Rehabilitation and Prosthetic Services

Device Review: Breathe2Relax

Reviewed on September 25th, 2017

By Mandy J. Freeman, MS, OTR/L

Overview

Breathe2Relax is a portable stress management tool, designed by the National Center for Telehealth & Technology, to teach breathing techniques to help manage stress and provide detailed information on the effects of stress, on the body. This application offers detailed instructions for hands-on diaphragmatic breathing or “belly breathing" exercises. These breathing exercises help to activate the body’s natural relaxation response, which is a physical state of deep rest that changes the physical and emotional responses to stress. Diaphragmatic breathing, not only decreases the body's stress response (“fight or flight”), but it also helps with mood stabilization, anger and anxiety management. The skills taught, may be of particular value to veterans who are experiencing post-traumatic stress disorder (PTSD), providing an easily accessible relief for stress and anxiety. Breathe2Relax can be accessed through an iPhone, iPod touch, iPad and/or Android device and can be used as a separate stress management program/tool, or can be used in conjunction with receiving clinical care from a healthcare professional.

Indications

The Breathe2Relax application is indicated for veterans who report issues with stress management and a need to learn stress management techniques, to help decrease the impact stress has on their life and over all well-being. The Breathe2Relax application can benefit individuals with a variety of diagnosis/needs, such as anxiety disorders, stress, and PTSD.

In general, the following criteria should be met for a veteran to benefit from the Breathe2Relax application:

1. The veteran must have adequate vision, hearing, and dexterity (or an alternate method) to successfully and easily access an iPhone, iPod touch, iPad and/or Android device.
2. If using outside of therapy sessions, the veteran must demonstrate independent understanding and use of the application.

3.The veteran must demonstrate motivation and willingness to use the Breathe2Relax application, as indicated.

Contraindications

In general, The Breathe2Relax application should not be used when:

1. Veteran does not own or have access to an iPhone, iPod touch, iPad and/or Android device (if using outside of therapy sessions).
2. Veteran does not have a physical access method to use an iPhone, iPod touch, iPad and/or Android device (i.e. efficient hand movement).
3. Veteran is unable to demonstrate comprehension and utilization of the application, due to cognitive and or physical barrier.
4. Veteran should not use the Breathe2Relax application as a substitution for seeking professional mental health assistance, from a health care provider, when needed.
5. For veterans with lung issues, or those who simply have a weak diaphragm, this exercise could be tiring at first and it is important not to overly strain or injure oneself and stop exercise, if discomfort is felt. If the veteran has critical pulmonary issues, they should consult a doctor before attempting the diaphragmatic breathing exercises, taught in this application.

Criteria for Evaluation of Assistive Technology Device

Affordability: The Breathe2Relax application can be downloaded from the iTunes store for Apple devices or from Google Play or Amazon for Android devices, at no charge with no hidden fees to create or update an account. Although, the application is free of charge, it must be accessed on an iPhone, iPod touch, iPad and/or Android device, which can cost anywhere from $200-$1200.

Compatibility: This application operates on an iPhone, iPod touch, iPad and/or Android device and because these items have become commonplace in most home and work environments, and are available at several public facilities (i.e. public library), at no charge, it is unlikely that the use of this application will become obsolete.  Although iPhones, iPod touches, iPads and/or Android devices and Applications are very common and frequently used today, the older population and or veterans may not be as familiar or comfortable with using these technologies and may not be receptive to trialing/using this application. 

Consumer Reparability: An initial set-up guide has been added to this application, to assist with tailoring the application to the user’s desire. There is also a Frequently Asked Questions section on the National Center for Telehealth & Technology Breathe2Relax website, where a consumer can have quick access to frequently asked questions related to this application. On the National Center for Telehealth & Technology Breathe2Relax website, the customer-service telephone number & an address, are provided and there is an option to instant message, to help resolve any further issues that may arise.

Dependability:  In order for this application to be dependable, with predictable levels of accuracy, the user must have access to an iPhone, iPod touch, iPad and/or Android device and the device must be adequately charged, on a regular basis.  These devices typically are not made to be used in or withstand extreme temperatures or water. The volume should be on/up and screen brightness should enable adequate sight of the screen. There are no other additional factors or special considerations for reliable use of this application.

Durability: The application is aimed to never expire or require major updates or changes. The durability of the application is also dependent on the durability of the device upon which the application is accessed.

Ease of Assembly:   Once a device (iPhone, iPod touch, iPad and/or Android), is set-up and ready to use, this application can easily be downloaded from either the iTunes store for Apple devices or from Google Play or Amazon for Android devices. The application typically only takes a few seconds to minutes to download.

Ease of Maintenance: This application, in general, is easy to maintain. Software updates may be recommended at regular intervals, at no charge. Maintenance of the device, in which the application is downloaded (iPhone, iPod touch, iPad and/or Android), will require regular charging and cleaning/infection control, as needed.  

Effectiveness:  Breathe2Relax was developed to teach a skill called diaphragmatic breathing. Diaphragmatic breathing, when performed correctly, has been documented to decrease the body's 'fight-or-flight' (stress) response, and help with mood stabilization, anger control, and anxiety management. Although the Breathe2Relax application, can be useful during highly stressful situations, it is important to understand that it is not an immediate remedy to high levels of stress. The Diaphragmatic breathing exercises, taught in this application, will not immediately slow a racing heart or filter adrenaline from your body, however, as with any stress management skill, diaphragmatic breathing requires practice and regular use, in order to experience the full benefits.   

Research shows that health care providers, overall, have reported that their patients have benefited from using Mental Health applications, such as Breathe2Relax, in treatment, however, discussion around technology and mental illness frequently revolves around mobile applications, and that although they can be personalized to an extent, still should not replace one-to-one therapeutic intervention.

Flexibility:  Breathe2Relax can be used as a stand-alone stress reduction resource or can be used in conjunction with treatment provided by a healthcare provider. This app has an initial setup guide, to assist with customizing this application to the user's desire. The user can customize the background scenery viewed and the background music played, during the breathing exercises. The user also has the option to customize the inhale & exhale length, of the breathing exercises.  The personalization of this application is very easy to access, as there is a “Personalize” tab located on the top left corner of the main screen. This application, unfortunately, does not have the option to turn off the narrator’s voice and also does not have the option to change the narrator’s voice.

Learnability:  The Breathe2Relax application is designed to be user friendly and provides step-by-step instructions for set-up and use. Each button/selection is clearly labeled (Personalize, Tip, Show Me How, Breathe, Setup, Results, Learn, About) and when selected each section provides a brief description of what is offered (i.e. The “Results” section describes to the user that as you breathe to relax you can set how much stress you feel before and after the breathing exercise is complete and that overtime should be able to see how the diaphragmatic breathing is beneficial). This application also offers a detailed, step-by-step video demonstration of how to perform the breathing exercises, correctly to receive the full stress relief/physiological benefits of the exercises.

Although each button/selection has detailed instructions on the use and purpose of each section, because the application/instructions provided are language-based, it may be difficult for a veteran with aphasia or other language/cognitive deficits to use effectively. In addition, if a patient is not familiar with technology (i.e. use of smart-phones, tablets, etc.), the application could be overwhelming and the individual may benefit/need guidance and practice, in order to use the application effectively.

Operability: This application is designed to be straight forward and easy to operate. The visual and audio settings and displays under the “Settings” section, can easily be adjusted/personalized to meet the patients’ needs/preferences.  The individual’s level of comfort with operating this application may depend on their familiarity with it. Comfort levels with using this application, will likely increase with practice. An individual with no technology knowledge, may have difficulty with set up and use of the application, without guidance.

Personal Acceptability: This application can be accessed via an iPhone, iPod touch, iPad and/or Android device. Because all of these devices are relatively mainstream in society, use of the device and application is typically acceptable and comfortable for the user. Acceptability of use of this application in public areas, may differ based on the individual’s comfort level, however the application can be used more discretely, if headphones are used with the device.

Physical Comfort:  This application does not need to be accessed constantly, therefore, there is no significant risk for mental exhaustion or physical damage/injury. This application can be started and stopped, as needed, at the user’s discretion.

Portability:  Fortunately, the devices that this application can be used on (iPhone, iPod touch, iPad and/or Android device), are all devices that can readily be transported, operated and battery charged, in different locations.  All of these devices can fit into a medium to large purse, backpack, and/or briefcase.

Securability:  All of the devices that this application can be used on (iPhone, iPod touch, iPad and/or Android device), can easily be transported and kept within reach of the user, therefore, the consumer can reduce the likelihood that the device, this application is used on, be vandalized or stolen.  This application does not have a log-in option with a username and/or password, however most of the devices that this application can be used on, all have the option to set-up an access user touch ID or passcode.

Supplier Repairability: If there is an issue with this application, The National Center for Telehealth & Technology can be contacted to provide assistance through the telephone or via an instant message option, on their website.

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