By Erica Swallow, Contributor
It’s no secret that after returning from combat, veterans can face a whole new set of battles at home. Recent research from RAND Corporation, a global policy think tank, shows approximately one-third of troops returning from Iraq or Afghanistan suffer from either post traumatic stress disorder (PTSD), major depression, or a traumatic brain injury. All three, if prolonged, are potentially life threatening.
During a PTSD episode, memories of trauma can trigger a psychological and physical response, including depression, memory loss, insomnia, nausea, sweating, and an accelerated heart rate. The rippling effects of PTSD can also spark family issues, job loss, drug addiction, and — in more extreme cases — self-harm or violence towards others.
Suicide rates among veterans have risen about 25 percent since 2005, and veterans are nearly twice as likely as non-veterans to take their own lives, according to the U.S. Department of Veterans Affairs (VA).
It’s due to the seriousness and prevalence of psychological afflictions veterans face that researchers at the Massachusetts Institute of Technology (MIT), among others, are collaborating with the VA to find tech solutions to aid with veteran reintegration.
The Power of Mobile in PTSD Treatment
Unfortunately, only 30 percent of veterans with PTSD seek help. Common veteran-specific reasons for not reporting mental health issues, according to the U.S. Government Accountability Office, include the stigma of being perceived negatively by peers and employers for accessing mental health care, lack of understanding around mental health care, logistical challenges (including scheduling, transportation, time constraints, or physical or mental impairments), and concerns about the quality and availability of VA’s health care services.
Yet, mobile technology can be used to help solve at least three of these concerns. If veterans are accessing care with the aid of their phones, they can skip the stigma of walking into a clinic, access educational resources from the comfort of their homes, and even skip the need to travel to an office.
As an entry point into mobile health, the VA’s National Center for PTSD launched the PTSD Coach app in 2011. The app featured a self-assessment for PTSD, a symptom tracker, professional care information, and symptom management tools, including mindfulness and breathing exercises, as well customizable soothing pictures and sounds.
Since its release, the U.S. Department of Veterans Affairs states PTSD Coach has been downloaded over 100,000 times in over 74 countries. However, the app still relies on veterans to track their own symptoms.
In recent years, researchers have begun to shift their focus to both mobile and wearable technologies that can provide real-time stress monitoring and intervention, lighting the path for new PTSD treatments.
A Step Further
A research scientist at MIT, an assistant professor at the University of Massachusetts Medical School, and an Air Force veteran himself, Dr. Rich Fletcher is deeply invested in finding solutions for veterans when it comes to mental health and drug addiction issues.
His team at the MIT Mobile Technology Lab investigates how mobile technologies can help people and communities. The lab focuses on social impact applications such as mobile health and psychiatry, using “just-in-time adaptive interventions”— or, JITAI. This behavioral medicine practice uses technology, such as wearables and smartphones, to measure a user’s physiological state and provide real-time, individualized intervention.
Fletcher began focusing on JITAI solutions in 2009 while working alongside Dr. Rosalind Picard at the MIT Media Lab. The two initiated one of the first large-grant JITAI studies funded by the National Institute of Health (NIH). The study focused on the potential for mobile health interventions for U.S. military veterans dealing with drug addiction and PTSD.
Fletcher’s JITAI solution consists of wearable wrist and ankle bands fitted with wireless biosensors that collect physiological data, such as skin temperature, heart rate, perspiration level, and specific motions. A machine learning algorithm then learns the unique patterns of the wearer to detect abnormal behavior. If the system predicts an upcoming moment of distress, the patient is alerted on his or her smartphone, and the system interferes with on-device therapy in the form of positive messages or images. However, Fletcher and Picard’s teams found that was that “phones can only do so much.”
“Early on, we thought the phone could deliver therapy itself, such as mindfulness or breathing exercises, or by showing pictures that might distract the user,” Fletcher explained. Instead, the researchers found mobile phones were better suited for connecting PTSD sufferers to their human lifelines, including directly to therapists, support groups, or helplines. For example, the device could be part of a patient’s cognitive behavioral therapy treatment whereby a therapist would have access to the data as well.
When it comes to the people on the other side of the phone, connections beyond the cognitive behavioral therapist include support group friends, caregivers, family members, helplines, or nearby centers focused on veteran needs. “People are the forces that can really modify or change your behavior,” Fletcher emphasized.
This early research and pilot program at MIT yielded a number of spin-off technologies, including Fletcher’s own Ashametrics wearables and software company, which sells wrist, ankle, and chest bands that can be used by any type of wearer — veterans and beyond.
In developing mental health technology, Fletcher emphasized that it is important to remember that each person is different. Users’ physical reactions to stress —and their response to new technology — will differ.
Fletcher expressed that the current state of JITAI technology hinges on understanding individuals, graphing a baseline, and then recognizing behavior that is out of the ordinary. Still, issues such as patient adherence, will arise.
Researchers still grapple with users irregularly wearing the device and lack of engagement with the intervention messages. “Even though wearable [technology] is popular, a lot of the patients who really need wearables won’t wear them,” Fletcher said. “They have more serious things to worry about than having to remember to charge the battery.”
And while adoption may be behind the technology, there are new veteran-focused products meant to put the onus on health care providers to reach out to their patients in times of intense stress.
HealthRhythms, one commercially available technology—also with MIT Media Lab roots—that has broad user applications. Like Fletcher’s Ashametrics products, it uses JITAI tech to sense and intervene in mental health situations. HealthRhythms, however, is focused more on providing daily behavioral data to mental health providers, so that they can tailor their clinical help.
“If you look at working class, middle America, places where a lot of veterans come from, they are the ones struggling, facing a lot of socioeconomic problems that lead to depression, suicide, and mental illness. I hope in the next 20 years, we can reach everyone, not just the privileged, with the benefits of this technology.”
-Dr. Rich Fletcher, research scientist at the MIT Mobile Technology Lab and assistant professor at UMASS Medical School
The company was awarded a $2.1 million National Health Institute grant last fall to further develop its patient-facing smartphone app. The company’s president and CEO Tanzeem Choudhury also runs Cornell University’s People-Aware Computing Lab, where doctoral students work with her to develop mobile sensing systems that improve people’s lives.
One such project by PhD Candidate Jean Costa is called EmotionCheck, a smart wearable that senses an upcoming stress episode and uses gentle vibrations to help the user calm down. “This tapping, which is slightly slower than the user’s heart-rate, is shown to help the user regulate their emotions and calm down,” Costa stated in the The Cornell Daily Sun. The benefits show promise for swaths of the population, such as veterans, who suffered from regular, acute anxiety.
On a Mission
Developments in JITAI technology reveal that physiological data is a powerful predictive tool for veterans facing mental health issues.
Fletcher and his lab team are eager to explore non-contact technologies that integrate with smart home devices, accomplishing the same mission without the hassle of wearing a device.
In addition, Fletcher explained he’s on a mission to find technologies that can reach people with economic obstacles, who perhaps don’t have access to wearable technology, or who aren’t as interested in wearing a device.
“If you look at working class, middle America, places where a lot of veterans come from, they are the ones struggling, facing a lot of socioeconomic problems that lead to depression, suicide, and mental illness,” Fletcher said. “I hope in the next 20 years, we can reach everyone, not just the privileged, with the benefits of this technology.”