This Company Wants to Replace Therapy With Wearable Tech

This is the future of your mental healthcare, as imagined by Sentio Solutions, a San Francisco-based tech company: 

You will wear a sensory wristband that tracks your sweat, skin temperature and blood flow. Something—a chewing out from your boss, a reminder of a traumatic experience, an anxiety attack—increases your pulse rate and activates your sweat glands. The wristband signals to an app on your phone and a notification asks you to choose your feelings from a menu of words, like “distressed,” “sad,” and “content.” Your phone then tasks you with a breathing or journaling exercise. Maybe it recommends an online article on coping strategies.

As for appointments with a licensed therapist? They would be condensed to a weekly 15-minute video chat with one who has access to your data.  “It’d be like calling up your [primary care provider] and saying, ‘My glucose level is so high. What do I do?’” Sentio Solutions CEO George Eleftheriou told Motherboard.

This loop between physiological input, algorithms, and mostly automated interventions is called the Feel Program, and it’s currently in its testing stages. Eventually, Sentio hopes to sell it to individuals and also employers, as a way of maintaining morale and productivity while decreasing healthcare costs.

Eleftheriou—whose background is in data and analytics and not psychology—claims that time spent with a therapist can be replaced with data pumped through devices. “Your therapist spends more time learning about what happened than suggesting interventions,” he said. “In our program, the therapist knows what happened during the key events of the week and that reduces the time you need to spend in therapy.”

Psychologists might find that a simplistic explanation. The time-tested therapeutic methods employed by mental health professionals often depend on detailed personal information that can't be gathered by a sensor. “There are many diagnoses and ways to treat them,” said Kevin Caridad, an educator, clinical psychologist and CEO of the Institute for Cognitive Behavioral Therapy. One of the most common therapies, Cognitive Behavioral Therapy “reviews beliefs we may have had since birth and gets to the bottom of those very rigid beliefs.” 

Still, companies like Sentio are rushing to integrate wearables as part of one’s mental health routine as the market for wearable devices is expected to balloon to $57.7 million by 2022. Some utilize signs of distress to prompt an automated intervention. Others vibrate, buzz, emit sounds, or do something to instigate a brain sensation, recreating some obscure therapeutic technique. Whereas mental health wearables were once the brainchildren of niche startups, Amazon and Fitbit now want in. Both have added psychological metrics to their new smart watches. 

Researchers in digital psychology worry the nascent field isn’t ripe for commercialization.

“At this point, the research is in its infancy and I would be skeptical of any company that would be able to say they get clinical results,” Benjamin W. Nelson, a psychologist who researches mental health and personal technology at the University of North Carolina at Chapel Hill, told Motherboard. He said the tech sector’s drive to smash old systems and standards to advance technology and fix bugs later is ill-suited for mental health.

“The Silicon Valley model of moving forward and breaking things is good for moving a lot of technology,” said Nelson, “but I’m skeptical of any technology that would deal with something as critical as suicidal thoughts.”

Most mental health devices are not promising clinical results. Although some starry-eyed developers talk of one day replacing therapy or meds, most of their products are sold as "wellness devices," a wide Food and Drug Administration designation that also includes shoulder massagers and therapeutic lamps. These products purport to promote a healthy lifestyle or help manage—not treat—a condition.

A few manufacturers of mental health wearables have aimed for a higher FDA designation, and the agency has signaled a willingness to consider them. In November, it approved NightWare, an Apple Watch program that shakes the user awake during a nightmare, as a prescription treatment for post-traumatic stress patients. In August, the FDA granted its "breakthrough device" designation to help speed the approval process for Relivion DP, a headband that delivers electrical pulses to the brainstem as a possible treatment for depression. 

But most manufacturers aren’t waiting for government approval to sell a world where your watch monitors and responds to your moods.

Eleftheriou imagines an entire “emotional wear world,” where a smart watch is constantly intervening in daily stresses, like traffic and meetings, with calming music and cues to meditate.

“It will help make mental healthcare more affordable when there is such a demand for therapy,” he told Motherboard.

A central goal of many mental health wearables is to harness physiological signs of stress. Another device, The PIP, which retails for $179,  is a triangle-shaped gadget that fits in your pocket. Press your thumb to the device and it records sweat and heat, which its makers say provides a measurement of stress, visualized in charts on an app. The app also provides mindfulness exercises. 

These exercises, guided meditations, and breathing techniques are the go-to solution for mental health wearables: cheap, done solo, and familiar to their potential customer base through apps like Headspace. They’re deployed like a sprinkler system to the physical signs of a psychological episode.

Wearable devices like the Apple Watch and Fitbit do absorb a lot of health-related information, said John Torous, a Harvard psychiatrist and head of the American Psychiatric Association's work group on the evaluation of smartphone apps. 

“We’ve been using consumer wearables to measure things like sleep and heart rate and usually those things are reliable,” he told Motherboard. But where technology falls short is converting those factors into reliable signs of psychological distress, he said. Mere indicators of anxiety, like increased heart rate and skin temperature, cannot be added up to definitely show a particular condition.

“There are no biomarkers for mental health that are used in a consistent way,” said Torous. “If there was an EEG signal so that we could just see how your mood is, we’d be using that. We just don’t have a signal like that.”

Still, mental health metrics have moved from niche companies into the marquee products of tech giants. In October, Fitbit unveiled its deluxe health signal reader, the Fitbit Sense, containing an electrodermal sensor. Press your thumb to the touch screen and get its evaluation of your stress level. Perhaps not incidentally, FitBit added a library of mindfulness exercises to its premium subscription. 

Amazon also integrated supposed emotional metrics into its Halo smartwatch, which was released in August. The device's much-discussed Tone feature uses voice analysis “to analyze energy and positivity in a customer’s voice so they can better understand how they may sound to others,” a company press release claims. 

The feature was dubbed “creepy” by some consumers, and AI experts doubted its accuracy. Sandra Wachter, an associate professor who studies the legal and ethical applications of artificial intelligence at the University of Oxford, expressed deep skepticism about the Amazon product. “Human emotions are extremely complex,” she told Motherboard. “There is context and culture and gender norms. There is unspoken context that is hard for humans to understand. We talk past each other. We use sarcasm. We say yes when we mean no. I don’t see any way it could be accurate.” 

At another frontier for the wearables market are stimulating devices. Most of these go through a similar pipeline: Startups take a therapeutic technique and invent a device that delivers it, pay for tests and trials and release it. A wave of such products, costing upwards of $300, have come to market in the last year.

The Apollo, a vibrating plastic box strapped to the wrist or ankle, has heart rate variability as its seed. Past research has indicated that a low heart rate variability shows the body chugging along in an alert state. The long pulsations or rhythmic throbs unlock the body from this depleted state, according to its makers, who developed it at the University of Pittsburgh School of Medicine.

The Cove has a nascent therapeutic concept called “affective touch” as a mechanism. Researchers found, perhaps predictably, that a hand caress on the skin relieves pain in infants and adults. The Cove, a band that attaches to the ears and loops behind the head, tries to recreate the sensation, with vibration. 

Torous, from the American Psychiatric Association, said these devices are not harmful, but they shouldn’t replace time-tested methods, like medications and talk therapy. “It’s hard to see what role they would play in therapy,” he said.

He added that any daily ritual, including using these devices, could instigate a placebo effect. “I don’t think we can discount the effect of feeling like you’re taking control of your health.”