Smartphone Photoplethysmography Covaries with Stress and Anxiety During a Digital Acute Social Stressor Preprint

Abstract

Heart rate is a transdiagnostic marker of affective states and the stress diathesis model of health. While most psychophysiological research has been conducted in laboratory environments, recent technological advances have provided the opportunity to index heart rate dynamics in real world environments with commercially available mobile health (mHealth) and wearable photoplethysmography (PPG) sensors that allow for improved ecologically validity of psychophysiological research. Unfortunately, adoption of wearable devices is unevenly distributed across important demographic characteristics, including race, ethnicity, socioeconomic, education, and age making it difficult to collect heart rate dynamics in diverse populations. Therefore, there is a need to democratize mHealth PPG research by harnessing more widely adopted smartphone-based PPG to both promote inclusivity and examine whether smartphone-based PPG can predict concurrent affective states. In the current preregistered study with open data and code, we examined the covariation of smartphone-based PPG and self-reported stress and anxiety during an online variant of the Trier Social Stress Test (TSST), as well as prospective relationships between PPG and future perceptions of stress and anxiety in a sample of 103 adult participants. Results demonstrated that smartphone-based PPG significantly covaries with self-reported stress and anxiety during acute digital social stressors. PPG heart rate was significantly associated with concurrent self-reported stress, but not stress at subsequent time points. These findings highlight the potential use of smartphone-based PPG as an inclusive metric to index heart rate in remote digital study designs and indicate that PPG can provide a proximal, but not subsequent, measure of stress.

Technological Innovations in Biobehavioral and Psychosomatic Medicine

“…The overall scope of the current special issue of Psychosomatic Medicine is on “The Impact of Technological Innovation on Biobehavioral and Psychosomatic Medicine.” A comprehensive overview of technological innovations is provided with the goal that these and related innovations will be incorporated into research and clinical practice. The articles in this issue address the following general topics: the use of biological and behavioral sensors that are linked to user smartphones (8–13), the use of technology in clinical settings and issues related to VHs in clinical settings (14,15), digital mental health interventions (16,17), and the importance of reducing health disparities in technological development and implementation of technological innovation (18).…”

“…In this special issue, Van Dijk et al (8) demonstrated that photoplethysmography (using a smartphone’s camera) can be used to generate biofeedback of heart rate variability for reducing stress and anxiety among a cohort of 57 healthy volunteers as well as a traditional electrocardiogram-based heart rate variability biofeedback training in the laboratory. Nelson et al (9) conducted a proof-of-concept study that used photoplethysmography and a smartphone app to measure heart rate and then successfully correlate increases in heart rate to increases in perceived stress and anxiety among college students (using a modified version of the Trier Social Stress Test). In a study of approximately 32,000 adults, Mak et al (10) used an app-based optic sensor to measure both heart rate and blood pressure, which was then linked with ecological momentary assessments of acute and chronic levels of perceived stress.…”