Wearable devices as adjuncts in the treatment of anxiety‐related symptoms: A narrative review of five device modalities and implications for clinical practice.

Abstract

Anxiety disorders are a major public health problem, and a range of wearable technological devices for addressing the somatic symptoms of anxiety are increasingly available. This narrative review summarizes five distinct modalities underlying wearable devices and investigates clinical implications for managing clients using such devices. The literature suggests potential benefits of heart rate variability (HRV) biofeedback devices, while other modalities (aided meditation, false physiological feedback, electrodermal biofeedback, and respiration biofeedback) are less supported. High‐quality research on the efficacy of such devices is also lacking, particularly in clinical populations. Wearables could offer potential benefits, but may be contraindicated in some cases. Collaborative use of clinical evaluation tools, such as the American Psychiatric Association's application evaluation model, can aid in shared decision‐making about device use.

Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research

“…Recent information on the reproducibility and replicability crisis has swept the sciences and as such these issues are very important for digital health and mHealth research, which includes wrist-worn HR accuracy and any studies that utilize wearable HR data, as this new field will allow for large data samples 31 with various sensors that will increase the ease for p-hacking. Recent research has proposed using wearables in psychological research 32 and treatment settings 33 , whereas other research has already begun to use mHealth data to show important global realworld HR norms 16 , global differences in HRV by age, gender, and time of day 26 , and allowing for surveillance of influenza symptoms 34 , yet questions remain as to the accuracy and validity of data collected from wearables 35,36 .…”

Perceived acceptability of wearable devices for the treatment of mental health problems

“…Similarly to mental health apps, the current state of evidence for wearables means they may best serve as adjuncts to extend existing evidence‐based treatments (e.g., devices such as assisted meditation headbands), while exercising caution (Lui, Marcus, & Barry, 2017). Brief clinical evaluation frameworks such as the App Evaluation Model (American Psychiatric Association, 2017) can be easily adapted for use with wearable devices (Hunkin et al, 2019), and may provide a pragmatic way to systematically assess the suitability and safety of a given wearable device used adjunctively in a specific clinical situation.…”

“…Self‐help interventions have been viewed as a conduit to accessing higher intensity face‐to‐face services by increasing mental health literacy and emotional competence (Christensen & Hickie, 2010; Rickwood, Deane, & Wilson, 2007). However, without clinician guidance as to the suitability of wearable devices, there is a risk that they could be unhelpful, or even iatrogenic (Hunkin et al, 2019). Several strategies can be used by practitioners to overcome these emotional and attitudinal barriers in hesitant clients, including working through harmful effects of self‐stigma (Corrigan & Rao, 2012), challenging extreme attitudes about self‐reliance (Labouliere, Kleinman, & Gould, 2015), and increasing insight into the severity of one's condition (Mojtabai et al, 2012).…”

“…Technological adjuncts to therapy, such as wearable devices, are one proposed strategy for closing the treatment gap (Naslund et al, 2017). A range of wearables—devices worn as an accessory or item of clothing—have recently been developed with the goal of improving mental health (Coffey & Coffey, 2016; Hunkin, King, & Zajac, 2019; Torous & Gualtieri, 2016). Wearable devices typically operate in concert with smartphone applications (“apps”) by sensing and relaying physiological signals.…”

“…Some are worn throughout the day, while others are used for regular brief sessions of self‐administered training. A variety of wearable devices oriented toward mental health are now commercially available and being marketed directly to consumers, with the majority priced between $150 and $300 US dollars (Hunkin et al, 2019). One example is Muse (Interaxon, Inc.), an EEG headband designed to give auditory feedback during focused‐attention meditation.…”