The National Center for Telehealth and Technology (T2), an agency of the Department of Defense, has been introducing online and mobile health tools for people in the military, veterans, and their families since 2008. Their newest offering, BioZen, is an effort to get ahead of the trend of personal sensors and provide a free mobile tool to help people use those sensors to improve their health through the practice of biofeedback.

"One of the things we do here at T2 is constantly look for ways to innovate mobile health. Wearable technology is one of our interests," David Cooper, a psychologist at T2, told MobiHealthNews. "One thing we didn't see a lot of was people using biosensors for biofeedback. But we found a way to integrate some biosensors through the mobile phone using Bluetooth."

Biofeedback is a therapy wherein patients wear sensors while experiencing a problem like chronic pain or migraines. By seeing exactly how their physiological response changes throughout the experience, patients can gain control over those responses and, therefore, over their symptoms. It can be used in conjunction with other therapies or by itself: sometimes the awareness itself is therapeutic, other times biofeedback is a tool for determining what's the most effective way of dealing with a condition.

Biofeedback is an appealing area for mobile health because traditional biofeedback technology is cumbersome, requiring the patient to be hooked up to a lot of wires with limited mobility. Mobile biofeedback, which only requires some wireless sensors and a smartphone, not only allows a patient to take the therapy home and use it more often and more casually, it can also be used in the clinic, lowering the price point and effort involved.

Cooper says there is a stigma attached to mental health for many returning servicemembers. Part of the idea behind a biofeedback app is to provide a discreet personal treatment option for people who don't want to take medication or don't want others to know they're in therapy.

"That's why we like developing for mobile devices," said Cooper. "People don't know if you're checking Facebook or learning about your PTSD."

For that reason, the app is designed to work in the context of therapy, but it also includes tutorials so people can learn to do biofeedback on their own. It includes a highly informational graph-based interface, but it also includes a single-variable pictorial interface where, for instance, a picture of a tree becomes brighter and more detailed as your gamma waves increase.

The BioZen Android app works with a variety of commercially available sensors with open APIs. Sensors the app can interact with include electroencephalogram (EEG), electrocardiogram (ECG), electromyography, galvanic skin response, respiratory rate, and skin temperature. The app can either work with just one sensor or a whole suite. The device currently works with brainwave sensors from NeuroSky and BrainAthlete, as well as physiological sensors from Zephyr Technology and Shimmer Research, sensors Cooper said were chosen because they are commercially available and have open APIs.

"We're trying to move into a more open framework when it comes to health sensors," Cooper said. "We know that's an important consumer area, we know its going to be important in mHealth coming up. So we're trying to incorporate as many of these APIs in our future products as we can."

Cooper said T2 likes to make its apps multiplatform, but because of the difficulty in interfacing with Bluetooth, he doesn't think an iOS version of BioZen is likely.

T2 has 10 Apple and Android health apps available, including a mood tracker, an app for managing with PTSD, and an app to help combat stress with breathing exercises. T2 recently updated the mood tracker app with a new capability: users can now export and share their mood records with friends or care providers. In addition, the agency maintains two online communities to help people in the service and their families deal with the wide range of issues affecting them: afterdeployment.org and militarykidsconnect.org.

Cooper said the DoD is careful to only release apps based on research-driven practices, but they don't wait until the apps themselves are clinically proven to release them. T2 has published 75 papers since 2008, however, and is planning to do efficacy studies on BioZen in the future.