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FPG Faculty Fellow uses NC TraCS pilot program grant to address stress

Pensive teenage boy with medium brown hair and blue eyes in a navy sweatshirt and jeans sits by a window partially covering his face with his arms and hands.

FPG Faculty Fellow uses NC TraCS pilot program grant to address stress

January 23, 2025

Aysenil Belger, PhD, has long been interested in identifying biological, psychological, and social factors that contribute to mental health and stress-related well-being in children and adolescents. She was particularly aware of the lack of methodologies and technologies that could provide real-time measures of the biology of stress responses. She aimed to understand the contributing and moderating factors that stress has on the body in real time and develop tools for early intervention and building resilience. She also wants to follow up longitudinally with children and adolescents who experience trauma at different periods of development to better understand the reasons that some develop long-term mental health issues and begin mapping individual trajectories to mental health and dysregulation.

With support from a one-year North Carolina Translational and Clinical Sciences Institute (NC TraCS) clinical and translational science pilot program grant, Belger, a faculty fellow at the UNC Frank Porter Graham Child Development Institute (FPG), partnered with Alper Bozkurt, PhD, to develop a wearable stress-tracking device. Bozkurt is co-director of the NSF Nanosystems Engineering Research Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST) at NC State University, which focuses on “creating self-powered sensing, computing, and communication systems to enable data-driven insights for a smart and healthy world.”

The prototype device, designed to be worn on the user’s wrist, contains microcircuits that are self-powered by the wearer’s body heat, sweat, motion, and interstitial fluids, preventing the need to charge the device. The device measures electrodermal activity, a physiological reaction of sweating that occurs when one feels anxious or scared. In addition, the wearable senses the user’s heart rate which offers measures of the autonomic nervous system. This provides information about sympathetic and parasympathetic components which helps researchers understand stress responses and adaptation and arousal components. The prototype also includes a pulse detector and a motion sensor.

With the phase one development of the prototype complete, Belger and her team will pilot test it this spring on 25 Carolina students. These young people will be tested in a UNC lab using both the new wearable and a well-validated “gold-standard” mobile physiological measurement system. After each subject receives a psychosocial stressor to activate their stress response, the researchers will measure and compare how these signals are detected by both devices. The team will examine how the subjects’ stress levels recover after a rest interval, measuring them through these devices, to establish the functionality of the new device and validate it against the existing gold standard.

Belger, a professor in the psychiatry department of the UNC School of Medicine, envisions that the data will be delivered to the cloud where calculations and algorithms can immediately analyze the heart rate, electrodermal activity, and other stress indicators. Individuals will then receive instant feedback about being dysregulated and be connected to an app that offers a tool to help them self-regulate in real time. She noted that this closed loop—sensing data and delivering an intervention as needed—could be especially useful in environments where few other services are available.

In fact, watching population migration through refugee camps in Turkey, where Belger grew up, provided the inspiration for this research. Decades ago, Belger’s concern about the well-being of children and adolescents in these camps sparked her interest in creating mobile sensors that could track individual well-being and deliver programs to support young people’s mental health in association with social, emotional, and biological needs in real time to potentially assist with prevention and early interventions in high-risk low-resource environments.

Like Belger, Bozkurt hails from Turkey. Belger appreciates the large community of Turkish scientists in the Triangle and says that working with Bozkurt is joyful. “Science is science but it is also a social endeavor,” she said. “When you have an idea, you bounce it off others and they enrich it and you go back and forth thinking about ideas. Working in your own culture brings a different way of thinking about the science because our cognition is tied to linguistics. And even if we're not using that language during our project all the time, knowing that you can express your thoughts in different ways is special.”

Belger said that this type of device allows scientists to measure data that is inaccessible through retrospective surveys, observations, and questionnaires. By allowing researchers to understand the mechanisms and biology associated with psychological states directly, the wearable can further help scientists understand potential psychological distress in infants or in nonverbal individuals.

Once the proof-of-concept study for the device is completed, Belger plans to develop an intervention study to ensure that real-time analysis in the cloud is feasible. Belger would then test the device on youth who don't have a disorder but may experience momentary distress, lack of pleasure, or anxiety, emotions that often precede and may herald risk for more significant psychiatric conditions. She said that the empirical question she wants to explore is whether there are early physiological, neural and related psychological markers of increased risk and vulnerability in those who later experience neuropsychiatric disorders.

With a GPS sensor in the wearable, researchers can also explore how subjects’ physiological regulation changes as a function of their social environment, whether they are in school, at home or with particular people. By identifying triggers associated with physiological dysregulation, researchers would gain insight into “contextual” targets for behavioral or pharmacological interventions. The wearable could offer a window for early intervention by better recognizing triggers before early signs and symptoms escalate and become more established, chronic and severe and end in a psychiatric diagnosis.

“When we have a question that requires innovation and we don't have the tools or collaborations in place, it is important to go out of our comfort zone and build a collaboration like this,” said Belger. “The future is going to depend more and more on these types of technological advances that allow both the precision of an individualized approach, but also the mobility, wearability, accessibility and scalability of a device like this one.”