Monday, June 22, 2015

Muse: Technology-Assisted Mindfulness

The Muse is a relatively new product, dubbed the "brain sensing headband." InteraXon, the company behind Muse sent me a Muse to review. I also had the opportunity to have a short interview with InteraXon's co-founder and Chief Product Officer, Trevor Coleman. Below is a thorough review of the device and its application. It starts with some background on mindfulness and neurofeedback, so skip ahead if you're familiar with these topics.

Mindfulness is all the rage. Corporations are promoting mindfulness at work, and mindfulness-based therapies are the focus of regular research in the behavioral health world. I've seen the benefits first-hand, being intensively trained in the mindfulness-centered Dialectical Behavior Therapy (DBT) and therefore regularly teaching and leading mindfulness activities. More and more people are also recognizing the congruence and benefits of spiritual forms of mindfulness to enhance their spiritual lives, as well (centering prayer and lectio divina can be considered forms of mindfulness).

For those unfamiliar, mindfulness has many different definitions and forms, but my oversimplified summary is essentially awareness of and being present in the moment. It has been shown to be helpful for things from depression, anxiety, and ADHD to improving relationships to enhancing one's spiritual life. There is a lot of overlap with meditation, which is in some ways a specific type of mindfulness, where one maintains attention on a single object, thought, phrase, etc. Based on my training and a sense that people are more open to the term "mindfulness" than "meditation," I tend to use the term "mindfulness."

A year or so ago, I explored neurofeedback for my department as a potential intervention we might want to consider. In short, neurofeedback is a form of biofeedback that uses EEG (electroencephelography) technology to provide feedback to a user about their brain activity. Biofeedback traditionally focuses on easier-to-capture biometrics, like heart rate, breathing, sweat level, and muscle tension, to provide immediate feedback to the user about physiological symptoms related to a variety of conditions. It has been particularly effective for anxiety disorders. Raising awareness of one's physiology, even parts that we cannot directly control (like heart rate), allows us to adjust (sometimes subtly and unconsciously) parts of behavior (including breathing, elements of attention, etc.) that help us become calmer and in turn impact the involuntary physiological symptoms that create conditions like anxiety. This immediate feedback reinforces new skills that help us better cope with emotional dysregulation, and these skills generally "stick" after therapy ends.

I see neurofeedback as essentially a more efficient way of reinforcing skills, especially around mindfulness. Brain waves are not something we can directly control, but our behaviors influence brain waves, which in turn influence behaviors. Changing some of our behaviors, such as where we direct our attention and how we breathe, impacts our brain activity, which reinforces calmer, more focused behavior. Some neurofeedback providers claim their systems directly change the brain. I have seen no evidence of this, and I view it as either a blatant lie to sell a product/service or ignorance on the part of the clinician (I'm not sure which is more dangerous, frankly...). This is an important distinction, as many people would be (appropriately) concerned about direct brain intervention.

The beauty of neurofeedback and biofeedback in general is that they help us become more aware of our bodies to aid us in shaping our behaviors and building new habits that allow to live healthier lives. It's actually a very natural, culturally sensitive, non-invasive way of improving all elements of holistic health, including physical, psychological, and spiritual.

Neurofeedback can be quite pricey, easily running at least $1500 for a course of treatment by a licensed provider (still cheap if it's effective). Some insurances cover it, some don't. But does all treatment, especially when it's focused on improving health rather ameliorating pathology, need to be mediated by a provider? What is appropriate to be done on your own? Health care providers regularly encourage at home practice of a variety of exercises that shape our behavior (think diet, physical exercise, relaxation exercises, thought records, etc.). Mindfulness is regularly "prescribed" as an exercise to practice on your own after some education about how to do it (which does not require any licensed provider). So why couldn't technology-assisted mindfulness be done on your own?

The Muse Method
Enter the Muse, the "brain sensing headband," which I see as essentially a $300 consumer neurofeedback device focused on reinforcing mindfulness. Now to be clear, this is not advertised nor meant to be a health care device or to take the place of any professional advice. It is "a brain fitness tool that helps you do more with your mind by helping you calm and settle your mind." InteraXon, the company behind Muse, has a long history of brain sensing technology integrated into consumer life.

InteraXon generally uses the term "meditation" in conjunction with the Muse, as it is currently based on maintaining one's attention on an object. When using the Muse, there is a one minute calibration to ensure the Muse knows what an active brain looks like for you (everyone's brains are quite different). Then you engage in a focus activity for a length of time you choose. The calibration and activity are done with eyes closed, and the instructions are to focus on your breath, a common mindfulness meditation that is also convenient as it can be done anywhere, as needed (we always have our breath with us!). The feedback portion is achieved through sound. There are currently two audio environments, one a beach with a windstorm, the other a rainforest with a... (wait for it...) rain storm. Coleman stated, anecdotally, they have found people who want to boost their mind use the storm, while those who want to relax use the rain. Interestingly, I prefer the rain, and my interest is really relaxation... The more you maintain focus on your breath, the calmer the sounds are. When your brain waves hit the "calm" region, you also start collecting birds.

The mindfulness reinforcement comes via calmer, quieter sounds when you are focused and increased storminess when you get distracted (quite parallel to how our brains can feel!). This can be a very effective way to raise our awareness of distraction. It is very easy to practice mindfulness and not realize you are distracted, so this is much more valuable than one might realize. While the storm can be very helpful in raising awareness of distraction, I found that over time I could sometimes tune it out (that was usually when I was quite distracted). More significantly, sometimes the storm made it harder to focus on my breath and could lead to frustration with not getting calmer. Lowering the volume seemed to help a great deal. A recent app update gives much more flexibility in adjusting volume of different sound elements. I highly recommend trying out different volumes to find a "sweet spot" of what's most effective for you.

Coleman explained they are exploring additional exercises and feedback methods. That's the benefit of modern technology--software upgrades can provide a lot of new features for the same hardware. While there can be no guarantees, I wouldn't be surprised if some good new features are available in the near future with no new hardware investment required. I also recently took a survey that indicates InteraXon is considering a freemium model for the software features. This makes sense from a business standpoint, but after investing $300 for a device, I hope they continue to provide significant software enhancements for free. Coleman had mentioned they were working on a way of normalizing one's calibration over time so you wouldn't have to do the calibration each time and so it would be more accurate. This was also mentioned in the survey. This is an example of something that I would hope would be free. Things like additional audio environments, extra challenges, advanced analytics, and performance comparisons with other seem potentially appropriate in a subscription context. There is no indication that a subscription would ever be required, and the basic features are still very effective and strong.

My Experience and Tips
While there are basic instructions that are available for the sessions, I think I significantly benefitted from knowing a lot about mindfulness. I was able to coach myself through sessions having this background, which I'm sure improved my performance. If you find yourself struggling with maintaining a calm state, I recommend doing some reading/training on mindfulness and its principles, especially not judging your own performance. Remembering to gently move our attention back is helpful. I would at times get frustrated with having a storm when I thought I was focused on my breath. This, itself, emphasizes a benefit of the feedback--sometimes we're not as focused and calm as we think. I found when I reduced my tension and just tried to have a posture (physically and mentally) of acceptance, my mind calmed faster and birds came and stayed longer. Trying to force myself to focus was often counter-productive. I discovered my brain also would not immediately calm when I redirected focus back to my breath. While a storm would come quickly if there was a distraction (like a cat jumping on my lap or a toddler being a toddler), the storm would usually take a few seconds to calm. This, in itself, is a good life lesson and practice of patience...

The App and Technology
It's also important to note that while your performance will hopefully improve, you're competing against yourself. With the current method of calibration, if you're having a calm day, your baseline will be lower, so it will be more difficult to achieve a high calm state (according to the software's scoring). Longitudinal calibration, if released, will be very helpful for more effectively tracking one's practice and assessing progress and challenges. In any case, the scores are relative to yourself. However, this is still helpful, as a storm in even the calmest state indicates some level distraction.

While I didn't try it, it could be possible to use the Muse with other kinds of mindfulness activities, like visual focus. However, the calibration would then have to be done with eyes open (just opening one's eyes increasing brain activity significantly). I'd also be curious to try other types of focus activities, like a centering prayer, where a word or short phrase is repeated. I would guess it would be more challenging to achieve an official calm state with this type of activity, as there would probably be more brain activity than with just focusing on one's breath.

The Muse team does a nice job of encouraging regular sessions in a variety of ways. The presence of a current streak and longest streak of doing session every day in a row has been very effective for me not yet missing a day since I received the device. They also have a variety of challenges that get you to higher levels. For those of us with a competitive streak, this encourages improving our practices in a variety of ways. I would sometimes do an extra session just to get to the next level. While it took a few days to have the time available, I wouldn't have done a 40 minute session without this challenge requirement. And it was not as hard as I had expected (and surprisingly quite pleasant!).

Technologically, the Muse connects to a phone or tablet via bluetooth. The pairing process is easy, and I experienced no problems maintaining a connection. Sometimes the sensors over the ears take a little longer to establish a strong signal, but I found if I just patiently wait (always less than a minute), they connect. I can easily go a week before charging the device, which is easy, as there are two micro-USB ports. A recent app update that allows you to see the current battery level is very helpful. The app itself is good looking and easy to navigate. The one thing I don't understand is the requirement of the screen to be on during a session. For long sessions, keeping the phone/tablet screen off would be helpful to save battery life. This may be a way to keep the bluetooth connection alive or something, but it's strange. I originally thought I'd like using the app on my iPad, but since there is not visual feedback during a session, I only use it on my iPhone, which I ultimately prefer. A smaller device to hold or keep nearby during a session is easier.

There were a couple of problems I had with the app recognizing times and days, which affected challenge completion. One email to support, and I received a very prompt, helpful response. It turns out there was a bug in the app, which was quickly fixed in the next update. As many of us know, customer service, especially with technology products, is of utmost importance and can make or break a product/service. From what I saw, Muse is putting quick, friendly, helpful customer care as a top priority.

So is the Muse effective? I'd say yes. I've known for a long time I "should" practice mindfulness on my own outside of the professional context. But it was hard to get the motivation to do so. However, I quickly looked forward to and really wanted to practice with the Muse. For me, playing with technology in itself is fun and a reinforcer, but I do notice I generally feel calmer and more centered. My mood does seem to be a bit better and more regulated after I engage in a session. I'm also more aware of being distracted throughout the day, which allows me to bring my attention back to the present moment.

While $300 is not cheap, it is quite cheap for this type of technology and could be quite worth it for the benefits. It is not a magic device; you have to work and keep engaged in the activities. Coleman explained it takes about 2-3 weeks for most people to notice a difference and regular users settle into a pattern of sessions 4-5 times a week. 15-20 minute sessions are often the minimum to be effective based on their initial findings, although I find 7-10 minute sessions are helpful and easy to fit into my day.

One of the things I really appreciate is that InteraXon is doing solid research on the device. They have partnerships with some universities using the Muse in various projects. They also ask users to opt-in to share their data for continued improvement. Their privacy practices seem strong and appropriate, and I encourage participation. The more users who contribute their data, the better chances at seeing strong updates that will help us all. While no research is yet published, anecdotal evidence of benefits matches the values of mindfulness, including improved emotional regulation, sleep, mood, interpersonal interactions, etc.

No formal case comes with the Muse, although the hard plastic packaging works well (and is what I currently use, although it's bulky and awkward). There is an official Muse case, which sells for $40, and doesn't seem much smaller than the clear plastic sales packaging. From reviews I've seen, many people question the price-point. For $300, it would seem appropriate to have a case included. I definitely recommend keeping it protected in some format, especially if you travel with it (to work, vacation, etc.). A universal headphone case or something similar might work, as well.

If you think practicing mindfulness regularly would be a benefit to your life, then the Muse could be an excellent investment. I've been using it for more than 60 straight days (every day since I received it), for a total of over 760 minutes of practice, and I plan to continue to use it daily. I even took it with me on vacation because of its benefits.

For those interested in purchasing the Muse, it is available through Muse's website, Amazon, some retailers in Canada, and will be in US Best Buy stores in mid-July.

Disclosure of Material Connection: I received this item free from the manufacturer. I was not required to write a positive review. The opinions I have expressed are my own. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

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