpful than another). Wearables can assist in tracking real-time changes as biofeedback which can be useful to the client and the provider in providing additional relevant signals as to whether a given technique is having the intended effect.

Benefits for mental health professionals

As with any new technology, the question for mental health professionals often becomes, how will this benefit my practice? And is it worth the cost (both financial and the time to learn and integrate this new technology)?

Consider a common issue for mental health providers:

I asked, “How much weight loss?” “I don’t know,” said the patient. “How much sleep are you now getting?” “I don’t know, I just can’t sleep.” “How often are you moving about?” “I don’t know, just not as much.” Such subjectivity and vagueness! If only I could see objective wearable data showing trends in weight loss, sleep, and activity, I could create a more robust differential for this patient’s presentation. ~ Dr. Jared Dashevsky (Dashevsky, 2024)

The function of wearables to collect continuous data can be beneficial in care as one can have access to data outside the clinical setting, through which they can address real-life triggers and behaviors with greater precision. By having access to continuous monitoring of a patient’s daily stress levels, sleep patterns, and physical activity, therapists can gain deeper insights into the patient’s life beyond the therapy room and patient’s ability to accurately recall large amounts of past details. This rich data allows for more informed discussions and personalized interventions, making each session more targeted and effective.

The earlier you can detect a shift in a person starting to go in a negative direction, the better, ~ Dr. Michelle Newman (Hara, 2019)

Moreover, one huge gap in the current mental health care is accurate diagnosis and detecting symptoms for early intervention. Using these tools in addition to the traditional approach for diagnosis can help identify needs accurately at an earlier stage. For instance, a majority of the cases of depression are undiagnosed and therefore digital biomarkers collected through wearable devices (e.g., fitness trackers, smartwatches) can provide an unobtrusive method for depression screening (Rykov et al., 2021).

Additionally, speech as a biomarker (e.g., reduced speech rate, less pitch variability, increased white spaces in speech), have been linked to the psychomotor retardation symptoms in depression (Cummins et al., 2015; France et al., 2000; Ozdaz et al., 2004). In fact, Upheal measures a range of speech based metrics such as speech cadence (i.e., number of words spoken in a session), response time etc. which can be integrated with the wearables to consolidate insights from the sessions. 

Specific application domains in mental health 

Analyzing biomarkers with artificial intelligence is playing a pivotal role not just in diagnosis and early detection but also relapse prevention. Here are some examples of applications in specific domains: 

Sleep disorders: Wearables can help to gather insights by tracking sleep patterns which can inform healthy sleep habits. Products range from rings, to wristbands to headbands and there is research supporting the effectiveness of each. Oura’s sleep ring has been shown to be accurate and measures outcomes such as REM sleep, deep sleep, sleep efficiency, resting heart rate, etc.

In a personal example with one of the authors (Dr. Scult) in doing Cognitive Behavioral Therapy for Insomnia with patients, he’s found that patients often find it challenging to recall when they fell asleep, how many times they woke up, and the other details on their Sleep Logs. Now that more of his patients have been using Garmin watches to track their sleep, they are able to send them their sleep data and he is able to compare that to the self-report data to get more helpful estimates of “Time in Bed Prescriptions” for his patients.

These tools therefore offer a more comprehensive look and can inform interventions to improve CBT-I interventions. Beyond instances of insomnia, poor sleep quality can serve as a transdiagnostic marker of deteriorating mental health and early intervention can prevent more severe issues from developing, allowing for timely and targeted care that can improve overall well-being.

Mood tracking: Wearables help to track mood and assess how one’s surroundings, stress, and activities impact mood. Assessing mood highlights the need for behavioral changes that can help improve well-being. Think of it as a journal of one’s mood that mental health professionals have access to that adds layers to subjective mood reporting. Such data can provide insights to the direction of therapy and help clients become more aware of the changes in mood. For instance behaviors and tracking negative mood can highlight potential triggers in the daily environment (e.g., specific locations or lack of activity being linked to worsening mood states). 

Stress and anxiety: Wearables continuously monitor physiological markers such as heart rate variability, skin conductance, and cortisol levels, which are directly linked to stress responses. By collecting this data throughout the day, wearables provide a detailed picture of how a patient’s stress and anxiety fluctuate in response to various environmental triggers—insights that might not emerge during therapy sessions alone. This continuous monitoring allows therapists to identify specific situations or times of day when a patient is most vulnerable to stress, facilitating more targeted and effective interventions. For example, a wearable might detect elevated heart rates and increased skin conductance during specific daily activities, indicating heightened anxiety. This data can be shared with the therapist, who can then work with the patient to develop coping strategies for those specific triggers. Additionally, wearables can track the effectiveness of these strategies in real-time, allowing both patient and therapist to adjust the treatment plan as needed. This data-driven approach not only enhances the understanding of stress and anxiety in patients but also supports more personalized and proactive care. Moreover, tracking progress over the course of therapy can be beneficial for the client to track which interventions are effective for them and access to this data can help with continuity of care with other professionals as well.

Navigating limitations and concerns

Similar to any other developments in the field, the use of wearables comes with limitations that one must be cautious and aware about: 

1. Trust: There could be apprehensions about how the data collected on wearables is being used by the companies as it is sensitive personal data, including physiological and psychological metrics. Both patients and professionals must trust the accuracy and privacy of the data collected. It's important to ensure that the wearable devices are reliable, secure, and supported by robust encryption methods to protect patient confidentiality. States are beginning to pass laws to protect this type of data, and it will be important to stay abreast of current rules and regulations.
   
2. Inaccuracies: Wearable data is often designed to be unobtrusive and easy to use, but the data is rarely as accurate as medical-grade equipment and data collection protocols. Therefore it is important to use the data cautiously, and to use clinical judgment (and patient input) in interpreting possible causes for the results.
   
3. Sustained adoption by users: For wearable technology to be effective, users must consistently wear and interact with the devices. However, sustained adoption can be challenging due to issues like user fatigue, discomfort, or the need for regular charging. Mental health professionals should consider these factors and work to encourage long-term engagement through personalized support and education.
   
4. Cost: The high cost of wearables can be a significant barrier to widespread adoption. With the average cost of smart rings or watches ranging from $300 to $600, these devices may not be accessible to all patients. Sometimes there are additional costs for provider-facing software as well.
   
5. Continued research: Ongoing research is critical to addressing existing gaps in the accuracy and reliability of wearable technology. As more companies enter the market, it’s essential for mental health professionals to carefully evaluate the scientific validity of these products. Selecting tools with strong research backing ensures that the technology used in patient care is both effective and evidence-based.

Using tech to transform care 

The integration of wearable technology in the field of mental health care offers an exciting opportunity to enhance therapy through real-time data and personalized insights. As the field is marching forward, it is important to be aware of new tools that are available and their potential benefits and limitations.

‍Wearable technology cannot replace the existing methods of care, rather it is a piece of the puzzle that will work in conjunction with others to elevate care from a holistic lens. These technologies have the potential to unlock insights that were never available to mental health professionals and patients in the past and this is only the beginning.