Mental health: An old, stubborn door

Wearable Tech Could Unlock Mental Health Issues

Another Key to Unlock the Unlockable Doors?

Mental health issues are stubborn. To get a lasting change is often a long, disheartening process. You truck along so well for a time only to return to your bleak state; depression sets in again or the anxieties begin to overwhelm. It’s like you’re missing something, the right key to unlock the right door. I think wearable tech could be one of those bright keys.

Society, often mercilessly, expects everyone to look like everyone else. If you are wrestling with endless anxieties or your mood is being pulled in multiple directions at once, looking like everyone elese is a terribly difficult thing to do. You have to battle with your own inner storms and then look like you’re not battling those storms at all. “Just close the shutters as the storm passes by and no one will know it’s there!”. Really?

Many wonderful therapies can help these conditions. They often involve tracking your own internal states and understanding the triggers that lead you there so that you can put into play helpful alternative strategies for dealing with the triggers. The problem is that if you have these conditions, you have a bunch of symptoms that prevent you from effectively doing your homework. And you can’t blame the dog for chewing it all up.

Take, for example, the very basic process of taking medication. Being depressed or experiencing frequent anxiety puts your body into a such a chemical state that it is biologically impossible for you to have a brilliant memory of details (we blame the stress hormones). Your memories will still be in your mind somewhere, it’s just terribly difficulty to recall them at will. Well, sometimes, of course, you just can’t code them into long term storage, either; the hormones all get in the way. So you forget to take your medication. Your practitioners and family tell you off, speaking strongly to you, saying how you must remember to take it. But you forgot. Forgot. It’s not deliberate.

Or what about keeping a mood diary, that bastion of tracking mental health? It’s a daily and sometimes twice daily routine of marking off how you feel on a scale of 1 to 10. You may also need to record what other activities you were doing, what kind of and how much food you ate and any exercise or stressful events. That’s a lot for anyone to keep track of. You can imagine, then, that to ask someone with a condition that directly affects their motivation and memory to fill something like that out regularly and expect it to be an easy thing for them to do — or to come across as if you do — is a little bit stupid.

Wearable Tech Gives Hope. Wearable tech may be key to sufferers and practitioners to gain new and useful insights into how their body is at different times and provide a means to give feedback and monitor change over time. It can automate many of the processes, provide personal reminders, correlate data gathering and symptom mapping and accrue data related to climate changes, location when symptoms occurred and provide an open stream of communication between practitioner and client.

Two of the many mental health issues that I imagine could be helped through wearable technology are anxiety panic attacks and bipolar depressions. They can help the person experiencing the issues and they can help the professionals researching and treating the experiences.


Panic Attack

People crowded into Jim’s space, their faces a giant and warped reflection of reality, like a surreal reflection of their heads in a spoon. “Breathe! Just breathe!” Jim was breathing but his breaths were shorter and faster than usual. He was panicked. The clamping down on his chest — a tightness like crocodile’s jaws — mixed with his clenching teeth. Panic, fear, tight throat, heart racing, shoulders high. That’s just the stuff people can see from the outside.

Inside his mind was a relentless circus but not the kind you take your kids to. Like the people’s faces on the outside, on the inside was a frenzy of activity, a looping of thoughts that just made themselves larger and larger and an orchestra playing a frenetic piece, like a Hungarian Rhapsody gone wrong. It was an off key piece that fed on itself and on the happenings in the body. The faster he breathed and the more insistent the people on the outside became, the more the circus on the inside loomed large, the more he could hear only the same old piece playing over and over, louder and louder, the same old performance from the same tired clowns.

It was called a panic attack because it was relentless, a dark enemy accosting him unbidden and without warning, and with it came a sense of uncontrollable dread. It wasn’t a thing you just call off. Everyone thinks that taking deeper breaths will change it, or they think you’re overreacting, over thinking, worrying too much. It’s a panic attack because you feel within yourself the inevitable doom. Whatever that is. And it seems unstoppable. A loop of endless horrible. It would be nice if you could have some kind of forewarning about the attack, perhaps then you could curtail it.

Imagine if we could teach someone how to track what’s happening in their body before, during and after such an attack. Imagine if we could teach them to feel and notice the sensations of before. How does the body change in those moments before the attack? If we know what happens before, then perhaps we can pre-emptively strike. Maybe there are earlier indicators than we realise. And when I say earlier, I mean maybe there are signs of an impending attack one hour, three hours or 24 hours before it hits.

Imagine if we could see the difference between how the body changes from before an attack to during one. Does the heart rate elevate? Is there a particular pattern of heart rate variability that changes depending on the severity of the triggers? What about skin conductance? Is it a linear change or an exponential one? And breathing? Does it change predictably? Constantly? Is there a positive or an inverse relationship, and how much will changing one change the other? Which sympotms are causative? You get the idea.

Pre-emptive Strikes. There is an amazing product on the market — I have no connection with them except that I wish to own a few of their products — called the Hexoskin. This product can do amazing things. It tracks your heart rate, your ventilation rate and minute volume, your acceleration, sleep, and your ECG (only one channel). It’s a vest you wear like a compression garment.

If you put all of this together, you can have some interesting data to correlate. Think about the person, like Jim, trapped inside that moment. It feels like an eternity. Believe me, I’ve been there. The first time I had a panic attack like that was scary.

By wearing this kind of technology, the sufferer could begin tracking what happens in their body immediately before an attack, during an attack and after one. With the help of a practitioner appropiratly trained in tracking, correlating and interpreting the data (and no, a GP or a Physiotherapist or a Psychologist or a Psychiatrist is not trained to do that. They would need to think differently and to learn what the correlations mean, how to ask the right kind of questions and listen for the best answers. They already have some of these skills but this kind of tech has never been so freely available before, so thy’ve never had to think about what its data could mean).

Recovery. After an attack, a person could learn when their ventilation rate and minute volume start normalising, when their heart rate starts lowering and what their ECG was doing, if anything, in order to understand their recovery. We could track the changes and see which treatments work and which don’t and when. A person could learn to slow or stop an oncoming attack and derail one midcourse. They could learn which things to do after the attack to optimise recovery.

Prevention. We could monitor their movement through space and ask, how quick are they moving before an attack sets in? Then, we could get the person to monitor their signs to become aware of what the different elements mean. We could then add in exercises to modify their physiology and become so much more precise than “breathe differently”. We could harness the power of this data to precisely fit the treatment to the need of the client and to their unique physiological response. Talk about person centred therapy!

Modelling Change. Finally, think about the humble Apple Watch (or other watches for that matter). It provides real time monitoring of your heart rate; reminders of whatever needs reminding (meditation? medication? mood diary? clean the chikpeas before dinner tonight?). More specifically, think about communicating with the practitioner. You could send your heart at different intervals to your practitioner for the week that you wear the Watch (let’s say it’s hired!) and the practitioner can observe your heart rate and send back to you a graphic reminder of what to do.

You could develop a series of images or lines that you send on the Watch using Digital Touch. A horizontal line might mean exhale long and slow; a vertical one might mean lift your chest tall; a circle could mean reapeat. Then, and here’s a simple one I’m excited about, a practitioner could set up a time, say when doing their own meditation, when they send their own heart rate via Digital Touch to their client. The client can learn through visual and felt feedback to train their heart rate to approach the practitioner’s. The client can be mentored in self-biofeedback in real time by watching someone more adept at the task performing it. This is part of what’s known as Mastery Modelling and is not really practised, in my experience, among health practitioners. Here’s a chance to use technology to help people to master the skills they need to. You could run workshops for multiple clients at once!


Bipolar Depressions

There are so many popular images surrounding bipolar depressions. Robyn Williams, Vincent van Gogh and asylums from the 19th Century all spring into my mind. As we all know, these images are the stuff of legend and so distant from the reality.

You may have noticed I pluralised depression and refrained from calling it bipolar ‘disorder’. There are multiple types and appearances of bipolar depression. The overriding thread of bipolar is one of depression; but it is a depression that is erratic, inconsistent even when the same, and set upon an unstable base of agitations, delightful ideas and unexplainable, persistent neuroses. The unfortunate understanding is that depression usually follows a manic state. It often does. And it is usually present at many other times of life. Depression, mild or not, is often the common thread of life for people with bipolar.

A truer image, I think, is one of an entity in the form of a thick, dark blanket, woollen and heavy. Slowly, it creeps up behind you, an unseen and mostly unfelt force. Whereas a dragon would approach with its talons bared forth, this heavy shadow creature rests its weight softly on your head. Down its edges slide, over your shoulders and slowly around your arms. A big threat to a blanket is the wind.

The winds of life start buffeting it, blowing against it. The stressors of life, the inconsistencies, the expectations of the world, society and family all rip the blanket on and off your body, slapping you here, there and everywhere and then, in a moment of isolated frustration, it lifts from your head. You know that feeling when you take your hat off and the head feels light, fresh and cool? In that moment, while the blanket clings to your shoulders and raps itself repeatedly against your torso, your mind feels light. It feels free. And suddenly you can see the world through clearer eyes.

Thoughts race — you still feel the agitations of the blanket around your body — ideas make sense — you still feel the agitations against your legs — you can put ideas together so fast, so clear, and words stream from your mouth — you still feel the agitations around your shoulders, your neck — and you know now, in this wind, in this moment, that your arms are finally freed from the restriction, powerful and able and there’s no reason to care about what happens next because right now is exhilarating, right now is so much better than when that blasted blanket wrapped its soft and heavy self around your life — you feel the blanket beating against your head once again, the sound of its touch deafening you — the thoughts and feelings won’t stop —and after all is said and done, after you’ve said things and done things you had no mind to care about but had no control over because they just came so fast, and it felt so good for the blanket to be lifted — you realise what you did — the blanket wraps its dark self around your own and presses down, around and against your head — with its weight comes the darkness and the heaviness of mood mixed with its beating edges — and now you know the depression.

Objective Feedback. Imagine a world where the client could discover the physiological changes that occur in concert with a manic, a hypomanic or a mixed state. What could we discover? What could we change? What heart ache in countless families and how many marriages could be saved? Jobs kept?

Imagine if we could combine the power of the Hexoskin with that of the Apple Watch. Imagine if a person could receive an alert on their wrist that told them of erratic heart rate, altered breathing or an altered ECG trace. It could tell them when their arms are gesticulating more wildly, or pick up on their altered and excited speech patterns. The reading on their wrist could be a real time indicator of the physiological transformation within their body, even as the blanket buffets against them. It could be key to them knowing through an external, objective source what’s going on inside their very subjective source. This is oh, so important in bipolar, because when that hypomanic or manic state kicks in, you enter your own reality distortion field. You think clearly on one level but fail to see the changes in you on another. You need something to let you know things have changed before you do something you’ll regret.

Threshold Monitoring. There are other ways, too. The arch nemeses of bipolar disorders are sleep and stress. When one is stressed in life, then sleep is disturbed. They say that exercise is one way to handle stress but if a person exercises too much, too often with too little sleep, then it can lead to significant mixed, hypomanic or manic states. Using tech to accurately monitor sleep depth, frequency and length, along with heart rate variabilities associated with a person’s unique stress profile could combine with a galvanic skin response reading. The practitioner could develop a clear map of the client’s patterns.

By combining these data, we could a) determine a person’s general tolerance of sleep disturbance and stress (allostatic load) and b) determine when they are reaching their threshold (galvanic skin response, breathing patterns and heart rate), which could be called their allostatic state. This could potentially provide a means of anticipating the labile moments and train them to respond in ways that are helpful.

Automated Data Accrual. The tech could keep track of where the person travels, how long they are there, how their heart rate varies, and it could automate the collection of data such as temperature, humidity, wind and UV and map these against the mood that is easily recorded on the watch. It could track how the person responds to certain types, intensities and frequencies of exercise over time and establish a probability of what type of exercise the client would be best doing to prevent relapses after a day with a given allostatic load. You could have an app on the watch that popes up a reminder to record your mood, energy or exertions levels at that moment — in a matter of seconds you have a record via the touch screen of whichever self-reported data you need, without the client having to remember it or overcome the perception of effort required to do the recording. Many of these things would require a some decent algorithms but that’s what researchers and programmers are for!

There are many other ways that you could use the tech. I can think of many exciting applications but haven’t the time for it all here. I just hope that some people are inspired to think differently around how to use the tech. Let’s be honest. I also hope that someone sees these ideas and funds me to do some research — or at the very least, to invest in some tech that can be used to make clients’ lives better! All cheekiness aside, I hope some thinkers and doers out there take a hold of these ideas and grow them into useable, useful and affordable solutions.

The Thing About Feedback

Avoid Becoming Dependent

The thing about this kind of biofeedback — or indeed, any kind of biofeedback — is that it diminishes a person’s capacity to perform if used incorrectly. I know, crazy, isn’t it? You don’t hear about that part of it. You just hear that biofeedback is great for improving performance. The research, however, shows a more complete picture, as research often does.

What we know is that if a person only relies upon such feedback as we get from this technology, then they will be more likely to have a diminished performance, injury or exacerbation of injuries without being weened off the feedback. It’s like learning to ride with training wheels on your bike. The wheels keep you safe by ensuring you don’t fall over. The other important thing they do is provide you feedback, just like learning to stand. It’s a kind of balance feedback. If you tilt too far to the left, that wheel touches the ground. If you lean too far to the right, that wheel touches the ground. Slowly you learn how far to lean in order to ride upright. But if you rely on the wheel to feel safe, then you will never ride fast or turn sharp corners on a normal bike. You must ween yourself off them.

Here are three possibilities for how to manage this. I am sure other people will create many more wonderful possibilities, and that is the joy of this technology, its possibilities:

  • Hire the tech out to people for chunks of time, and taper those times out (in both length and distance between hiring) until they are titrated off their reliance on the equipment such that they know what their body is doing and are able to thrive through their own insight into their current way of being.
  • Code software for data analysis and distribution that has the capacity to limit how often and how much data a person can see. This way the practitioner can adjust how much biofeedback a client receives over time in accordance with how they going through ongoing clinical assessments.
  • Teach the person how the feedback correlates with what they experience inside their body. Rather than engineering their time using the tech, teach them to think positively about their body. They can learn to separate from their negative assessments about their body sensations by learning to see them as data on a computer screen — and then forge a new relationship with those feelings. By teaching them to wonder about the feelings of their body and live mindfully and without judgment of the sensations, they can learn to change their body, initially depending on the data as non-judgmental and then to embrace the feelings again as their own.

In other words, people should never rely solely upon the tech. They must learn to read their own body if they are to thrive in the world. This an important lesson for people experiencing these things and for the practitioners helping them. They must be taught to ween off the technology and understand themselves by themselves.

Finally, I have looked briefly at some ideas for how wearable tech could help panic attacks and bipolar depressions. The ideas presented here are few. There are so many other ways they could help. As well as the different ways this tech could help, think of the other experiences that could be transformed. Post traumatic stress disorder and chronic fatigue syndrome are two that come to mind. The potential for amazing research, assessment and treatment is an open world. I think the kind of wearable technology that is emerging today holds another key that will open some long closed doors of change for those battling mental health issues.