Effect of Brief Biofeedback via a Smartphone App on Stress Recovery: Randomized Experimental Study

Abstract

BackgroundSmartphones are often vilified for negatively influencing well-being and contributing to stress. However, these devices may, in fact, be useful in times of stress and, in particular, aid in stress recovery. Mobile apps that deliver evidence-based techniques for stress reduction, such as heart rate variability biofeedback (HRVB) training, hold promise as convenient, accessible, and effective stress-reducing tools. Numerous mobile health apps that may potentially aid in stress recovery are available, but very few have demonstrated that they can influence health-related physiological stress parameters (eg, salivary biomarkers of stress). The ability to recover swiftly from stress and reduce physiological arousal is particularly important for long-term health, and thus, it is imperative that evidence is provided to demonstrate the effectiveness of stress-reducing mobile health apps in this context.ObjectiveThe purpose of this research was to investigate the physiological and psychological effects of using a smartphone app for HRVB training following a stressful experience. The efficacy of the gamified Breather component of the Happify mobile health app was examined in an experimental setting.MethodsIn this study, participants (N=140) underwent a laboratory stressor and were randomly assigned to recover in one of three ways: with no phone present, with a phone present, with the HRBV game. Those in the no phone condition had no access to their phone. Those in the phone present condition had their phone but did not use it. Those in the HRVB game condition used the serious game Breather on the Happify app. Stress recovery was assessed via repeated measures of salivary alpha amylase, cortisol, and self-reported acute stress (on a 1-100 scale).ResultsParticipants in the HRVB game condition had significantly lower levels of salivary alpha amylase during recovery than participants in the other conditions (F2,133=3.78, P=.03). There were no significant differences among the conditions during recovery for salivary cortisol levels or self-reported stress.ConclusionsThese results show that engaging in a brief HRVB training session on a smartphone reduces levels of salivary alpha amylase following a stressful experience, providing preliminary evidence for the effectiveness of Breather in improving physiological stress recovery. Given the known ties between stress recovery and future well-being, this study provides a possible mechanism by which gamified biofeedback apps may lead to better health.

The Effects of Biofeedback Training and Smartphone-Delivered Biofeedback Training on Resilience, Occupational Stress, and Depressive Symptoms among Abused Psychiatric Nurses

“…This result was congruent with previous studies [34,35]. Moreover, The Kruskal Wallace nonparametric (pre-intervention and post-intervention) and post-hoc tests comparison revealed that there was no significant difference among the BT group, SDBT group and the control group in depressive symptoms, whereas the BT and SDBT groups had greater reduction in depressive symptoms than the control group., which was not consistent with a previous study [17]. Our results suggested that BT and SDBT had a contribution on improving depressive symptoms, compared to the control group, without significant difference.…”

“…In addition, the Kruskal Wallace H test and post-hoc tests comparison also revealed that the SDBT group had significantly lower occupational stress than did the control group. One study showed that resilience-based and relaxation music-based smartphone applications was better than a control group in improving perceived stress in workers [17], and a similar result was also obtained in our study. BT can be provided only in the hospital which was a relatively a stressful place to nurses, and SDBT was usually carried out during nonworking hours when individuals felt relatively less stress.…”

“…Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats, stress, serious health problems, or workplace conflict-it means 'bouncing back' from difficult experiences [14]. Workplace resilience interventions have been shown to increase job satisfaction, work engagement, and resilience [15]; as well as decrease burnout and perceived stress [15][16][17][18]. Many interventions have been effective for enhancing one's resilience, such as positive psychology, psychotherapy, biofeedback, meditation, and yoga [19].…”

“…In summary, the use of biofeedback interventions is effective in managing stress, anxiety, depression, and enhancing resilience [15,18]. In addition to computer-assisted biofeedback, there is a growing interest in the use of smartphone applications for biofeedback to promote better stress-management and relaxation [17,22]. In other words, smartphones can be used as a tool for biofeedback training (BT) because smartphones and the Internet are popular, conveniently accessible, and have an array of technological capabilities [17,23].…”

Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized Experimental Study

“…In addition, the breathing rate used in this study was based on past literature suggesting 6 breaths per minute as the average rate to achieve RSA [ 54 ]. Our findings also support recent evidence showing that a brief 5-min app-based biofeedback training session was effective in enhancing physiological recovery after laboratory-induced stress, as assessed by levels of salivary alpha-amylase, another commonly used stress biomarker [ 74 ].…”