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Wearable Biomarkers of Anxiety: The Next Big Shift in Mental Health Care

For years, heart rate has been the go-to physiological marker for anxiety. Simple, accessible… but also limited. Anyone who has worked with anxious clients knows heart rate doesn’t always tell the full story — especially in subtle or chronic anxiety states.

Now, a new wave of research is pointing toward something much more powerful: electrooculography (EOG) and electrodermal activity (EDA) as real-time, reliable biomarkers of anxiety. And the implications for clinical practice, especially exposure-based work and digital therapies, are huge.


Why EOG + EDA Are So Promising

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A 2025 study by Dao and colleagues tested whether simple wearable sensors could detect anxiety during a cold-pressor task — and the results were surprisingly strong [1].


Their key findings:


  • EOG (eye movements, blink patterns) changed systematically with rising anxiety.

  • EDA (skin conductance) reflected moment-by-moment sympathetic arousal.

  • When combined and analysed with machine learning, these signals formed a robust, real-time anxiety biomarker — even under noise and natural movement.


Why does this matter? Because anxiety is a dynamic, fluctuating state. Self-report captures snapshots. Heart rate misses nuance. EOG and EDA — especially together — offer something richer:


A continuous physiological fingerprint of how the client is feeling.


What This Means for Clinicians Right Now

While most practitioners don’t yet have EDA/EOG wearables in their standard toolkit, the clinical implications are already clear:


1. More Accurate Anxiety Assessment

Instead of relying solely on “How anxious are you right now?”, clinicians could access objective indicators that catch:

  • Hidden spikes in anxiety

  • Underreported distress (e.g., high-maskers)

  • Subtle changes that clients struggle to articulate


For some clients — especially those with alexithymia, attentional issues, or avoidance — this could be a game changer.


2. Tailored Exposure Therapy

Imagine being able to adjust exposure intensity based on physiological readiness rather than guesswork. For example:

  • If EDA is spiking faster than expected, you pause or scale back.

  • If physiological arousal stabilises quickly, you progress the hierarchy more confidently.


This is exposure therapy with precision.


3. Between-Session Insights

Wearables could help identify real-world patterns:

  • Workplace triggers

  • Commute stress profiles

  • Early-morning arousal spikes

  • Social anxiety signatures during conversations or meetings


These insights could guide session planning and provide more targeted homework.


Biofeedback vs Closed-Loop Systems — A Quick Clarification

As this technology evolves, you’ll hear two terms often: biofeedback and closed-loop intervention.


  • Biofeedback: The client sees their physiological signals in real time (e.g., EDA on a screen) and learns to regulate them.

  • Closed-loop systems: The environment responds automatically to the client’s physiology.For example, if EDA crosses a threshold, a digital tool adjusts exposure intensity or introduces grounding cues.


Biofeedback helps clients regulate. Closed-loop systems help the therapy regulate itself.

Both are part of the future.


Where This Is Heading: VR + Biomarkers + Personalised Anxiety Treatment

Virtual reality exposure therapy is already effective — but physiological biomarker integration may elevate it to another level.


Here’s what’s coming:


1. VR sessions that adapt in real time

A VR social scene could slow down, reduce crowd density, or dim sensory load automatically when a client’s EDA spikes.When they settle, the scene strengthens again.


2. Personalised “anxiety profiles”

Across multiple sessions, systems could learn a client’s unique patterns:

  • Their blink-rate changes before panic

  • Their typical EDA curve when stressed

  • Their threshold of tolerable exposure


This could allow exposures to be finely tuned — neither too mild nor too overwhelming.


3. Intelligent treatment planning

With continuous biomarker data, clinicians would be able to track progress with unprecedented clarity:


  • Reduced sympathetic reactivity

  • Shorter recovery times

  • More stable physiological baselines


Objective progress indicators could help clients stay motivated and feel confident they're improving.


The Takeaway for Clinicians

EOG and EDA are not science fiction — they’re emerging, validated biomarkers that offer:


  • richer insight into anxiety,

  • more tailored exposure therapy,

  • and the possibility of truly personalised, adaptive digital treatment.


We’re moving toward a world where digital mental health tools — including VR — don’t just display anxiety-related environments. They understand the client’s internal state and respond to it.


And for the field of anxiety treatment, that’s one of the most exciting developments in years.


References

[1] Dao, J., Liu, R., Solomon, S., & Solomon, S. A. (2025). Using Electrooculography and Electrodermal Activity During a Cold Pressor Test to Identify Physiological Biomarkers of State Anxiety: Feature-Based Algorithm Development and Validation Study. JMIRx med, 6, e69472. https://doi.org/10.2196/69472

 
 
 
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