Name: Daniel Gaztambide, PsyD
Class: Clinical Psychologist
Available For: Real life.
ROUND 1: Engagement, Interface, & Feedback
Breathe2Relax is described as a "portable stress management tool" by its developer, the National Center for Telehealth & Technology or "T2." You can find more about T2 and its relationship to the Department of Defense here. Breathe2Relax, like T2's other apps, were developed with veterans, their families, and mental health providers in mind. That being said, they were designed to be applicable to non-military populations as well.
Breathe2Relax is a basic, but incredibly useful, tool for learning diaphragmatic breathing and breathing relaxation techniques. It's usefulness lies precisely in how simple and straightforward it is. On your first startup, the app invites you to watch a brief demonstration video on what diaphragmatic breathing is, what it looks like, and how to practice it. You can review those steps using the "Show Me How" button.
Take a moment now to take a deep breath. Notice how you breathed right now. Some of you may have noticed that you breathed through your chest (felt your shoulders go up and down). Some of you may have noticed that you breathed through "your belly" (felt your stomach fill up, then relax). The latter is more closely associated with diaphragmatic breathing. We find that this type of breathing encourages a full intake of oxygenated air, with greater carbon dioxide output. Breathing through our chest, although so natural to many of us, mirrors the physiological mechanisms associated with the fight-or-flight or "stress response."
Each type of breathing can in a sense be correlated with a different physiological process. Breathing through our chest can mimic feeling anxious, short of breath, or panicked--hallmarks of the stress response. Breathing through our belly helps stimulate the "relaxation response." This the body's natural built-in break on stress, and has been associated with a number of positive physical and mental health outcomes.
Once you decide you'd like to give it a whirl, you hit the "Breathe" button, where you'll be prompted to "Rate Your Stress," sort of like a feeling thermometer or a graphical depiction of Subjective Units of Distress (SUDs). Using the touchscreen, you can move the oval shaped button farther to the left for more relaxed, farther to the right for more stressed (as depicted above). This is important, as the app asks you to re-rate your level of stress after the exercise.
Once you start the breathing exercise, the app displays a metronome (see the cylindrical shape to the left of the screen) which rises and falls at the speed and rhythm you should be breathing. The app also displays a text cue letting you know when to inhale, the length of time you should inhale (e.g. for 6 seconds), when to exhale, and the length of time you should exhale. This is a great visual device, as it allows you to pace your breath accordingly so that you can feel your way through each cycle. If you find that each breathing interval is going too fast or too slow to your liking, you can use the "Shorten" or "Lengthen" buttons on the lower portion of the screen to adjust them accordingly.
Ideally, you want to both increase the length of time you are able to draw out each breath, and slow down your breath so that you are taking in air in a deeper, more purposeful way to engage the body's natural relaxation response.
Once you complete each cycle in the exercise (standard setting is 16 cycles), or you decide to pause and end the exercise, you will once again be presented with the Rate Your Stress screen (pictured left below). You can once again use the touch screen to move the oval button accordingly in order to answer "How do you feel now?" Do you feel more stressed? About the same? Or (ideally) less stressed? Doing this stress rating at the beginning and end of the exercise not only helps you see if you feel better, but also (ironically) whether this app is right for you!
You can actually look at your results over time by tapping on the "Results" button on the main screen (pictured right below). This chart will--ahem--chart your 1) ratings of stress and relaxation, 2) before and 3) after you complete breathing exercises with the app. As it charts these data points over time, you can really begin to see what impact being able to practice mindful, diaphragmatic breathing, can have on your level of stress each time you use it, and on your general level of stress over time. I have to note, however, that while the Rate Your Stress scroll bar is a nice visual aid, I would have liked if you could see some numerical, standardized scale. For example, most SUD scales range from 0 to 10, or from 0 to 100. The Results chart implies these values, but it would be great to actually see the concrete quantitative meaning of you scrolling more towards Relaxed versus Stressed. It is often useful for people in therapy to actually quantify their feelings or distress in this way.
The app also has various options for customizing your experience, although somewhat under-optimized from a user interface standpoint. Using the "Personalize" function you can set the background scenery, background music (for those of you who need accompaniment with your mindfulness!), as well as engage in a brief breathing exercise to set your ideal pace for inhaling and exhaling. Tapping the "Setup" button will take you to a similar "Settings" screen, where you can not only set the visual background/music for he exercise, but also determine inhalation/exhalation length, number of cycles, whether you want stress levels tracked over time, and etc. Admittedly, it seems redundant to have two separate "options" menus with more or less the exact same items to choose from. This inserts some unnecessary redundancy with the user interface and settings. Another odd duck is that you can access the diaphragmatic breathing demonstration video from both the main screen and the "Personalize" screen.
Lastly, the "Learn" button leads to a little treasure trove of information, videos, and mini-articles regarding the fight-or-flight response and the biology of stress. It also includes a cute but highly informative "Body Scanner" that breaks down the effects of stress on different biological systems.
ROUND 2: Join Forces or Versus?
I admit, this is not a Rolodex of hundreds of mindfulness exercises. This is a basic app with one simple breathing exercise. But, once again, the app's strength lies precisely in its simplicity. It is a tool aimed at teaching you one skill, and helping you hone that skill over time. Although to be honest, it's actually two skills: how to practice mindful relaxation using diaphragmatic breathing, and how to track your level of distress over time (stress rating). Being able to quantify, track, and monitor your level of distress is itself as useful skill to not only notice what stresses you out, and to what degree, but also to track those behaviors that actually help you feel better. In that sense, Breathe2Relax teaches you how to learn both of those skills in a targeted manner. No digging through tens of dozens of exercises--just practicing one.
Great audio-visual cues for pacing one's breath, good initial psychoeducation to get started quickly and easily. 4.5 Couches out of 5. Not perfect, but highly targeted toward its intended skill.
Simple, if somewhat under-optimized interface. Unnecessary redundancy of features. Easy to navigate overall, however. 3 Couches out of 5.
OUTCOME MONITORING & FEEDBACK:
Useful interface for rating stress levels before/after the breathing exercise, produces a Results chart for tracking outcomes over time. However the lack of numerical scaling for stress/relaxation levels makes the rating feel a little too abstract, even if these quantitative measures are implicit in the Results chart. 3 Couches out of 5.
I absolutely recommend this app as a cool resource for patients and therapists in their work together, especially if the focus of the treatment is anxiety, stress, or pain management. Rather than taking home a written relaxation exercise script, patients can have an interactive, fully audio-visual guided experience, which they can also track over time. 5 Couches out of 5.
SHRINK VS. APP:
For people who notice they have very mild issues with anxiety, maybe. For clinically elevated or moderate-to-severe anxiety, better off seeing a mental health professional. Given how limited this app is in scope, it would not be very useful for the regular treatment of moderate-to-severe levels of anxiety. 1 Couch out of 5.
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