BACKGROUND: the prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. OBJECTIVE: the aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. METHODS: a 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. RESULTS: After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=-3.51; P 

BACKGROUND: University students in the United Kingdom are experiencing increasing levels of anxiety. A program designed to increase awareness of one's present levels of well-being and suggest personalized health behaviors may reduce anxiety and improve mental well-being in students. The efficacy of a digital version of such a program, providing biofeedback and therapeutic content based on personalized well-being metrics, is reported here. OBJECTIVE: the aim of this study was to test the efficacy and sustained effects of using a mobile app (BioBase) and paired wearable device (BioBeam), compared with a waitlist control group, on anxiety and well-being in university students with elevated levels of anxiety and stress. METHODS: the study employed a randomized, waitlist-controlled trial with assessments at baseline, 2 weeks, postintervention (4 weeks), and follow-up (6 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored >14 points on the Depression, Anxiety, and Stress Scale-21 items (DASS-21) stress subscale or >7 points on the DASS-21 anxiety subscale, (3) owned an iOS mobile phone, (4) did not have any previous psychiatric or neurological conditions, (6) were not pregnant at the time of testing, and (7) were able to read and understand English. Participants were encouraged to use BioBase daily and complete at least one course of therapeutic content. A P value ≤.05 was considered statistically significant. RESULTS: We found that a 4-week intervention with the BioBase program significantly reduced anxiety and increased perceived well-being, with sustained effects at a 2-week follow-up. Furthermore, a significant reduction in depression levels was found following the 4-week usage of BioBase. CONCLUSIONS: This study shows the efficacy of a biofeedback digital intervention in reducing self-reported anxiety and increasing perceived well-being in UK university students. Results suggest that digital mental health interventions could constitute a novel approach to treat stress and anxiety in students, which could be combined or integrated with existing therapeutic pathways. TRIAL REGISTRATION: Open Science Framework (OSF.io) 2zd45; https://osf.io/2zd45/. 

© 2020 JMIR Publications. All rights reserved. Background: Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery. Objective: This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress. Methods: in total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: App-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period. Results: Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups. Conclusions: Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees' cardiovascular health. 

In recent years, measures of cardiac interoceptive accuracy have been heavily scrutinised. The focus has been on potentially confounding physiological and psychological factors; little research has examined whether the device used to record objective heartbeats may influence cardiac interoceptive accuracy. The present studies assessed whether the device employed influences heartbeat counting (HCT) accuracy and the location from which heartbeats are perceived. In Study One, participants completed the HCT using a hard-clip finger pulse oximeter, electrocardiogram (ECG) and a smartphone application. In Study Two, an ECG, hard-clip and soft-clip oximeter were compared. Moderate-strong correlations were observed across devices, however, mean HCT accuracy and confidence varied as a function of device. Increased sensation in the finger when using a hard-clip pulse oximeter was related to increased accuracy relative to ECG. Results suggest that the device employed can influence HCT performance, and argue against comparing, or combining, scores obtained using different devices. 

BACKGROUND: the speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery. OBJECTIVE: the aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor. METHODS: a total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min). RESULTS: There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P50 ms (pNN50; P 

Wearable physiological monitors are becoming increasingly commonplace in the consumer domain, but in literature there exists no substantive studies of their performance when measuring the physiology of ambulatory patients. In this Letter, the authors investigate the reliability of the heart-rate (HR) sensor in an exemplar 'wearable' wrist-worn monitoring system (the Microsoft Band 2); their experiments quantify the propagation of error from (i) the photoplethysmogram (PPG) acquired by pulse oximetry, to (ii) estimation of HR, and (iii) subsequent calculation of HR variability (HRV) features. Their experiments confirm that motion artefacts account for the majority of this error, and show that the unreliable portions of HR data can be removed, using the accelerometer sensor from the wearable device. The experiments further show that acquired signals contain noise with substantial energy in the high-frequency band, and that this contributes to subsequent variability in standard HRV features often used in clinical practice. The authors finally show that the conventional use of long-duration windows of data is not needed to perform accurate estimation of time-domain HRV features. 

The objective of this study was to examine the association between perseverative cognition in the form of work-related rumination, and heart rate variability (HRV). We tested the hypothesis that high ruminators would show lower vagally mediated HRV relative to low ruminators during their leisure time. Individuals were classified as being low (n = 17) or high ruminators (n = 19), using the affective scale on the work-related rumination measure. HRV was assessed using a wrist sensor band (Microsoft Band 2). HRV was sampled between 8 pm and 10 pm over three workday evenings (Monday to Wednesday) while individuals carried out their normal evening routines. Compared to the low ruminators, high affective ruminators demonstrated lower HRV in the form of root mean square successive differences (RMSSDs), relative to the low ruminators, indicating lower parasympathetic activity. There was no significant difference in heart rate, or activity levels between the two groups during the recording periods. The current findings of this study may have implications for the design and delivery of interventions to help individuals unwind post work and to manage stress more effectively. Limitations and implications for future research are discussed. 

As video games have grown from crude and simple circuit-based artefacts to a multibillion dollar worldwide industry, video-game music has become increasingly adaptive. Composers have had to use new techniques to avoid the traditional, event-based approach where music is composed mostly of looped audio tracks, which can lead to music that is too repetitive. In addition, these cannot scale well in the design of today's games, which have become increasingly complex and nonlinear in narrative. This paper outlines the use of experience-driven procedural music generation, to outline possible ways forward in the dynamic generation of music and audio according to user gameplay metrics. © 2009-2012 IEEE.