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Researchers study wearable technology to help students with anxiety disorders

November 7, 2018

Anxiety for people of all ages is on the rise in an interconnected, 24/7 world, one where cell phones go everywhere their users go, always on and constantly begging for attention.

Research has indicated that up to 28 percent of K-12 students experience anxiety, which isn’t surprising given the increasing emphasis on standards and testing, pitfalls with social media and never-ending pressure to excel.

Students with disabilities and special needs also deal with anxiety, of course, with up to 40 to 50 percent of students with autism spectrum disorder being diagnosed with anxiety-related disorders.

But the tools often used to help typically developing students deal with anxiety – talk therapy or cognitive behavior modification, for examples – are not always effective for children and youth with deficits in communication and abstract reasoning skills. Alternative approaches are needed.

Wearable biomarker technology could provide that powerful solution, and faculty in the NIU Department of Special and Early Education are investigating the possibilities.

Professors Toni Van Laarhoven and Jesse (Woody) Johnson began conducting studies in the summer of 2017, working with a team of NIU Board Certified Behavior Analyst candidates to provide students with technology-based coping strategies aimed at reducing their anxiety.

Toni Van Laarhoven and Jesse (Woody) Johnson
Toni Van Laarhoven and Jesse (Woody) Johnson

Van Laarhoven, Johnson and their research team used wearable devices such as the Spire Stone and the Empatica E4 to measure physiological responses associated with stress.

The Spire Stone and its associated app, the “Spire Breath and Activity Tracker: Discover Calm,” display breath waves in real-time along with built-in algorithms that can indicate whether breathing is “calm,” “focused,” “tense” or “neutral.”

When Spire detects a change in the breathing rate or pattern, it transmits a notification to a phone or other device to alert the user or teacher. The app can also vibrate the devices to signal if the users are tense or haven’t taken a breath in a while.

The Empatica E4, which tracks heart rate, heart rate variability, motion/activity, electrodermal activity and skin temperature, was also used to measure students’ anxiety under a variety of circumstances.

Initial investigations looked at whether or not these devices could provide coping strategies for students to calm themselves. Could, for example, students follow directions on the Spire Stone app to help users manage stress? Could they follow the directions on the app’s breath guide to “breathe slowly to turn the dots green” as they looked at screens with mixtures of green and gray dots?

NIU’s team later expanded its project to include more schools, programs for adults with special needs and NIU undergraduate students.

Additional investigations, meanwhile, began looking at the use of biomarkers as a screening and functional behavior assessment tool to identify circumstances associated with anxiety for participants to identify potential individualized behavior interventions.

Lisa Liberty
Lisa Liberty

Later, Van Laarhoven and Johnson melded their work with SEED colleague Lisa Liberty to measure the impact of wearable biomarker technology supports on the anxiety of students with disabilities in academic settings.

Generally speaking, the potential is great – although more research is necessary.

“Wearable biomarker tools give us a better picture of what’s going on internally with students rather than relying so heavily on observation and outward signs of anxiety,” says Van Laarhoven, an NIU Presidential Teaching Professor. “This will push the field beyond where it’s been and could be a game changer.”

“That’s the critical piece,” says Johnson, an associate professor. “Teachers have difficulty recognizing situations when students are getting anxious, and knowing what to do.”

Behavioral indicators of anxiety are often difficult to measure and do not always provide adequate information, adds Johnson, who believes that physiological information obtained from wearable devices has the potential to enhance the effectiveness of interventions for individuals with special needs who experience anxiety.

“When combined with other assessment methods, the information would allow practitioners to design interventions that are more effective,” he says. “Additionally, challenging behavior and anxiety are often barriers to independence. Providing individuals with disabilities with the tools to manage their behavior and anxiety has the potential to open new opportunities for employment and participation in community life.”

Liberty’s work examined student breathing patterns during academic instruction and while writing.

“Anxiety related behaviors have not always been easy to measure when students are asked to complete academic tasks,” Liberty says. “These behaviors can be hard to observe while also trying to deliver instruction.”

Prior to intervention, students responded to writing prompts using pen and paper. During periods of intervention, students were monitored while writing using a Google Chromebook or Chromebooks equipped with Texthelp’s Read&Write software extension.

Read&Write offers such features as speech to text, a picture dictionary, word prediction, and a text-to-speech tool that “allows the text that was written to be spoken back to you,” Liberty says

Liberty hopes to extend her research with elementary and middle school students and explore academic tasks that might trigger anxiety-related behaviors. If teachers can use wearable biomarker tools to anticipate tasks that could prove stressful, they can approach the academic task using additional supports and, perhaps, make the task more manageable.

Other future studies for the SEED team will include looking at other wearable technology – the Hexoskin Smart Shirt, the Feel Wristband and the Muse brain-sensing headband among them – as well as a comparison of different coping and self-management strategies.

“We’re just scratching the surface,” Van Laarhoven says. “We’ve always seen students just leave the classroom when they’re anxious, but when they come back, they’re still anxious. Providing students with coping or calming strategies based on what they’re experiencing at that moment can be extremely valuable for both students and teachers.”