A Smartphone Application Using Vibro-Acoustic Technology for Stress Management

A Smartphone Application Using Vibro-Acoustic Technology for Stress Management | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Article A Smartphone Application Using Vibro-Acoustic Technology for Stress Management Tomonori Motokawa, Tomomi Kato, Shuji Seto, Junko Okuyama This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3998545/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We developed an easy-to-use smartphone-based stress care system that employs simultaneous vibratory sensations and synchronized music. In this study, we evaluated the usefulness of this technology and discussed its potential for societal implementation. This prospective study was conducted in three phases in Tokyo. Phase 1 tested the application’s efficacy in stress management following one month of use using subjective surveys assessing depression, anxiety, stress, insomnia, mood, and fatigue. Phase 2 assessed the effect of one month of application on internal stress markers (salivary cortisol, IgA, and oxytocin levels). Phase 3 assessed the application’s perceived efficacy and potential for social integration using a questionnaire survey administered after one week of use. Significant improvements were observed in all subjective stress markers and salivary cortisol levels one month after application. Sixty-seven percent of the participants reported perceiving their therapy as effective in relaxing both their body and mind, while 46% felt that it contributed to improved sleep after one week of application use. Additionally, 73% of participants expressed a positive intention to continue with therapy. The smartphone-based stress care application offers an individualized experience through both tactile and auditory stimulation, demonstrating its potential for widespread societal implementation of stress management. Biological sciences/Psychology Health sciences/Health care smartphone depression anxiety insomnia fatigue cortisol Figures Figure 1 Figure 2 Introduction Recently, the significance of well-being in daily life has increased, partially due to the impact of COVID-19. This growing emphasis is underscored by the Sustainable Development Goal 3 of the World Health Organization, which centers on “Good Health and Well-being” highlighting the global importance of maintaining a healthy state. A key focus in the pursuit of this goal is stress management, recognizing that stress can manifest as a physical or mental illness, affecting not only performance but also emotions. Although effective stress management is important, it is often challenging to implement it successfully. In addition to identifying the need for comprehensive and user-friendly stress monitoring technologies, accessible self-care methods that provide tangible effectiveness for individuals are lacking. Effective stress management requires readily accessible and easily implemented self-care approaches. While common approaches involve sensory experiences, such as listening to relaxing music, looking at beautiful images, smelling aromas, or engaging in mindfulness meditation, these methods often require preparation and personalized choices, leading to varying efficacy. Therefore, we aimed to develop an individualized, user-friendly, and effective sensory experience tailored to individual conditions, thereby creating a system suitable for broader societal implementation. To achieve widespread adoption, we identified three critical conditions: (1) the solution must be effortlessly experienced, avoiding the need for proactive skill acquisition; (2) it should provide a pleasant experience to encourage consistent use; and (3) the system should be accessible to the public without requiring special equipment. To address conditions (1) and (2), we have explored the concept of a “relaxed experience with a slow change in rhythm.” Existing research supports the idea that a slow change in rhythm induces relaxation, as seen in slow-breathing techniques [ 1 – 4 ], music with decreasing tempo [ 5 ], and gentle rocking movements [ 6 ]. In our ongoing research, we demonstrated that holding an oscillator with a tempo decreases the subject’s heart rate to 50 bpm, and experiencing simultaneous vibratory sensations and synchronized music led to a decrease in salivary cortisol levels, indicating a beneficial effect on stress (in review). Leveraging these findings, we envisioned the construction of an easy-to-use stress care system integrated into daily life. Considering condition (3), we propose integrating this technology into smartphones, which are widely owned by the public. Our approach involves implementing this technology in a smartphone application in which the main structure calculates the heart rate from facial information. Subsequently, the application delivers a vibration experience starting from the user’s heart rate and changing to 50 bpm, synchronized with accompanying music. In this study, we evaluated the usefulness of this technology through various tests and discussed its potential for widespread societal implementation. Materials and Methods Application Design Figure 1 illustrates the design of the application, which focuses on analyzing facial color changes in the cheek area through facial videos to determine heart rate by employing a previously reported logic framework [ 7 ]. Simultaneously, the application gathers information about the users’ psychological state by prompting them to answer a questionnaire on their smartphone screen. Utilizing these results, the application tailors individualized content comprising the vibration and sound elements as follows: Vibration The vibration started at the subject’s heart rate and gradually decreased to 50 bpm. Music When the smartphone’s vibration tempo drops to 60 bpm, the music starts playing, with the subsequent slowing of the tempo, synchronizing with the ongoing vibration. Voice guidance Informed by the questionnaire results, the necessity for voice guidance (including mindfulness and self-compassion guidance) was determined, and voice guidance was integrated into concurrent vibration and music playback as required. In total, 200 types of contents were meticulously prepared. Study Design This prospective study was conducted in Tokyo, Japan, from 2021 to 2023 and enrolled Japanese men and women aged between 20 and 60 years. Participants with serious cardiovascular, hepatic, renal, respiratory, endocrine, or metabolic disorders, those with a medical history of these disorders, or those taking pharmaceuticals that could potentially affect the autonomic nervous system were excluded. Patients deemed unsuitable by the investigator were excluded. This study was approved by the Committee for the Protection of Human Subjects (CPHS) of POLA Chemical Industries, Inc., Kanagawa. Japan (Approval # 2021F78, 2021F83, and 2022F7), and was conducted according to the Ethical Guidelines for Medical and Health Research Involving Human Subjects (Ministry of Education, Culture, Sports, Science, and Technology and Ministry of Health, Labour, and Welfare, 2014, revised in 2017) and the Declaration of Helsinki (revised in 2013). Subjects received a sufficient briefing of the objective and content of the present study and signed a written informed consent form. This study comprised three distinct parts (Table 1 ). Phase 1 and Phase 2 aimed to comprehensively evaluate the application’s efficacy in stress management following prolonged use from subjective (Phase 1) and objective (Phase 2) evaluation perspectives. In Phase 1, participants were randomized in a 2:1 ratio to use the application for one month (application group) or not (control group), and seven types of subjective survey scores (Depression Scale, Anxiety Scale, Stress Scale, Insomnia Scale, Positive Mood Scale, Negative Mood Scale, and Fatigue Scale) before and after one month of application use were compared. In Phase 2, three types of internal stress markers (Salivary cortisol, Salivary IgA, and Salivary oxytocin) were compared. Phase 3 comprised a questionnaire survey designed to gather insights into the subjects’ perceived efficacy of the application after a brief period (one week) of application use and their intention to continue using the application. Table 1 Overview of the Study and Participants. Phase Study Type Scale Items Duration of application use Sex n Application group Control group n age (± SD) n age (± SD) 1 Stress improvement effect Subjective survey Depression Scale DASS21 1 month Female 76 49 Female 30.2 ± 3.5 27 Female 31.0 ± 3.49 Anxiety Scale Stress Scale Insomnia Scale Athens Insomnia Scale Positive mood Scale The Positive and Negative Affect Schedule Negative mood Scale Fatigue Scale Chalder fatigue scale 2 Objective survey Stress Scale Salivary cortisol Male/ Female 99 25 Male/ 24 Female 44.5 ± 9.7 25 Male/ 25 Female 45.0 ± 9.43 Salivary IgA Salivary oxytocin 3 Possibility of social implementation Questionnaire survey 1 week Male/ Female 1487 862 Male/ 625 Female 39.5 ± 10.6 -- -- Participants independently downloaded and used the application for either one month (Phases 1 and 2) or one week (Phase 3) in their respective living environments. The assessment of the participants’ conditions before and after the application involved the use of questionnaires and saliva analysis to evaluate their stress states using multiple parameters [ 8 – 10 ] (Table 1 ). Phase 1: Effects on Stress Improvement (Subjective Survey) In 76 female participants (age 25–35 years), Depression Scale, Anxiety Scale, and Stress Scale were assessed using Anxiety Stress Scale (DASS-21) [ 11 ], Insomnia Scale was assessed using the Athens Insomnia Scale [ 12 ], Positive/Negative Mood Scales were assessed using the Positive and Negative Affect Schedule score [ 13 ], and Fatigue Scale was assessed using the Chalder Fatigue Scale [ 14 ] before and after the application’s use. For the Chalder Fatigue Scale, a high-fatigue subgroup was created with an initial score of 15 or higher, a value indicating the possibility of chronic fatigue syndrome [ 15 ]. Phase 2: Effects on Stress Improvement (Objective Survey) In 99 male and female participants (age 30–59 years), the stress improvement effects were assessed using salivary cortisol [ 16 ], IgA [ 17 ], and oxytocin [ 18 ] levels. Saliva samples were collected using a Salivette (SARSTEDT AG & Co. KG) and analyzed by a contractor (Macromill, Inc., Japan). Phase 3: Verification of Feasibility of Social Retention after Application Use To assess the application’s potential for social integration, a questionnaire was administered to gather feedback from 1,487 participants (age 20–59 years; 862 Male / 625 Female) after one week of application use. The questionnaire comprised three key items focusing on both immediate/recent use experiences and future intentions. Specifically, participants were prompted to respond to the following questions: (Q1) “Did you feel relaxed in mind and body?”; (Q2) “Did you find it easier to fall asleep?”; and (Q3) “Do you want to continue to use it in the future?”. For Q1 and Q2, respondents selected responses from a scale that included “felt,” “felt a little,” “did not feel,” or “other.” In the case of Q3, participants conveyed their future usage intentions by selecting options such as “want to use it daily,” “want to use it occasionally,” or “do not want to use it in the future.” The questionnaires were completed online, and data were collected for analysis. Statistical Analysis Data are summarized as mean and standard error (SE). The pre- and post-application values of the stress parameters were compared using Wilcoxon signed-rank sum tests. Statistical analysis was performed using JMP® 17 (SAS Institute Japan) with a significance level set at 0.05 or lower. Results Participants The general characteristics of the participants are presented in Table 1 . The average age of the participants ranged from 30.2 ± 3.5 years in Phase 1 to 44.5 ± 9.7 years in Phase 2 and 39.5 ± 10.6 years in Phase 3. Phase 1: Effects on Stress Assessed by Subjective Surveys After one month, subjective stress values remained unchanged in the control group, whereas the application-using group exhibited significant improvements in depression, anxiety, stress, insomnia, and positive/negative mood scales. On the Fatigue Scale, there was no change in either the control group or the application-using group; however, analyses of the highly fatigued subgroup revealed significant improvement only in the application-using group (Table 2 ) . Table 2 Effects on Stress Assessed by Subjective Surveys . Significant (p < 0.05) differences in parameters before and after application use are marked with an asterisk (*) Study Application group (n = 49) Control group (n = 27) Mean, SE Mean, SE Depression Scale pre- 17.51 2.06 18.74 2.62 post- 13.67 1.81 14.89 2.03 p-value p = 0.008* p = 0.136 Anxiety Scale pre- 11.76 1.54 14.81 2.54 post- 8.24 1.40 10.44 2.10 p-value p = 0.0045* p = 0.1557 Stress Scale pre- 17.06 1.81 19.56 2.51 post- 13.31 1.66 15.41 1.99 p-value p = 0.0034* p = 0.1178 Insomnia Scale pre- 7.06 0.67 7.96 0.90 post- 5.27 0.57 7.30 0.78 p-value p = 0.0034* p = 0.1178 Positive Mood Scale pre- 18.92 1.04 21.74 1.49 post- 22.45 1.03 21.89 1.51 p-value p = 0.0002* p = 0.9287 Negative Mood Scale pre- 24.47 1.58 26.81 1.80 post- 21.92 1.21 24.11 1.69 p-value p = 0.0224* p = 0.1491 Fatigue Scale All pre- 23.06 1.36 24.96 1.97 post- 21.90 1.39 25.52 1.79 p-value p = 0.3275 p = 0.7283 Subset (score > 15) n n = 40 n = 24 pre- 26.23 1.15 27.54 1.48 post- 23.33 1.58 27.29 1.61 p-value p = 0.0220* p = 0.8825 Phase 2: Effects on Stress Assessed by Objective Analyses After one month, the application group exhibited significant improvements in salivary cortisol levels, whereas values remained unchanged in the control group (Table 3 ) . There were no significant changes in salivary IgA or cortisol levels in either group after application. Table 3 Results of Stress Assessed by Objective Analyses. Significant (p < 0.05) differences in parameters before and after application use are marked with an asterisk (*) Study Application group (n = 21) Control group (n = 22) Mean S.E mean S.E Stress Scale Salivary cortisol (µg/dL) pre- 0.34 0.02 0.31 0.03 post- 0.30 0.03 0.30 0.15 p-value p = 0.0463* p = 0.7268 Salivary IgA (µg/ml) pre- 179.21 18.04 184.03 18.75 post- 210.59 20.41 220.60 21.29 p-value p = 0.0593 p = 0.0919 Salivary oxytocin (pg/ml) pre- 249.73 13.36 254.19 12.99 post- 237.99 21.76 255.95 19.10 p-value p = 0.5258 p = 0.9157 Phase 3: Verification of Feasibility of Social Retention After one week of application use, 67% of the participants reported that their therapy was effective in relaxing both their body and mind, while 46% felt that it contributed to improved sleep. Additionally, 73% of participants expressed a positive intention to continue with therapy, indicating a desire for either daily or occasional use (Fig. 2 ). Discussion In this study, we developed an application designed to provide individualized experiences through a gradually slowing rhythm employing tactile and auditory stimuli. Previous research has indicated that perceiving vibrations synchronized with music and decreasing the subject’s heart rate to 50 bpm mitigated their stress. However, these effects were previously validated in a controlled laboratory setting with a single stimulus. This study aims to assess the impact of combined tactile and auditory stimuli on daily life. The results of the Phase 1 study revealed significant improvements in depression, anxiety, stress, insomnia, and positive/negative mood scales. These findings suggest that the application positively influences mental health in multiple ways. This finding aligns with the current understanding that stress affects various mental states. This application also had a significant beneficial effect on fatigue, particularly in highly fatigued subgroups. This subgroup had a Chalder Fatigue Scale score of 15 or higher, indicating very severe physical and mental fatigue status, with the possibility of the onset of chronic fatigue syndrome. The fact that the application demonstrated significant effects on these conditions further demonstrates the value of this system for treating stress. Furthermore, in the Phase 2 study, improvements in salivary cortisol levels, a commonly used stress marker in the body, were observed in the application-using group. Similar improvements in cortisol levels were elucidated in our controlled laboratory studies using a single stimulation for stress relief (in review). The results of Phases 1 and 2 demonstrate the usefulness of this application system in both the subjective and objective reduction of stress states. Chronic mental stress is known to manifest in a variety of phenotypes (including altered skin conditions, poor recovery, and onset of illness [ 17 , 19 – 21 ]). Considering the widespread positive effects on stress states measured both subjectively and objectively in the current study, we believe that there is the possibility of obtaining other positive results. These may include enhancements in skin condition, expedited recovery from various illnesses, and improvements in daily performance, extending beyond the outcomes documented in this study. Subsequent research studies will further investigate and elucidate the broader scope of these adaptive effects. Despite these positive effects, a significant obstacle arises when considering the widespread adoption of the application. Typically, smartphone applications face challenges in sustaining user engagement. To overcome this hurdle, an immediate perception of the effectiveness of an application is crucial. A large-scale survey conducted after one week of application use in Phase 3 of the study indicated that a substantial number of users perceived the application as effective in a short duration. Notably, 70% of users expressed an intention to continue using the application, suggesting that its design fostered its usage in real-world scenarios. This positive response is attributed not only to the perceived effectiveness of the application but also to the intriguing analytical approach employing facial data analysis. This study has a few limitations. These studies focused exclusively on the Japanese population and lacked data on other ethnic groups. Additionally, this study did not collect data on men or women in any of the study phases because of grant objectives and budget constraints. Although we anticipate that the outcomes will remain consistent across ethnicities and sexes, since the underlying system remains unchanged, future studies should include participants from multiple ethnicities and both sexes. However, digital mental health solutions that have demonstrated efficacy in alleviating stress through diverse avenues are scarce. Hence, we assert that the results of this study are pivotal and denote significant progress in mental healthcare. Conclusion In this study, we designed an application that offers an individualized experience characterized by gradual changes in rhythm through both tactile and auditory stimulation. We demonstrated the positive impacts of the application on various facets of stress states, including subjective and objective states, following one month of use and a high-perceived effectiveness and social retention following one week of use. Thus, this study highlights the usefulness and potential of this application for widespread societal implementation of stress management. Declarations Acknowledgments: Editorial support, in the form of medical writing, assembling tables, creating high-resolution images based on authors’ detailed directions, collating author comments, copyediting, fact-checking, and referencing, was provided by Editage and Cactus Communications. Author Contributions: T.M. participated in the conceptualization, supervision, project administration, investigation, analysis, and writing. T.K., J.O., and S.S. participated in the investigation. All the authors reviewed the manuscript. Data Availability: The data that support the findings of this study are not openly available for reasons of sensitivity, but are available from the corresponding author upon reasonable request. Competing Interests: Employment : TM and TK are employees of the POLA Chemical Industries, which partially funded this study. Funding : This research was supported by a grant from the FemTech support service demonstration project of the Ministry of Economy, Trade, and Industry of Japan, the Innovative Research Program on Suicide Countermeasures (Grant number: JPSCIRS20220301), and the POLA Chemical Industries. Ethical Approval/Informed Consent: This study was approved by the Committee for the Protection of Human Subjects (CPHS) of POLA Chemical Industries, Inc., Kanagawa. Japan (Approval # 2021F78, 2021F83, and 2022F7), and was conducted according to the Ethical Guidelines for Medical and Health Research Involving Human Subjects (Ministry of Education, Culture, Sports, Science, and Technology and Ministry of Health, Labour, and Welfare, 2014, revised in 2017) and the Declaration of Helsinki (revised in 2013). Subjects received a sufficient briefing of the objective and content of the present study and signed a written informed consent form. References Clark, D. M., Salkovskis, P. M. & Chalkley, A. J. Respiratory control as a treatment for panic attacks. J. Behav. Ther. Exp. Psychiatry 16, 23–30 (1985). Fincham, G. W., Strauss, C., Montero-Marin, J. & Cavanagh, K. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Sci. Rep. 13, 432 (2023). Hibbert, G. A. & Chan, M. Respiratory control: its contribution to the treatment of panic attacks. A controlled study. Br. J. Psychiatry 154, 232–236 (1989). Jerath, R., Crawford, M. W., Barnes, V. A. & Harden, K. Self-regulation of breathing as a primary treatment for anxiety. Appl. Psychophysiol. Biofeedback 40, 107–115 (2015). Brownlow, B. N. The Effect of Music Tempo on the Psychophysiological Measures of Stress , (2017). van Sluijs, R. et al. Gentle rocking movements during sleep in the elderly. J. Sleep Res. 29, e12989 (2020). Xu, S., Sun, L. & Rohde, G. K. Robust efficient estimation of heart rate pulse from video. Biomed. Opt. Express 5, 1124–1135 (2014). Agha, N. H. et al. Salivary antimicrobial proteins and stress biomarkers are elevated during a 6-month mission to the International Space Station. J. Appl. Physiol. (1985) 128, 264–275 (2020). Egawa, M. et al. Evaluation of psychological stress in confined environments using salivary, skin, and facial image parameters. Sci. Rep. 8, 8264 (2018). Kobayashi, M., Hoshi, N. & Horiguchi, M. Validity of self-diagnosis fatigue checklist for young women. Int. J. Hum. Cult. Stud. 2019, 526–536 (2019). Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W. & Swinson, R. P. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol. Assess. 10, 176–181 (1998). Soldatos, C. R., Dikeos, D. G. & Paparrigopoulos, T. J. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J. Psychosom. Res. 48, 555–560 (2000). Watson, D., Clark, L. A. & Tellegen, A. Development and validation of brief measures of positive and negative affect: the Panas scales. J. Pers. Soc. Psychol. 54, 1063–1070 (1988). Chalder, T. et al. Development of a fatigue scale. J. Psychosom. Res. 37, 147–153 (1993). M.o.H. Fatigue Research Group. Labour and Welfare of Japan, Establishment of an Objective Fatigue Diagnostic Method for Patients Complaining of Chronic Fatigue with Abnormal Autonomic Nervous System Function and Development of a Diagnostic Guideline for Chronic Fatigue , (2011). James, K. A., Stromin, J. I., Steenkamp, N. & Combrinck, M. I. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Front. Endocrinol. (Lausanne) 14, 1085950 (2023). Bosch, J. A., Ring, C., de Geus, E. J., Veerman, E. C. & Amerongen, A. V. Stress and secretory immunity. Int. Rev. Neurobiol. 52, 213–253 (2002). Takayanagi, Y. & Onaka, T. Roles of oxytocin in stress responses, allostasis and resilience. Int. J. Mol. Sci. 23 (2021). Gouin, J. P. & Kiecolt-Glaser, J. K. The impact of psychological stress on wound healing: methods and mechanisms. Immunol. Allergy Clin. North Am. 31, 81–93 (2011). Salleh, M. R. Life event, stress and illness. Malays. J. Med. Sci. 15, 9–18 (2008). Al'Abadie, M. S., Kent, G. G. & Gawkrodger, D. J. The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. Br. J. Dermatol. 130, 199–203 (1994). Additional Declarations Competing interest reported. TM and TK are employees of the POLA Chemical Industries, which partially funded this study. JO and SS have no conflicts of interest. Funding: This research was supported by a grant from the FemTech support service demonstration project of the Ministry of Economy, Trade, and Industry of Japan, the Innovative Research Program on Suicide Countermeasures, and the POLA Chemical Industries. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3998545","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":280502083,"identity":"c0934950-61db-4946-a202-ccacf8c0e24a","order_by":0,"name":"Tomonori Motokawa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYJACZgYGGwYGdjiHCA1AVWlwtURrOUycWjDQbe8/+Lmw7XwePzPzA4YfFQzs5oS0mJ05zCw9s+12sWQzmwFjzxkGZssGQlpuJLMx87bdTtxwmMGAmbGNgdngAHFazgG1sH8gScsBoBYeYm05c9hYmudcMtAvPAUHe85IEOGX440PP/OU2eXxs7dvfPCjwiaZYIiBASMbQwKIBjpJItmAKC0MfyBaQMCOSC2jYBSMglEwggAAvaM4y+8K4UoAAAAASUVORK5CYII=","orcid":"","institution":"POLA Chemical Industries, Inc","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Tomonori","middleName":"","lastName":"Motokawa","suffix":""},{"id":280502084,"identity":"6d932b65-415d-4079-81a6-10ea04474ece","order_by":1,"name":"Tomomi Kato","email":"","orcid":"","institution":"POLA Chemical Industries, Inc","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tomomi","middleName":"","lastName":"Kato","suffix":""},{"id":280502086,"identity":"4ce1addb-bded-4761-bbb1-d6fc52be3189","order_by":2,"name":"Shuji Seto","email":"","orcid":"","institution":"Akita University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shuji","middleName":"","lastName":"Seto","suffix":""},{"id":280502087,"identity":"fe7dfc4b-4bed-4896-924a-b55c6ce08b76","order_by":3,"name":"Junko Okuyama","email":"","orcid":"","institution":"Tohoku University Graduate School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Junko","middleName":"","lastName":"Okuyama","suffix":""}],"badges":[],"createdAt":"2024-02-29 04:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3998545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3998545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52918446,"identity":"a95b1aee-810b-4265-8248-052b97b00875","added_by":"auto","created_at":"2024-03-18 17:07:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":583857,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eApplication Workflow\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFacial video information was used to estimate the heart rate, particularly focusing on changes in the red color of the cheek area. A questionnaire was administered to guide the selection of a tailored solution program. Emphasizing the heart rate data, the subject experienced vibrations dropping to 50 bpm, synchronized with accompanying music. Mental states were inferred from the questionnaire and, if necessary, audio guidance, such as mindfulness and self-compassion guidance, was integrated.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3998545/v1/159508aa5110ac326244993a.png"},{"id":52918445,"identity":"66dee22f-8c2c-4122-913e-6dba95970dde","added_by":"auto","created_at":"2024-03-18 17:07:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":404424,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eVerification of Feasibility of Social Retention (Phase 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe surveyed the participants’ perceptions of the effectiveness of the application (a, b) after one week of use. We also investigated the participants’ intentions to use the application in the future (c).\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3998545/v1/41d27e48e4739e68abcd06a1.png"},{"id":71202186,"identity":"dd52881b-7470-4db6-ab4c-b14d25b68ea7","added_by":"auto","created_at":"2024-12-12 06:24:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1697408,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3998545/v1/227f094c-711a-4f99-8641-6a6777baf868.pdf"}],"financialInterests":"Competing interest reported. TM and TK are employees of the POLA Chemical Industries, which partially funded this study.\nJO and SS have no conflicts of interest.\n\nFunding: This research was supported by a grant from the FemTech support service demonstration project of the Ministry of Economy, Trade, and Industry of Japan, the Innovative Research Program on Suicide Countermeasures, and the POLA Chemical Industries.","formattedTitle":"A Smartphone Application Using Vibro-Acoustic Technology for Stress Management","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRecently, the significance of well-being in daily life has increased, partially due to the impact of COVID-19. This growing emphasis is underscored by the Sustainable Development Goal 3 of the World Health Organization, which centers on \u0026ldquo;Good Health and Well-being\u0026rdquo; highlighting the global importance of maintaining a healthy state.\u003c/p\u003e \u003cp\u003eA key focus in the pursuit of this goal is stress management, recognizing that stress can manifest as a physical or mental illness, affecting not only performance but also emotions. Although effective stress management is important, it is often challenging to implement it successfully. In addition to identifying the need for comprehensive and user-friendly stress monitoring technologies, accessible self-care methods that provide tangible effectiveness for individuals are lacking.\u003c/p\u003e \u003cp\u003eEffective stress management requires readily accessible and easily implemented self-care approaches. While common approaches involve sensory experiences, such as listening to relaxing music, looking at beautiful images, smelling aromas, or engaging in mindfulness meditation, these methods often require preparation and personalized choices, leading to varying efficacy. Therefore, we aimed to develop an individualized, user-friendly, and effective sensory experience tailored to individual conditions, thereby creating a system suitable for broader societal implementation. To achieve widespread adoption, we identified three critical conditions: (1) the solution must be effortlessly experienced, avoiding the need for proactive skill acquisition; (2) it should provide a pleasant experience to encourage consistent use; and (3) the system should be accessible to the public without requiring special equipment.\u003c/p\u003e \u003cp\u003eTo address conditions (1) and (2), we have explored the concept of a \u0026ldquo;relaxed experience with a slow change in rhythm.\u0026rdquo; Existing research supports the idea that a slow change in rhythm induces relaxation, as seen in slow-breathing techniques [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], music with decreasing tempo [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and gentle rocking movements [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In our ongoing research, we demonstrated that holding an oscillator with a tempo decreases the subject\u0026rsquo;s heart rate to 50 bpm, and experiencing simultaneous vibratory sensations and synchronized music led to a decrease in salivary cortisol levels, indicating a beneficial effect on stress (in review). Leveraging these findings, we envisioned the construction of an easy-to-use stress care system integrated into daily life. Considering condition (3), we propose integrating this technology into smartphones, which are widely owned by the public.\u003c/p\u003e \u003cp\u003eOur approach involves implementing this technology in a smartphone application in which the main structure calculates the heart rate from facial information. Subsequently, the application delivers a vibration experience starting from the user\u0026rsquo;s heart rate and changing to 50 bpm, synchronized with accompanying music. In this study, we evaluated the usefulness of this technology through various tests and discussed its potential for widespread societal implementation.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eApplication Design\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the design of the application, which focuses on analyzing facial color changes in the cheek area through facial videos to determine heart rate by employing a previously reported logic framework [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Simultaneously, the application gathers information about the users\u0026rsquo; psychological state by prompting them to answer a questionnaire on their smartphone screen. Utilizing these results, the application tailors individualized content comprising the vibration and sound elements as follows:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eVibration\u003c/strong\u003e \u003cp\u003eThe vibration started at the subject\u0026rsquo;s heart rate and gradually decreased to 50 bpm.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMusic\u003c/strong\u003e \u003cp\u003eWhen the smartphone\u0026rsquo;s vibration tempo drops to 60 bpm, the music starts playing, with the subsequent slowing of the tempo, synchronizing with the ongoing vibration.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eVoice guidance\u003c/strong\u003e \u003cp\u003eInformed by the questionnaire results, the necessity for voice guidance (including mindfulness and self-compassion guidance) was determined, and voice guidance was integrated into concurrent vibration and music playback as required. In total, 200 types of contents were meticulously prepared.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis prospective study was conducted in Tokyo, Japan, from 2021 to 2023 and enrolled Japanese men and women aged between 20 and 60 years. Participants with serious cardiovascular, hepatic, renal, respiratory, endocrine, or metabolic disorders, those with a medical history of these disorders, or those taking pharmaceuticals that could potentially affect the autonomic nervous system were excluded. Patients deemed unsuitable by the investigator were excluded. This study was approved by the Committee for the Protection of Human Subjects (CPHS) of POLA Chemical Industries, Inc., Kanagawa.\u003c/p\u003e \u003cp\u003e Japan (Approval # 2021F78, 2021F83, and 2022F7), and was conducted according to the Ethical Guidelines for Medical and Health Research Involving Human Subjects (Ministry of Education, Culture, Sports, Science, and Technology and Ministry of Health, Labour, and Welfare, 2014, revised in 2017) and the Declaration of Helsinki (revised in 2013). Subjects received a sufficient briefing of the objective and content of the present study and signed a written informed consent form.\u003c/p\u003e \u003cp\u003eThis study comprised three distinct parts (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). \u003cb\u003ePhase 1\u003c/b\u003e and \u003cb\u003ePhase 2\u003c/b\u003e aimed to comprehensively evaluate the application\u0026rsquo;s efficacy in stress management following prolonged use from subjective (Phase 1) and objective (Phase 2) evaluation perspectives. In Phase 1, participants were randomized in a 2:1 ratio to use the application for one month (application group) or not (control group), and seven types of subjective survey scores (Depression Scale, Anxiety Scale, Stress Scale, Insomnia Scale, Positive Mood Scale, Negative Mood Scale, and Fatigue Scale) before and after one month of application use were compared. In Phase 2, three types of internal stress markers (Salivary cortisol, Salivary IgA, and Salivary oxytocin) were compared. \u003cb\u003ePhase 3\u003c/b\u003e comprised a questionnaire survey designed to gather insights into the subjects\u0026rsquo; perceived efficacy of the application after a brief period (one week) of application use and their intention to continue using the application.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of the Study and Participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePhase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eScale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of \u003c/p\u003e \u003cp\u003eapplication use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eApplication group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eage (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eage (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eStress improvement effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSubjective survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepression Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDASS21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e49 Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e27 Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e31.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnxiety Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStress Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInsomnia Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAthens Insomnia Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive mood Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe Positive and Negative Affect Schedule\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative mood Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFatigue Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChalder fatigue scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eObjective survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStress Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSalivary cortisol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMale/ \u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e25 Male/\u003c/p\u003e \u003cp\u003e 24 Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e44.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e25 Male/\u003c/p\u003e \u003cp\u003e 25 Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e45.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSalivary IgA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSalivary oxytocin\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePossibility of social implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuestionnaire survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale/ \u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e862 Male/\u003c/p\u003e \u003cp\u003e 625 Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants independently downloaded and used the application for either one month (Phases 1 and 2) or one week (Phase 3) in their respective living environments. The assessment of the participants\u0026rsquo; conditions before and after the application involved the use of questionnaires and saliva analysis to evaluate their stress states using multiple parameters [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePhase 1: Effects on Stress Improvement (Subjective Survey)\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eIn 76 female participants (age 25\u0026ndash;35 years), Depression Scale, Anxiety Scale, and Stress Scale were assessed using Anxiety Stress Scale (DASS-21) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], Insomnia Scale was assessed using the Athens Insomnia Scale [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Positive/Negative Mood Scales were assessed using the Positive and Negative Affect Schedule score [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and Fatigue Scale was assessed using the Chalder Fatigue Scale [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] before and after the application\u0026rsquo;s use. For the Chalder Fatigue Scale, a high-fatigue subgroup was created with an initial score of 15 or higher, a value indicating the possibility of chronic fatigue syndrome [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePhase 2: Effects on Stress Improvement (Objective Survey)\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eIn 99 male and female participants (age 30\u0026ndash;59 years), the stress improvement effects were assessed using salivary cortisol [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], IgA [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and oxytocin [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] levels. Saliva samples were collected using a Salivette (SARSTEDT AG \u0026amp; Co. KG) and analyzed by a contractor (Macromill, Inc., Japan).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePhase 3: Verification of Feasibility of Social Retention after Application Use\u003c/h2\u003e \u003cp\u003eTo assess the application\u0026rsquo;s potential for social integration, a questionnaire was administered to gather feedback from 1,487 participants (age 20\u0026ndash;59 years; 862 Male / 625 Female) after one week of application use. The questionnaire comprised three key items focusing on both immediate/recent use experiences and future intentions. Specifically, participants were prompted to respond to the following questions: (Q1) \u0026ldquo;Did you feel relaxed in mind and body?\u0026rdquo;; (Q2) \u0026ldquo;Did you find it easier to fall asleep?\u0026rdquo;; and (Q3) \u0026ldquo;Do you want to continue to use it in the future?\u0026rdquo;. For Q1 and Q2, respondents selected responses from a scale that included \u0026ldquo;felt,\u0026rdquo; \u0026ldquo;felt a little,\u0026rdquo; \u0026ldquo;did not feel,\u0026rdquo; or \u0026ldquo;other.\u0026rdquo; In the case of Q3, participants conveyed their future usage intentions by selecting options such as \u0026ldquo;want to use it daily,\u0026rdquo; \u0026ldquo;want to use it occasionally,\u0026rdquo; or \u0026ldquo;do not want to use it in the future.\u0026rdquo; The questionnaires were completed online, and data were collected for analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData are summarized as mean and standard error (SE). The pre- and post-application values of the stress parameters were compared using Wilcoxon signed-rank sum tests. Statistical analysis was performed using JMP\u0026reg; 17 (SAS Institute Japan) with a significance level set at 0.05 or lower.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe general characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The average age of the participants ranged from 30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 years in Phase 1 to 44.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7 years in Phase 2 and 39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6 years in Phase 3.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePhase 1: Effects on Stress Assessed by Subjective Surveys\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eAfter one month, subjective stress values remained unchanged in the control group, whereas the application-using group exhibited significant improvements in depression, anxiety, stress, insomnia, and positive/negative mood scales. On the Fatigue Scale, there was no change in either the control group or the application-using group; however, analyses of the highly fatigued subgroup revealed significant improvement only in the application-using group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eEffects on Stress Assessed by Subjective Surveys\u003c/b\u003e. Significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) differences in parameters before and after application use are marked with an asterisk (*)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eApplication group (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMean, SE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMean, SE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eDepression Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.008*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eAnxiety Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0045*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.1557\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eStress Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0034*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.1178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eInsomnia Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0034*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.1178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003ePositive Mood Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0002*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.9287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eNegative Mood Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0224*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.1491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eFatigue Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.3275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.7283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSubset\u003c/p\u003e \u003cp\u003e(score\u0026thinsp;\u0026gt;\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0220*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.8825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePhase 2: Effects on Stress Assessed by Objective Analyses\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eAfter one month, the application group exhibited significant improvements in salivary cortisol levels, whereas values remained unchanged in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. There were no significant changes in salivary IgA or cortisol levels in either group after application.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eResults of Stress Assessed by Objective Analyses.\u003c/b\u003e Significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) differences in parameters before and after application use are marked with an asterisk (*)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eApplication group (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eS.E\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eS.E\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eStress Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSalivary cortisol (\u0026micro;g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0463*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.7268\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSalivary IgA (\u0026micro;g/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e179.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e184.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e210.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e220.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSalivary oxytocin (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e249.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e254.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epost-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e237.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e255.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.5258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.9157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePhase 3: Verification of Feasibility of Social Retention\u003c/h2\u003e \u003cp\u003eAfter one week of application use, 67% of the participants reported that their therapy was effective in relaxing both their body and mind, while 46% felt that it contributed to improved sleep. Additionally, 73% of participants expressed a positive intention to continue with therapy, indicating a desire for either daily or occasional use (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we developed an application designed to provide individualized experiences through a gradually slowing rhythm employing tactile and auditory stimuli. Previous research has indicated that perceiving vibrations synchronized with music and decreasing the subject\u0026rsquo;s heart rate to 50 bpm mitigated their stress. However, these effects were previously validated in a controlled laboratory setting with a single stimulus. This study aims to assess the impact of combined tactile and auditory stimuli on daily life.\u003c/p\u003e \u003cp\u003eThe results of the Phase 1 study revealed significant improvements in depression, anxiety, stress, insomnia, and positive/negative mood scales. These findings suggest that the application positively influences mental health in multiple ways. This finding aligns with the current understanding that stress affects various mental states. This application also had a significant beneficial effect on fatigue, particularly in highly fatigued subgroups. This subgroup had a Chalder Fatigue Scale score of 15 or higher, indicating very severe physical and mental fatigue status, with the possibility of the onset of chronic fatigue syndrome. The fact that the application demonstrated significant effects on these conditions further demonstrates the value of this system for treating stress.\u003c/p\u003e \u003cp\u003eFurthermore, in the Phase 2 study, improvements in salivary cortisol levels, a commonly used stress marker in the body, were observed in the application-using group. Similar improvements in cortisol levels were elucidated in our controlled laboratory studies using a single stimulation for stress relief (in review). The results of Phases 1 and 2 demonstrate the usefulness of this application system in both the subjective and objective reduction of stress states. Chronic mental stress is known to manifest in a variety of phenotypes (including altered skin conditions, poor recovery, and onset of illness [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]). Considering the widespread positive effects on stress states measured both subjectively and objectively in the current study, we believe that there is the possibility of obtaining other positive results. These may include enhancements in skin condition, expedited recovery from various illnesses, and improvements in daily performance, extending beyond the outcomes documented in this study. Subsequent research studies will further investigate and elucidate the broader scope of these adaptive effects.\u003c/p\u003e \u003cp\u003eDespite these positive effects, a significant obstacle arises when considering the widespread adoption of the application. Typically, smartphone applications face challenges in sustaining user engagement. To overcome this hurdle, an immediate perception of the effectiveness of an application is crucial. A large-scale survey conducted after one week of application use in Phase 3 of the study indicated that a substantial number of users perceived the application as effective in a short duration. Notably, 70% of users expressed an intention to continue using the application, suggesting that its design fostered its usage in real-world scenarios. This positive response is attributed not only to the perceived effectiveness of the application but also to the intriguing analytical approach employing facial data analysis.\u003c/p\u003e \u003cp\u003eThis study has a few limitations. These studies focused exclusively on the Japanese population and lacked data on other ethnic groups. Additionally, this study did not collect data on men or women in any of the study phases because of grant objectives and budget constraints. Although we anticipate that the outcomes will remain consistent across ethnicities and sexes, since the underlying system remains unchanged, future studies should include participants from multiple ethnicities and both sexes. However, digital mental health solutions that have demonstrated efficacy in alleviating stress through diverse avenues are scarce. Hence, we assert that the results of this study are pivotal and denote significant progress in mental healthcare.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we designed an application that offers an individualized experience characterized by gradual changes in rhythm through both tactile and auditory stimulation. We demonstrated the positive impacts of the application on various facets of stress states, including subjective and objective states, following one month of use and a high-perceived effectiveness and social retention following one week of use. Thus, this study highlights the usefulness and potential of this application for widespread societal implementation of stress management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eEditorial support, in the form of medical writing, assembling tables, creating high-resolution images based on authors\u0026rsquo; detailed directions, collating author comments, copyediting, fact-checking, and referencing, was provided by Editage and Cactus Communications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eT.M. participated in the conceptualization, supervision, project administration, investigation, analysis, and writing. T.K., J.O., and S.S. participated in the investigation. All the authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are not openly available for reasons of sensitivity, but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEmployment\u003c/em\u003e:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eTM and TK are employees of the POLA Chemical Industries, which partially funded this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e: This research was supported by a grant from the FemTech support service demonstration project of the Ministry of Economy, Trade, and Industry of Japan, the Innovative Research Program on Suicide Countermeasures (Grant number: JPSCIRS20220301), and the POLA Chemical Industries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval/Informed Consent:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Committee for the Protection of Human Subjects (CPHS) of POLA Chemical Industries, Inc., Kanagawa.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJapan (Approval # 2021F78, 2021F83, and 2022F7), and was conducted according to the Ethical Guidelines for Medical and Health Research Involving Human Subjects (Ministry of Education, Culture, Sports, Science, and Technology and Ministry of Health, Labour, and Welfare, 2014, revised in 2017) and the Declaration of Helsinki (revised in 2013). Subjects received a sufficient briefing of the objective and content of the present study and signed a written informed consent form.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eClark, D. M., Salkovskis, P. M. \u0026amp; Chalkley, A. J. Respiratory control as a treatment for panic attacks. J. Behav. Ther. Exp. Psychiatry 16, 23\u0026ndash;30 (1985).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFincham, G. W., Strauss, C., Montero-Marin, J. \u0026amp; Cavanagh, K. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Sci. Rep. 13, 432 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHibbert, G. A. \u0026amp; Chan, M. Respiratory control: its contribution to the treatment of panic attacks. A controlled study. Br. J. Psychiatry 154, 232\u0026ndash;236 (1989).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJerath, R., Crawford, M. W., Barnes, V. A. \u0026amp; Harden, K. Self-regulation of breathing as a primary treatment for anxiety. Appl. Psychophysiol. Biofeedback 40, 107\u0026ndash;115 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrownlow, B. N. \u003cem\u003eThe Effect of Music Tempo on the Psychophysiological Measures of Stress\u003c/em\u003e, (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Sluijs, R. \u003cem\u003eet al.\u003c/em\u003e Gentle rocking movements during sleep in the elderly. J. Sleep Res. 29, e12989 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu, S., Sun, L. \u0026amp; Rohde, G. K. Robust efficient estimation of heart rate pulse from video. Biomed. Opt. Express 5, 1124\u0026ndash;1135 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgha, N. H. \u003cem\u003eet al.\u003c/em\u003e Salivary antimicrobial proteins and stress biomarkers are elevated during a 6-month mission to the International Space Station. J. Appl. Physiol. (1985) 128, 264\u0026ndash;275 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgawa, M. \u003cem\u003eet al.\u003c/em\u003e Evaluation of psychological stress in confined environments using salivary, skin, and facial image parameters. Sci. Rep. 8, 8264 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKobayashi, M., Hoshi, N. \u0026amp; Horiguchi, M. Validity of self-diagnosis fatigue checklist for young women. \u003cem\u003eInt. J. Hum. Cult. Stud.\u003c/em\u003e 2019, 526\u0026ndash;536 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W. \u0026amp; Swinson, R. P. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol. Assess. 10, 176\u0026ndash;181 (1998).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoldatos, C. R., Dikeos, D. G. \u0026amp; Paparrigopoulos, T. J. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J. Psychosom. Res. 48, 555\u0026ndash;560 (2000).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson, D., Clark, L. A. \u0026amp; Tellegen, A. Development and validation of brief measures of positive and negative affect: the Panas scales. J. Pers. Soc. Psychol. 54, 1063\u0026ndash;1070 (1988).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChalder, T. \u003cem\u003eet al.\u003c/em\u003e Development of a fatigue scale. J. Psychosom. Res. 37, 147\u0026ndash;153 (1993).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM.o.H. Fatigue Research Group. \u003cem\u003eLabour and Welfare of Japan, Establishment of an Objective Fatigue Diagnostic Method for Patients Complaining of Chronic Fatigue with Abnormal Autonomic Nervous System Function and Development of a Diagnostic Guideline for Chronic Fatigue\u003c/em\u003e, (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames, K. A., Stromin, J. I., Steenkamp, N. \u0026amp; Combrinck, M. I. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Front. Endocrinol. (Lausanne) 14, 1085950 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBosch, J. A., Ring, C., de Geus, E. J., Veerman, E. C. \u0026amp; Amerongen, A. V. Stress and secretory immunity. Int. Rev. Neurobiol. 52, 213\u0026ndash;253 (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakayanagi, Y. \u0026amp; Onaka, T. Roles of oxytocin in stress responses, allostasis and resilience. Int. J. Mol. Sci. 23 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGouin, J. P. \u0026amp; Kiecolt-Glaser, J. K. The impact of psychological stress on wound healing: methods and mechanisms. Immunol. Allergy Clin. North Am. 31, 81\u0026ndash;93 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalleh, M. R. Life event, stress and illness. Malays. J. Med. Sci. 15, 9\u0026ndash;18 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl'Abadie, M. S., Kent, G. G. \u0026amp; Gawkrodger, D. J. The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. Br. J. Dermatol. 130, 199\u0026ndash;203 (1994).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"smartphone, depression, anxiety, insomnia, fatigue, cortisol","lastPublishedDoi":"10.21203/rs.3.rs-3998545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3998545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe developed an easy-to-use smartphone-based stress care system that employs simultaneous vibratory sensations and synchronized music. In this study, we evaluated the usefulness of this technology and discussed its potential for societal implementation.\u003c/p\u003e \u003cp\u003eThis prospective study was conducted in three phases in Tokyo. \u003cem\u003ePhase 1\u003c/em\u003e tested the application\u0026rsquo;s efficacy in stress management following one month of use using subjective surveys assessing depression, anxiety, stress, insomnia, mood, and fatigue. \u003cem\u003ePhase 2\u003c/em\u003e assessed the effect of one month of application on internal stress markers (salivary cortisol, IgA, and oxytocin levels). \u003cem\u003ePhase 3\u003c/em\u003e assessed the application\u0026rsquo;s perceived efficacy and potential for social integration using a questionnaire survey administered after one week of use.\u003c/p\u003e \u003cp\u003eSignificant improvements were observed in all subjective stress markers and salivary cortisol levels one month after application. Sixty-seven percent of the participants reported perceiving their therapy as effective in relaxing both their body and mind, while 46% felt that it contributed to improved sleep after one week of application use. Additionally, 73% of participants expressed a positive intention to continue with therapy.\u003c/p\u003e \u003cp\u003e The smartphone-based stress care application offers an individualized experience through both tactile and auditory stimulation, demonstrating its potential for widespread societal implementation of stress management.\u003c/p\u003e","manuscriptTitle":"A Smartphone Application Using Vibro-Acoustic Technology for Stress Management","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-18 17:07:44","doi":"10.21203/rs.3.rs-3998545/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"286fca8b-54cf-4820-93f7-e9261d0bd483","owner":[],"postedDate":"March 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29537758,"name":"Biological sciences/Psychology"},{"id":29537759,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2024-12-12T06:23:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-18 17:07:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3998545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3998545","identity":"rs-3998545","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}