Pablo Paredes sat in a doctor’s office, watching his family member scrutinize a photo of himself. Paredes knew what he was thinking: My chin is too big. They were there for the sixth appointment that month, arranged by Paredes in the hopes of arming his relative with tools to overcome a form of obsessive compulsive disorder that led him to agonize over his chin, which he believed was larger than normal.
The doctor took the picture of the relative’s face and drew a line around the chin, exaggerating its size. He was using a tactic called exposure therapy, which initially exposes the patient to the source of anxiety in high doses. Paredes’ relative fidgeted uneasily. The strategy, however uncomfortable at first, works by allowing the patient to become accustomed to the stressor, diminishing angst over time.
Paredes took the picture from the doctor. “I have another idea,” said Paredes, a graduate student of electrical and computer engineering at the time. He uploaded a digital version of the photo to an editing application on his laptop and altered the image, expanding the chin to twice its normal size, and showed it to his family member. “This is what you would look like with an enlarged chin,” Paredes said.
His relative winced at the digitally doctored photo, but the repetitive exposure worked as planned, and eventually, his angst subsided.
It wasn’t revolutionary technology, nor was it a definitive fix, but to Paredes’ relative, it was an effective, albeit initially distressing, strategy to blunt his anxiety. It was then, Paredes said, that he realized just how powerful technology could be in aiding mental health.
More than a decade later, Paredes is an instructor of radiology and of psychiatry and behavioral sciences at Stanford Medicine. His career was one he never foresaw — in a former life, he’d been a Latin rock band’s bass guitarist, a thriving entrepreneur and a high-level business manager at Intel in Brazil. But from his family member’s struggle, Paredes found inspiration for a new career — applying his engineering expertise to elevate the mental health of an entire population.
The mechanics of well-being
For now, it’s early days for Paredes’ work, and he’s sussing out how to tackle such a complex issue. “Understanding how to best influence mental health through engineering will take serious time; there’s no manual to follow. We’re figuring it out as we go,” said Paredes. “Eventually, our experimental data will point us to a more narrow path, which we will then investigate more deeply.”
In 2003, Paredes, originally from Ecuador, went to Georgia Institute of Technology on a Fulbright scholarship. After earning a master’s in electrical and computer engineering and an MBA, he spent several years managing product teams at various companies in South America before pursuing a new career in mental health technology. In 2010, he went back to being a full-time student at the UC Berkeley, joining a lab that used sensors and actuators to identify, measure and mitigate stress. Five years later, he graduated with a PhD, and moved south to Stanford, joining James Landay, PhD, a professor of engineering, as a postdoctoral scholar.
Now in his own lab at Stanford, Paredes leads the development of more than a dozen digital interventions that could one day provide millions of people the means to champion their own well-being. He designs technologies for the places we frequent the most — the office, car and home.
With his inventions, Paredes is after answers to one overarching question: How do you improve and measure emotional well-being? His goal is to implement and engineer technologies to help people grapple with mental health challenges while collecting data that show the biological changes linked to fluctuations in mental well-being.
“Broadly speaking, there’ve been few people taking a physiological approach to well-being and really looking at the underlying biology associated with why and how we feel better,” said Mark Cullen, MD, director of Stanford’s Center for Population Health Sciences and senior associate dean for research at the School of Medicine. “The idea that we could develop some integrative physiological measures of well-being is greatly appealing — it’s part of beginning to foster a real science around positive health outcomes.”
And that’s what Paredes is doing. His technology tracks different combinations of breathing rate, heart rate and cortisol levels (all of which are scientifically linked to a person’s mental state, stress level or anxiety), among other parameters, to gauge how well the interventions dampen stress and promote mental health upkeep.
Of his many projects, one takes to the road. Its strategy is to transform a notoriously stressful part of the day that holds millions of Americans captive to a bucket seat: the commute. After all, almost 117 million people in the United States spend about an hour a day ferrying themselves to and from work. Why not use that time for a little self-care?
This effort, deemed “the mindful commute,” aims to passively sense stress and enable people to use their commute time to mold their mental state — like turning the drive home from work into a cool-down or de-stress period.
“You can do something very simple — do breathing exercises, have a humorous moment, or simply reflect on something that encourages self-compassion,” said Paredes. These actions, he said, aren’t like triggering an immediate switch; a moment of gratitude won’t instantly erase the weight of a nerve-racking week, but it can initiate a “change of gears” and help dissipate built-up stress as you make your way home.
“We hope to change the commute with our inventions so that people don’t see it as a waste of time, but instead as a really transformative part of their day, where they can begin to detach and reattach to and from work,” said Paredes.
With Paredes’ inventions, after a long day, you could hop in a car that could sense your stress and recommend personalized digital de-stressors. For a handful of these sensing and intervention technologies, Paredes has published scientific papers that establish validity and set the stage for future investigation.
Those in the mood to talk might choose to hash out a tense situation with one of Paredes’ chatbots — a cadre of robots using various therapeutic tactics to help a driver cope with the situation at hand. (For instance, one bot prompts users to think about the problem as if they were giving advice to a friend.Another encourages the “glass half-full” approach and helps find positive aspects of the situation.)
While the data collection process has only just begun, 40 people have demoed the chatbots — half in a car, and half in a driving simulation — and Paredes is continuing to collect data on which bots are best suited for stress relief. Overall, participants have reported enjoying the therapeutic variety and generally said they’d prefer to hash out stress with a non-judgmental robot than a real person.
If you’re more of the silent type, you might opt for technologies Paredes created that help you train your breathing to slow down or persuade your heart into an optimal resting rate. (Some studies by others suggest a person’s heart can sync up with an external beat if exposed to its rhythm in the right way.)
Both tactics use machinery embedded in the seatback on the driver’s side to create vibrational patterns. In the breathing exercise, one buzz cues inhalation; another, exhalation. The vibrations of the heart rate exercise, on the other hand, turn the driver’s seat into a soft, thumping subwoofer.
“Some of these strategies could even work in reverse,” said Stephanie Balters, PhD, a postdoctoral scholar in Paredes’ lab who’s just begun recruiting participants for the guided breathing project. “There’s something called power breathing, or fast-paced breathing, and it’s been shown to heighten alertness.” Something, perhaps, to shake off Monday blues or wake up a drowsy driver.
For the day that we’re toted about by self-driving cars, Paredes has built a virtual reality experience that puts a deep-sea spin on meditation. In this open-ocean VR excursion, drivers-turned-divers plunge through ocean trenches, tag along with schools of fish and can even find themselves eye to eye with a giant humpback whale.
A dogbot, left, makes noises in response to a driver’s mood. A camera, right, is one of seven cameras that are installed in the test vehicle: four to observe the driver and three to capture the driving behavior.
To assist your inner ear, Paredes has added something called “kinesthetic congruence,” to the virtual reality experience, which allows the movement of the car to dictate the movement of the virtual world: If the car turns left, the whale turns left, and so does your field of vision, helping mitigate any car (or sea) sickness.
“One key aspect of meditation is being present and focused on one thing — maybe it’s your breathing, maybe it’s a repeated saying. That’s what a lot of meditation apps try to get people to do,” said Paredes. But with these more traditional apps, people benefit only insofar as they are able to focus on one thing without losing concentration or getting bored.
That’s where the humpback comes in. So far, 15 virtual whale watchers have participated in a preliminary test of the in-car tech. Survey data combined with physiological measurements that track relaxation (heart rate and skin conductance) showed that all the participants were less stressed when virtually swimming with whales than when using a more traditional virtual reality meditation app. And, while a few felt a bit woozy, no one got sick. The plan, Paredes said, is to see whether larger cohorts confirm these findings.
Today’s self-driving cars aren’t ready for this technology just yet — riders still need to be awake and able to take the wheel should circumstances go awry — but Paredes said that one day when autonomous cars are dependable enough that its occupants can go to sleep, it’ll be a green light for up-close, in-car whale watching.
On the pulse of mental health
Chattering bots and tranquil whales are well and good, but what makes Paredes’ gadgets transformative are real-time measurements that report how the user interacts with them. Tactics like surveys and recorded feelings are typically the go-to methods to evaluate mental well-being, but Paredes purposefully strays from conventional self-reporting.
“We’re not the first to use lights to sway mood or chatbots to talk to people, but companies working in this vein don’t have the science behind it — that’s what’s missing.” That, Paredes said, is why his lab is looking into it — to figure out how to passively assess stress and alter the lights or engineer the chatbots to support mental health based on data and scientific evidence.
“My deep desire is to use technology to understand the biology behind mental health issues so we can either prevent people from reaching a breaking point or help them manage mental ailments, long or short term,” he said. It’s a drive kindled by his anxiety-battling family member, his unsung hero, he said. “I doubt I’d be in this type of research if it weren’t for him.”