British Columbia

What biofeedback can teach us about stress

Real-time data can help us understand our response to stress and even learn to manage it better, but some experts warn stress tracking at the consumer level is still a work in progress.

Real-time data help us understand our response to stress but experts warn of unfounded claims in consumer tech

A hand rigged up with sensors for heart rate, microsweat and peripheral temperature, which Hiroko Demichelis uses with clients to help them learn how they respond to stress. (David Horemans/CBC)

Sitting in front of a computer screen is not normally considered a stress busting tactic.

But clinical counsellor Hiroko Demichelis uses real-time data — from an array of sensors strapped to her clients — to help them learn relaxation techniques.

"I think we are all in a great need to explore the science of calming down," she said.

"We all know about the accelerator in the Ferrari, but somehow we have forgotten, lost track of the brake."

Among her clinical tools for biofeedback is an interesting metric called heart rate variability — a sort of proxy measure for stress that's been used in studies to help pregnant women and army recruits.

It's also frequently popping up in consumer-level stress tracking devices, though experts warn the accuracy and usefulness of those technologies may be works in progress.

The blue line, showing breath, moves up and down in concert with the red line, showing heart rate — except when the sensors got bumped. An experienced professional can help interpret data, even when it gets messy. (David Horemans/CBC)

Variation is good

It may seem counterintuitive, but in this context a variable heart rate is a good thing.

"A healthy heart is not a metronome," as experts in the field say.

Clinical counsellor Hiroko Demichelisis, the owner and founder of Vancouver Brain Lab and co-founder of Moment Meditation in Vancouver. (David Horemans/CBC)

Using a computer algorithm, Demichelis measures the gap between heart beats and how it changes with each breath in someone at rest.

Breathe in, the heart speeds up. Breathe out — the "mini vacation," she calls it — and the heart slows down.

When the stress response kicks in, that natural variation goes away, but Demichelis teaches clients, from elite athletes to struggling clinical patients, how to use deep breathing techniques to invoke the parasympathetic nervous system's relaxation response.

She chooses her words carefully for relaxation. No orders to "breathe!" but rather "allowing yourself" a breath.

"Here we are exploring the non-doing," she explained. "All of us know too much about the doing, and maybe, a little too little about the non-doing and the calm and the rest."

Stress tracking at home?

As wearable technology has exploded — tracking steps and sleep and exercise — it's not surprising that devices promising stress tracking have followed suit.

There are even apps that use a smartphone's camera and flash to measure heart rate variability and give the user a score for their stress.

But the author of a 2015 study on an earlier generation of stress-tracking devices said despite the "enormous potential" of the field, many consumer claims are untested.

The device tested in that clinical study, StressEraser, didn't help the users, said Dr. Joseph Finkelstein, director of the Center of Bioinformatics and Data Analytics at Columbia University.

"It is very important to use evidence-based approaches," he cautions, "so that consumers ... make intelligent choices rather than be subject to advertising tricks."

Santosh Kumar, who leads a team at the University of Memphis working on mobile sensors, said past claims have hurt consumer trust.

"We have had many stress tracking technologies that have been claiming to track stress. It's just that their validity has not been as great, especially in the field setting."

Kumar's lab is working on real-time stress tracking, which he has called a "Holy Grail."

"That is what has been our goal, and that is where it becomes difficult," said Kumar, director of the NIH's Centre of Excellence in Mobile Sensor Data to Knowledge.

The challenge isn't so much the sensors themselves but keeping them in place as someone lives their lives and reliably interpreting the data to, say, distinguish the high heart rate of exercise from a stress reaction.

His team is currently testing its technology with people quitting smoking to see if measuring stress benefits them.

Exercise, of course, also raises a person's heart and breathing rates, and Kumar's lab is working on technology that can separate exercise from stress. (Brandon Wiggins)

Chaos of life

And that's the trick: whatever high-tech sensor is applied, it still takes real-world testing to know not just if it delivers precise enough measurements but also if it actually helps.

For Demichelis, she wants her clients to take what they learn in the stillness of her clinic — and use it in the chaos of life.

"How can I then learn to export this awareness into real life and self-regulate?" she said.

"So that next time someone cuts me [off] with his car, I'm not going to explode in anger."

The goal, after all, isn't wiring up but calming down.

Demichelis tells CBC reporter Lisa Johnson about the biofeedback tools she uses with clients. (David Horemans/CBC)

Listen to the CBC Radio special Keep Calm on the science of business of handling stress, or read more in the series here:

About the Author

Lisa Johnson is a reporter for CBC News in British Columbia, covering news around the province with a specialty in science, nature, and making sense of complicated things. Get in touch at or through Twitter at @lisasj.