- The document discusses developing technology to help manage stress and promote wellbeing in everyday, real-world ("in the wild") contexts through non-obtrusive sensing and subtle interventions. - Current approaches to stress management are often not adopted due to barriers like needing to visit a clinic. The goal is to develop interventions integrated into everyday activities and environments. - Examples discussed include detecting stress from driving behavior and providing guided breathing exercises in cars to help drivers relax. Other work aims to enhance driver arousal through fast-paced breathing interventions. - The approach aims to break up the daily stress cycle by intervening during work, commutes, and evenings using ambient and integrated technologies designed not to disrupt normal activities.

1. Life-hacking stress ”in the wild”
Pablo E. Paredes, PhD, MBA

2. On a daily basis…

3. overworked

4. tired

5. angry

6. overweight

7. unmotivated

8. distracted

9. unhappy

10. feeling isolated

11. 1 in 4 people affected by mental
or neurological disorders …

13. in the wild: 87% indoors & in cars

14. Pervasive Wellbeing Technology Lab
Keep people healthy with the
right intervention, at the right time.

15. Right intervention at the right time
Across multiple (indoor) scenarios

16. Could you estimate the efficiency of
mental health therapy?
Efficiency = (Adoption – Attrition) / Total
Efficacy = Successful completion

17. 1/4
10%
20% 1/3
0.05%
of the Population
(0.22% Efficiency)
1/3
APA / UCSF Latino Mental Health / Mohr, D.
An open problem:
policy, medicine, design, data
Referral Dx Treated No Relapse

18. Quit business career to solve mental
health technology gap
Human Computer/Robot Interaction (HCI/HRI)
Artificial Intelligence (AI)
Behavior Change
Biomechanics
Postdoc in Computer Science @ Stanford (HCI Group)
Computer Science PhD @ UC Berkeley (Berkeley Institute of Design)
About me …

19. Human health
World Health Organization (WHO) ’48:
“a state of complete physical, mental and
social well-being and not merely the absence
of disease or infirmity.”

20. Wellbeing
always
happened
“in the wild”

21. 21
Gambhir et al. Science Translational Medicine
Health is not the absence
of disease
WHO ‘48
No economic incentives
Healthy people are NOT
motivated
“too busy”, “let me be”
What about keeping people healthy?

22. 22
Precision Health: Everyday tasks can be
equipped with smart devices
Gambhir et al. Science Translational Medicine

23. Modern wellbeing “in the wild”

24. 60-80% of primary care visits due to
stress, 3% get stress management
69% say it is important to manage
stress but only 32% know what to do
42% of Americans lying awake at
night due to stress
[Nerukar, et al.] When Physicians Counsel About Stress: Results of a National Study,
JAMA Internal Medicine, (2013)
Stress in America, American Psychological Association, (2013)
Stress Management

25. Pervasive Wellbeing Technology Lab
Non-obtrusive
Sensing
(precision / use)
Subtle
Interventions
(what? / when?)

26. Interventions are NOT an organic evolution of sensing
Engagement is NOT an evolution of precision
Efficiency is NOT an evolution of efficacy
New science of interventions in the wild
Medicine + Engineering + Design + Economics
Fundamental Challenges

27. Out of the lab and into the wild
People forget, get bored, and break stuff
Context & noise can turn
interventions into exacerbations

28. Project examples:
Moustress: stress detection w/ PC mouse
Fast & Furious: stress detection w/ steering w.
PopTherapy: AI stress micro-interventions Just Breathe: slow breathing while driving
Fiat Lux: affective & efficient urban lights
Non-obtrusive
Sensing
(precision / use)
Subtle
Interventions
(what? / when?)

29. 29
Find people where they are…

30. Americans stuck in cars for 60 min/day
https://upload.wikimedia.org/wikipedia/commons/6/6d/TrafficJamFrustration.jpg

31. Turn this bug into a feature

32. Daily stress exacerbation
Work
Commute
Home

33. Daily stress exacerbation
Work
Sensing & Intervening
Commute
Home

34. Hidden sensors in the wild
sensing with

35. Fast & Furious:Detecting Stress with a Car Wheel
Paredes, P. E., Ordoñéz, F., Ju, W., Landay, J. A.,
CHI 2018

36. Sun, D., Paredes, P. E., Canny, J., CHI 2014
Detection of stress-based muscle stiffness
differences in mouse motion via Mass Spring
Damper (MSD) model
MouStress: Detecting Stress
from Mouse Motion
http://www.quickmeme.com/meme/3sp0z3

37. Peripheral Nervous System
Autonomic
Nervous System
Visceral motor
nuclei in
hypothalamus
------
Vision
Glands
Respiration
Digestions
Heart
Somatic
Nervous System
Motor cortex &
motor nuclei of
brain stem
------
Skeletal muscle
Brain
Spinal cord
Central
Nervous
System

38. Electro-dermal Activity (EDA)
Autonomic sensing
(Obtrusive)
Heart Rate Variability (HRV)

39. Fight or Flight
Autonomic + Somatic
Pupils dilate, tunnel
vision, constant
surveillance
Breathing becomes
fast and shallow
Heart beat is faster
and noticeable
Increase sweating
Mouth
gets dry
Leg muscles become
tense and strengthened
Neck, shoulder
and arm
muscles become
tense and
stronger
The car:
Non-obtrusive stress
sensor!

40. Subtle (just-in-time) interventions

41. Pop Culture:
Top Apps, Games, Media
Top Therapies:
Positive Psychology
Cognitive Behavioral
Meta Cognitive
Somatic
Everyone has something they do really well … find an
example on your Facebook timeline that showcases one of
your strengths.
http://www.facebook.com/me/
Affirmations always make me feel better. Here, check this
out.
http://m.pinterest.com/search/pins/?q=affirmation
Pop Therapy
Paradox: “Your stress app stresses me up!”
Paredes, P. E., Gilad-Bachrach, R., Czerwinski, M., Roseway, A., Rowan, K., Hernandez, J.
CHI 2014

42. Social
Network
CalmMeNow: Mobile stress Interventions
Paredes, P. E., Chan, M.
CHI 2011

43. Subtle interventions in a moving vehicle…

44. Manual Autonomous
Evaluating In-Car
Movements in the
Design of Mindful
Commute
Interventions:
Exploratory Study
Paredes, P. E., Hamdan, N.,
Cai, C., Clark, D., Ju, W.,
Landay, J. A.
Journal of Medical Internet
Research (JMIR) 2017

45. Just Breathe: In-Car Interventions for Guided
Slow Breathing
Paredes, P. E., Zhou, Y., Balters, S., Murnane, E., Ju, W., Landay, J. A.,
Journal of Interactive, Mobile, Wireless, Ubiquitous Technology (IMWUT) 2018

46. Just Breathe… Slower
0 5 10 15 20 25 3012 18
NormalDeep
6
Our Goal: 30% reduction
Experts
"Pranayama”
Diaphragmatic
Risk of Exacerbation*
Novices
Lower rate
*Ahmed, B. et al., ReBreathe: A calibration protocol that improves stress/relax classification by relabeling deep breathing exercises, IEEE Affective Computing, 2016
Paredes, P., & Chan, M., CalmMeNow: Exploratory research and design of stress mitigating mobile interventions: CHI, 2011
Breaths Per
Minute (BPM)

48. Use the car to guide the body
41 Linear Resonant Actuator
50 dB, 13000±3000 RPM
*p < 0.05, **p < 0.01, ***p < 0.001
Treatment time
Normalizedandbaseline
correctedBreathingRate(BR)
*RMSSD increases = reduction in autonomic arousal
Treatment time
Normalizedandbaseline
correctedHRV(RMSSD)

49. Side effect: Sleepiness (autonomous driving)

50. 50
What about fast breathing?

52. Breath Booster! Exploring In-car, Fast-paced Breathing
Interventions to Enhance Driver Arousal State
Balters, S., Murnane, E., Landay, J. A., Paredes, P. E.,
Pervasive Health 2018
52
BPM
12-18
https://www.youtube.com/watch?v=ZBjnograjq4
Hyperventilation
Normal
breathing
Breath of fire
0 20 40 60 80 100 120
Fast-
paced
Increase
Arousal

53. Ongoing work

54. 54
Make the new wild
look like the old wild

55. Driving with the Fishes: In-car calming
virtual reality (VR) interventions
Ocean + Moving calmer
than Island + Sitting
(p<0.05)
Paredes, P. E., Balters, S., Qian, K., Murnane, E., Ordonez, F., Ju, W., Landay, J. A.,
Journal of Interactive, Mobile, Wireless, Ubiquitous Technology (IMWUT) 2018

56. Breaking the daily stress chain
Work
Commute
Home
(Non-obtrusive) Sensing
+
(Subtle) Intervening

57. Our approach revisited:
Non-obtrusive
Sensing
(precision / use)
Sensorless (repurpose signals)
Non-contact (radar/camera)
Skin-like (tatoos)
Subtle
Interventions
(what? / when?)
Repurpose media (web/mobile)
Non-volitional (robotic furniture)
Subliminal (display/subwoofer)
Interstitial (commute)
Pre-
Intervention
Preparatory
Lower effect-size
Different scenario
(e.g. office ! car)

58. Integrated stress management
Workday Evening (pre-sleep)Commute
Cumulative daily stress
Reduced daily stressActive
Intervention
Ambient
Intervention
Ambient
Intervention

59. Pablo Paredes
Integrated wellbeing tech in the wild
Non-obtrusive stress w/ movement
Stress-aware conversational devices
Movement-based stress management Light-driven breathing/emotion regulation
Browser breathing
Sit-stand exercise & stress regulation
Non-obtrusive sensing
Subtle Interventions
Daily stress trajectories (a) Cumulative daily stress, (b) Reduced daily stress
Subliminal display Micro chatbots

60. Pablo E. Paredes
pparedes@stanford.edu
Pervasive Wellbeing Technology Lab
http://med.stanford.edu/pervasivewellbeingtech