Design Notes - How to Measure Emotional Stress, Distress, and/or Pain

Hello All - I've gotten a few requests to share "How to Measure Stress", so I thought I'd make a blog post sharing what I know, have tested, and links for further information.  Maybe I'll make a book next year on this topic.

A lot of the requests stem from my "Medical Monitor with Emotional Stress Pain Indicator and Biofeedback" and How to Make It.

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Here's some if not most of the methods by which you can empirically determine stress.  Most of these concepts started with basic Polygraphy or Lie Detection.  From there developed Biofeedback Devices, Medical Monitors, then Neurobiofeedback. 

Who knows what's next? I'm working on it!

All the above measure the physiological changes that occur when someone is stressed, e.g. telling a lie, in pain, distressed over some emotional issue, etc.

These links show the most common physiological signs or tests to identify and/or quantify "stress" - 

Polygraph - Most commonly measure are skin conductance, heart rate, and/or respiration.  Heart Rate Variability have been used most commonly lately to determine stress.

As far as I know, here's where it all started way back in 1881 -
Description of a Polygraph. In this crude start, the heart impulses and respiratory movements were measured and recorded.  From there, all of our modern devices have evolved.

Let's not forget Affective Computing, too, in our consideration.
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In my First Medical Monitor with Emotional Stress Pain Indicator and Biofeedback, I used skin conductance.  It was a start and showed the concept.  In my current model, I'm using Heart Rate Variability (HRV), since it is much more robust than skin conductance.  Skin conductance is good, but hard to measure reliably in a real-world setting.  Pulse sensors are more reliable and robust for this usage.  I like the Gravity: Heart Rate Monitor Sensor For Arduino - DFRobot (link below).

Here are some commercially available stress sensors/information available to the public for experimentation:

Skin Conductance -

Grove - GSR Sensor - Seeed Wiki

Galvanic Skin Response GSR - Arduino Forum

Heart Beat/Pulse -

Pulse Sensor - SEN-11574 - SparkFun Electronics

Heartbeat - Arduino Playground

Pulse Sensor With Arduino Tutorial: 9 Steps (with Pictures)

Arduino & Processing - HEART BEAT MONITOR With Pulse Sensor.

SparkFun Single Lead Heart Rate Monitor - AD8232 - SEN-12650 ...

Polar Heart Rate Monitor Interface - SEN-08661 - SparkFun Electronics

Gravity: Heart Rate Monitor Sensor For Arduino - DFRobot

Here are some links on how to measure and use Heart Rate Variability:

Topic: heart-rate-variability · GitHub

HRV Biofeedback - Joegle

Biohack: Heart Rate Variability « Adafruit Industries – Makers, hackers ...

Pulse Sensor HRV Poincare Plot – World Famous Electronics llc.

PulseSensor Project HRV - Arduino Forum

Arduino Pulse Sensor Cardio Graph: 3 Steps (with Pictures)

Hacking Mindfulness with an Arduino and the iPhone | kpkaiser.com

Meditation Trainer - Adafruit Industries

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Stay tuned for my next model!  You'll be surprised!

That's about all for now.  Have fun.  Let me know if you have comments, questions, etc.

Disclaimer - Article if for information only and is not medical advice.

How to Make a "Medical Monitor with an Emotional Stress and/or Pain Indicator and Biofeedback"

Typically, Medical Monitors only display the Patient's Vital Signs. - This new Medical Monitor indicates Emotional Stress and/or Pain, too.

This new monitor provides an External Indicator e.g. colored lights to show the Internal Distress/Pain Condition of a person, e.g. a Patient - and provides a means to assist a person, e.g. a Patient, to Reduce their Distress/Pain by Relaxation Means, e.g. Deep, Slow Breathing.

See this Video to see How It Works, Theory of Operation, Applications, etc. - Medical Monitor with an Emotional Stress And/or Pain Indicator - Explanation Video.

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There are two versions of this concept – one uses Skin Conductance or Galvanic Skin Response (GSR) and the other uses Heart Rate Variability (HRV).

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This Blog Post shows how the make the Skin Conductance Version (GSR). (My Working Model is not for sale – but you can make your own – and make it even better than I did!) 

The HRV version is being worked on and will be revealed soon.
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Here's the Big Picture of my Working Model:

See Parts List.


Here's How I Made it.... 

1. Make a Medical Monitor Simulator to illustrate the total concept of a “Medical Monitor with an Emotional Stress And/or Pain Indicators”. I just used a picture of a typical Medical Monitor with "Emotional Stress And/or Pain Indicators" glued onto the picture.

Of course, you could modify an actual existing Medical Monitor to add the "Emotional Stress And/or Pain Indicators", too.

2. Make a Patient Wrist Band that measures skin conductance or heart rate variability (HRV). For my GSR version, I made a wrist band with copper sensors glued on - instead of the finger sensors that came with the Grove GSR Sensor.

(On the HRV version, glue the Heart Pulse Sensor onto the wrist band instead of the GSR copper sensors.)

3. Make a Patient Bedside Console with “Emotional Stress And/or Pain Indicators” and also Biofeedback indicators to help patient relax. I just used a hacked up old TV Remote to illustrate the concept.

The upper horizontal string Green, Yellow, and Red Led's are the "Emotional Stress And/or Pain Indicators", same as on the Medical Monitor.

The Two Blue vertical Led's below them are the Patient Biofeedback Breathing Pacer Indicators.

4 Wire an Arduino Uno according to this Wiring Diagram, referring the Parts List.

5. Program the Arduino with this Sketch. (Copy and Paste into Arduino) - If you don't like the transition between Red, Yellow, and Green - try experimenting with with the sensorValue portion of the sketch that turns on and off the R, Y, G led's.

6. Replay this Video to see how to work the system and try it out.

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The "heart" of this model are the sensors:

* For Skin Conductance, the Grove GSR Sensor - Video1

* For Heart Rate Variability, the PulseSensor - and HRV - Scroll down to this Video


More Videos/Pictures.

This concept was shown by me at a local Maker Faire, last year.



Here's some Emotion Wearables to build your work on, too.

Questions? - Let me know and I'll try to answer them - tgideas@gmail.com
Good Luck!

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References -

Medical Monitor with an Emotional Stress And/or Pain Indicator

How to Make a “Medical Monitor with an Emotional Stress And/Or Pain Indicator”

Detecting Pain in Infants and Non-Responsive Patients

10 Exciting Ideas on How to Learn or Teach Healthcare “Bedside Manners” -

As a Healthcare Professional, Are You Checking All the Vital Signs to Evaluate Total Patient Condition?

Smart wearable body sensors for patient self-assessment and ...

Medical monitor
 
A Simple Physiological Monitor System For Neonatal Applications ...
 
How much does it hurt? New system quantifies pain | ISRAEL21c

The BioRadio Wireless Physiology Monitor |

China Bedside Monitor, Bedside Monitor Manufacturers, Suppliers ...

An ambulatory physiological monitor for extended use in animal ...

Patent WO2000044274A3 - Personal physiological monitor
 
Evaluation of Autonomic Nervous Activity Based on ... - ResearchGate
 
Heart rate variability and pain: associations of two interrelated ... - NCBI
 
HRV as Pain Indicator | PetPace Smart Collar
 
HRV Biofeedback in Pain Patients - Full Text View - ClinicalTrials.gov
 
Measurement of Heart Rate Variability to Assess Pain in Sedated ...
 
Heart Rate Variability Biofeedback Promising in Chronic Pain
 
Changes in skin conductance as a tool to monitor nociceptive ... - NCBI
 
The Capability of Skin Conductance to Monitor Pain Compared to ...
 
Use of Electrodermal Activity for Assessment of Pain/Stress in ...
 
The reaction to pain as determined by the galvanic skin response.
 
Autonomic responses to heat pain: Heart rate, skin conductance ...
 
The skin conductance response - MIT Media Lab
A Stress Sensor Based on Galvanic Skin Response (GSR) - MDPI
 
Heart rate and palmar skin conductance in anticipation of painful ...
 
Analysis of galvanic skin response - IUPUI ScholarWorks - Indiana ...

HRV Biofeedback - Joegle

Arduino Stress Detector: 6 Steps

Galvanic Skin Response Infographic - Getting Under the Skin - iMotions

 

Disclaimer - Articles and Videos are for information only and are not medical advice.  See additional disclaimers.

Health Care Costs Can Be Decreased by Enhancing the Placebo Effect

Capturing the Elusive Placebo Effect by Biofeedback Techniques

Health Care Costs Can Be Decreased by Enhancing the Placebo Effect

The Placebo Effect is a part of every medicine or medical treatment. The Placebo Effect makes medicines and treatments work better. Perhaps the Placebo Effect could be described as a patient's hope, faith, or belief in a medicine or treatment. The patient expects to get better by taking the medicine or by undergoing the treatment. 

If the Placebo Effect could be increased, the use of medicines and medical treatments could decrease. This could decrease overall health care cost.

 

Some researchers are indeed trying to maximize the Placebo Effect or at least find out how this phenomenon works. What we do know is that when a patient expects a medicine or treatment to work, it will work better. When the patient doubts the efficacy of a medical intervention, the intervention will be less effective. Essentially, the Placebo Effect is most active when the patient expects or anticipates relief. 

An example of the Placebo Effect at work is when someone takes a pain reliever and says, "I feel better already" after only a few minutes. In actuality, this is impossible because the body has not even absorbed the medicine yet. The patient perceives to feel better already, because they expect relief. 

Expecting or anticipating a positive response is an emotional event. Think of the last time you were excited about a future positive event. You could hardly wait and were emotional.

Consider the Placebo Effect an emotional event. Science has the tools to study emotional events. 

One such "Emotion Measuring Tool" is the Biofeedback Device. Many of these devices use Skin Conductance to determine emotional arousal. When a person is excited, they perspire and Biofeedback Devices measure this. Some devices even have a computer output to track events. 

It is proposed in this article to use Biofeedback Devices to learn how to enhance the Placebo Effect. Below is the description of how this might work.

 

1. The patient would be connected or wear a Biofeedback Device or Monitor.

2. To enhance the Placebo Effect, doctors would say or do things that might elicit a positive expectation of relief or healing. The doctors would continuously monitor the Biofeedback Device to determine if their actions are successful. If the doctor can get the patient to believe that relief is possible, the monitor will show that, since the patient will become excited and slightly perspire.

3. Through time, the Placebo Effect can be captured, studied, and shared. From this, we can learn to enhance the Placebo Effect. 

Takeaways:

• The Placebo Effect is rooted in the Sympathetic Nervous System as an expectation of a positive outcome (hope).
• Biofeedback devices, such as Skin Conductance, measure the activity of the Sympathetic Nervous System.
• Therefore, biofeedback techniques can provide quantitative information about the Placebo Effect.

For more information:

• Placebo Effect
• Enhancing the Placebo
• The Placebo Effect: Mechanisms and Methodology (R01) - Research Grant RFA-DA-12-003 from the U.S. National Institutes of Health (NIH) - See "enhance the therapeutic benefits of placebo effects in clinical research and practice"
• Biofeedback and Skin Conductance
• Reward anticipation, cognition, and electrodermal activity in the conditioned monkey
• Caffeine-associated stimuli elicit conditioned responses: an experimental model of the placebo effect
• The placebo effect and the autonomic nervous system: evidence for an intimate relationship

Disclaimer - Article is for information only and is not medical advice.

Using Biofeedback with Art Therapy, especially with those with PTSD

Could Art Therapy be enhanced by using Biofeedback?  Could Biofeedback quantify the effectiveness of Art Therapy?  Could Biofeedback help hone in on the most helpful method of Art Therapy?

These were questions I asked at a recent Symposium on Art Therapy.  At least one person thought Biofeedback might help with Art Therapy.  Therefore, I thought I'd write this article to stimulate discussion and innovation in this area.

Art Therapy has proven to be a very helpful adjunct to psychotherapy, especially when cognitive approaches have been unsuccessful.  Biofeedback combined with psychotherapy could be viewed as a form of Polygraphy, revealing the inner emotions of the patient.

Biofeedback might provide relief from those suffering from PTSD, according to an article from PubMed.  In addition, Art Therapy could be helpful those with PTSD, according to another article from PubMed.  Therefore, it makes sense to me to combine Biofeedback with Art Therapy, especially for those with PTSD.  I'm not a health care professional, in any sense, but I thought I'd at least propose this new concept to the public in this article.

Some ideas on how Biofeedback could be helpful are listed below.

• Emotional triggers (stressors) could be identified for those with PTSD, Autism, Epilepsy, etc.
• A patient's stressor profile could be determined.
• Using Art, Music, Sculpture, etc. a patient could learn how to deal with difficult emotions, thoughts, etc., using standard Biofeedback Therapy techniques.
• The Art Therapist could have a visual readout of the emotional state of the patient, thereby regulating the amount of trigger stimulation.
• The emotional state of non-communicative patients could be determined.
• The therapist could determine if the patient is "playing her", giving the "expected response or reply".

I couldn't find much previous work in this area.  Perhaps the following might give others clues, however, on how this concept might be implemented.  I used this search string - ("art therapy" (biofeedback OR polygraphy OR lie-detector))

• "Medical Art Therapy with Children", by Cathy A. Malchiodi, Jessica Kingsley Publishers, 1999 - Page 201
• "Confirming the Efficacy of Art Therapy with College Students Through Biofeedback", by Shubha Chatterjee, Emporia State University, 2010
• "Music Therapy & Biofeedback" by Eric B.Miller Ph.D. CMT-BC BCIAC

Some Biofeedback Tools available to the public:

• Mindplace Thoughtstream USB Personal Biofeedback
• GSR2 Home Biofeedback Unit
• CalmLink Biofeedback Software

Takeaways - 

• Art Therapy can be helpful to those with PTSD and other emotional disorders.
• Biofeedback can also be helpful to those with PTSD and other emotional disorders.
• Perhaps, Biofeedback could be combined with Art Therapy, to especially help those with PTSD and other emotional disorders.

Disclaimer - Article is for informational purposes only and is not medical advice. 

Emotion Sensors for PTSD

It seems like there is interest in an Emotion Sensor that would help with Post Traumatic Stress Disorder (PTSD).

First, let's lay down a little groundwork....

• PTSD is explained here - http://en.wikipedia.org/wiki/Posttraumatic_stress_disorder.  
• Emotions -  http://en.wikipedia.org/wiki/Emotion
• Affective Computing - tool to study emotions -  http://en.wikipedia.org/wiki/Affective_computing
• Biofeedback - used to modify emotional response -  http://en.wikipedia.org/wiki/Biofeedback
• Flight or Fight Response and PTSD -  http://ptsd.about.com/od/symptomsanddiagnosis/a/fight_flight.htm
• Galvanic Skin Response, as used in many emotion sensors -  http://en.wikipedia.org/wiki/Galvanic_skin_response

As you can see from above, this is an old topic.  Measuring emotions, feeding back messages, etc. has been known for some time.  Below is some of the latest activity relating sensing emotions for those with PTSD.

• https://www.beckinstitute.org/blog/cbt-for-drug-addiction-and-ptsd-via-wearable-sensor-platform-and-mobile-application/ - wearable sensors and phone therapeutic messages
• http://www.boston.com/lifestyle/health/articles/2012/02/27/turning_cellphones_and_sensors_into_a_therapy_for_ptsd_drug_cravings/ - cellphones and sensors
• https://www.bostonglobe.com/business/2012/02/27/turning-cellphones-and-sensors-into-therapy-for-ptsd-drug-cravings/jPGtqvRsLVSkJbLMbZMvcJ/story.html - shows photos of devices
• http://dailyfreepress.com/2012/02/26/upcoming-app-to-help-drug-addicts-curb-cravings-with-sensor-text-messages/ - iHeal smartphone app
• Methods and apparatus for monitoring patients and delivering therapeutic stimuli Richard Fletcher et al - U.S. Patent Application 2011/0004072 A1
• DEVICES AND METHODS FOR TREATING PSYCHOLOGICAL DISORDERS Robert Goldberg et al - - U.S. Patent Application 2011/0245633 A1
• EAR-WORN BIOFEEDBACK DEVICE Chang-An Chou - U.S. Patent Application 2010/0280338 A1
• http://radar.oreilly.com/2012/11/driven-to-distraction-how-veterans-affairs-uses-monitoring-technology-to-help-returning-veterans-adjust-to-normal-day-to-day-living.html - VA Center using sensors...
• http://www.youtube.com/watch?v=pVsKErmv57E - Emotion Q Sensor Video
• http://exmovere.cn/pdf/Emotions_Research.pdf - Emotion Monitoring
• Washable wearable biosensor Rosalind W. Picard et al - U.S. Patent Application 2010/0268056 A1

More can be found by Googling these search strings....

• (sensor OR detector) (PTSD OR post-traumatic-stress-disorder) (phone OR telephone)
• (stress OR emotion OR anxiety)-(sensor OR detector) (PTSD OR post-traumatic-stress-disorder)
• (stress OR emotion OR anxiety)-(sensor OR detector) (phone OR telephone)

-->

(PTSD OR post-traumatic-stress-disorder) (biofeedback OR biofeedback)  

For Skin Conductance Sensing, try this string - (Electrodermal- activity OR EDA OR skin-conductance OR galvanic-skin-response OR GSR OR electrodermal-response OR EDR OR psychogalvanic-reflex OR PGR OR skin-conductance-response OR SCR OR sympathetic-skin-response OR SSR OR skin-conductance-level OR SCL) (PTSD OR post-traumatic-stress-disorder)

From my own experience with biofeedback, this simple low-cost option might be helpful also....Complete GSR2/Temp2X Calmlink Pro System - http://www.mindgadgets.com/product/gsr-temp2x-biofeedback-system/


This recent posting might be of interest too - "Listen-n-feel: An Emotion Sensor on the Phone Using Speech Processing and Cloud Computing" - http://research.microsoft.com/apps/video/dl.aspx?id=152567 - Again this is just a new twist on old technology, e.g. voice stress analysis - http://en.wikipedia.org/wiki/Voice_stress_analysis

There is now a flurry of activity around the AFFECTIVA,INC. emotion sensor - Here is one patent application that seems to apply - WO/2011/156272. Reading the first claim, it reminds me of how researchers used biofeedback to monitor people watching movies, many years ago. - http://www.soc.northwestern.edu/webster/pubs/Webster%20(2008)%20Audience%20Research.pdf - also - http://eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED017172&ERICExtSearch_SearchType_0=no&accno=ED017172 - also - http://eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED326383&ERICExtSearch_SearchType_0=no&accno=ED326383 ******************************************************************************************

Now you have a snapshot view of what's been done before, here's what else could be done....

• Have a bracelet, wrist watch, or similar that the user "believes" is sensing emotions and automatically adjusts the body and mind to relax.  This is the Placebo Effect -  http://en.wikipedia.org/wiki/Placebo.  This effect works for about 35% of people all by itself.  Placebo devices are viewed by medical science as non-functional, but yet many  patients swear by them, e.g. copper bracelets.
• The Placebo Effect might work better if the user is given hypnotic suggestions.  "It could be said that hypnotic suggestion is explicitly intended to make use of the placebo effect. For example, in 1994, Irving Kirsch characterized hypnosis as a "nondeceptive placebo," i. e., a method that openly makes use of suggestion and employs methods to amplify its effects." -  http://en.wikipedia.org/wiki/Hypnosis
• The device could even work better if it were potentized, activated, or blessed.  Doctors could say words like "it works for some people, and I (emphasized) think it will work for you!".  Military, where PTSD may have formed, could endorse its use.  Clergy could bless the device.  Support group members could pass the the device around and add energy.
• To make it work better yet, make it look like it's doing something, e.g. an led that flashes periodically, similar to the led on your car warning system letting you know you're protected.  See attached image above.

If interested in this latter approach, Harvard might help you implement such a device - http://programinplacebostudies.org/ . 

Have fun, folks.  I am!

Disclaimer - Posting is for informational purposes and is not medical advice.