The Acceptability and Efficacy of Wearable Devices in Digital Mental Health

Abstract

Rapid advancements in technology through the early twenty-first century have led to the emergence of a new paradigm in mental health, in which digital platforms could become a fundamental part of mental healthcare delivery. Wearable devices, which are computational devices worn on the body, might form an important element of these new approaches by capturing and interpreting physiological data associated with psychological states. This thesis presents a series of studies investigating the range of wearable devices for the treatment of mental health problems, the perceived acceptability of these devices, and the evidence for one specific device modality, aided meditation. In Study 1, a literature review was conducted to identify wearable devices that could be used in the treatment of anxiety-related symptoms, determine what supporting evidence existed for each device modality, and explore potential clinical implications of using those devices. The review identified early-stage evidence for the use of heart rate variability biofeedback devices, but limited research on other modalities, indicating a need for further high-quality research. Study 2 surveyed a community sample of 427 adults to investigate perceived acceptability of wearable devices for treating mental health problems. Interest in using wearable devices as adjuncts to conventional therapy was strong, with acceptability closely linked to perceived device effectiveness (β = 0.28-0.30). Wearable devices also appeared to have greater acceptability in the presence of negative attitudes toward conventional therapies, suggesting they might help reduce barriers to treatment. Studies 3 and 4 focused on evaluating one particular device: the Muse electroencephalogram (EEG) meditation headband. In these studies, 68 adult participants used the device during a series of lab-based meditation tasks, with a subset (n = 29) also completing 14 days of home practice. Study 3 investigated the potential of the headband measures to assess state mindfulness, a process variable linked to psychological benefits resulting from meditation practice. The primary headband measure showed sensitivity to both within-participants (d = 0.56) and between-participants (r = -0.50) differences on a task measure of state mindfulness. Aggregate measures over 14 days’ practice explained around 30% of variance in self-reported trait mindfulness and related constructs. EEG biomarkers thus appear to have potential as a novel objective method of mindfulness measurement. Study 4 used a crossover trial design (auditory feedback of the primary headband measure vs no feedback) to examine the effect of receiving feedback. The feedback condition resulted in a higher level of state mindfulness (RR = 1.15), a lower level of the primary headband measure (d = -0.22), and differences in subjective experience of meditation. These results suggest that with appropriate guidance, feedback may be an effective adjunct to meditation. Together, these studies support the notion that wearable devices could be effective and engaging adjunctive digital mental health interventions. The results support the use of synchronous feedback of practice quality data to enhance the therapeutic benefits of meditation practice, and were consistent with the mechanisms through which neurofeedback is theorised to function. Continuing engagement with wearable devices by both researchers and clinicians is recommended.