“The Impact of Technological Innovation on Biobehavioral and Psychosomatic Medicine” is the theme of the current issue of this journal. This special issue of Psychosomatic Medicine opens with an overview of this field by the two Guest Editors, Mirela Habibović, PhD, and Bruce Rollman, MD, MPH. The articles in this issue focus on technological solutions that have been applied to patient-monitoring and assessment and treatment. Topics addressed in this issue include the use of biological and behavioral sensors that are linked to people’s smartphones; technological innovations in clinical conditions (asthma, alcohol-associated liver disease, and chronic pain); the use of virtual humans in clinical settings; digital mental health interventions, and the importance of reducing health disparities in the development and implementation of technological innovation. These topics are critically relevant to the field of biobehavioral and psychosomatic medicine and provide future directions for research and clinical practice.

Pages 565–567; https://doi.org/10.1097/PSY.0000000000001240

Major technological improvements have occurred in the ambulatory assessment of heart rate and heart rate variability (HRV). Biofeedback based on HRV (HRV-BF) has been used to reduce psychological distress and anxiety and is often offered by making use of an electrocardiogram (ECG) setup in a laboratory setting. However, this setting results in substantial costs and a lack of user-friendliness, hampering the availability of HRV-BF to a broad public in daily life. To test smartphone and smart watch alternatives, Van Dijk et al. compared HRV-BF obtained from 57 participants using smartphone rear-camera photoplethysmography (PPG) against classical ECG-based HRV-BF in a clinical setting. The investigators found measurement by PPG to be accurate and a promising alternative for ECG-based HRV-BF.

Pages 568–576; https://doi.org/10.1097/PSY.0000000000001236

Heart rate is a physiological measure that responds to a wide range of stressors. Commercially available smartphone photoplethysmography (PPG) sensors enable heart rate data to be collected in daily life settings while at the same time assessing the occurrence of stressors and psychological responses to these stressors using ecological momentary assessments. Nelson et al. found that smartphone PPG heart rate significantly covaried with self-reported stress and anxiety levels during daily life activities (n = 102), indicating that smartphone PPG can be used in remote digital study designs to index proximal measures of the physiological correlates of psychological distress and anxiety.

Pages 577–584; https://doi.org/10.1097/PSY.0000000000001178

Short-lived bursts of acute stress from demanding situations and chronic stress from unremitting life demands are rarely studied simultaneously. Using a research platform based on an app, Mak et al. examined the within- and between-person associations of acute and chronic stress with blood pressure (BP) and heart rate (HR) in a large sample (n = 31,964). Participants received notifications 3 times each day for 21 days to measure their BP and HR and to complete measures of their current thoughts and feelings, including measures of stress. Both acute and chronic stress were associated with higher BP levels both within and between persons. However, for individuals with higher chronic stress, acute stress was associated with blunted BP responses. The study highlights opportunities and challenges in scaling ecological momentary assessment studies to examine psychological stress and real-time BP and HR responses in daily life.

Pages 585–595; https://doi.org/10.1097/PSY.0000000000001224

For alcohol-associated liver disease (ALD), total abstinence can slow its progression. Wearable alcohol biosensors that identify alcohol use through perspiration are an emerging technology with potential application for patients with ALD. In a pilot study of 27 participants, DiMartini et al. reviewed biosensor acceptability and feasibility in ALD. Participants gave high scores for perceived usefulness, ease of use, overall acceptance of biosensor technology, and intent to wear. Importantly, acceptance remained high after 3 months of device wearing.

Pages 596–604; https://doi.org/10.1097/PSY.0000000000001203

The widely available ASTHMAXcel PRO mobile app provides asthma education information to users. Silverstein et al. evaluated the association of health/eHealth literacy and depressive symptoms with usage of ASTHMAXcel PRO and clinical outcomes (n = 96). Depressive symptoms were associated with worse asthma outcomes. eHealth literacy was associated with increased patient engagement with the app but worse asthma-related QOL. Digital health literacy might be key to increasing patient engagement with mobile health interventions to manage chronic illnesses such as asthma.

Pages 605–611; https://doi.org/10.1097/PSY.0000000000001170

Janevic et al. assessed pain and technology journals to see where pain tech research attention has been focused since 2000. The authors developed the Pain Tech Landscape model (PTL), a heat mapping system generated from their narrative review of pain care needs and characteristics of existing technological solutions. The model showed that most applications have been in the area of self-care apps. The PTL model is a potentially useful common language across research, clinical, and technological disciplines to track and speed digital innovation for chronic pain management.

Pages 612–618; https://doi.org/10.1097/PSY.0000000000001200

Virtual humans are autonomously animated, humanlike computer agents with social and emotional engagement driven by artificial intelligence. In a narrative review, Loveys et al. explored the implications of virtual humans for behavioral and psychosomatic medicine. Virtual humans show promise for health monitoring and psychological intervention delivery. However, the research field is at an early stage of development; further trials are needed, and ethical implications must be considered.

Pages 619–626; https://doi.org/10.1097/PSY.0000000000001227

Virtual human (VH) technology has ushered in highly interactive computer-animated interviewers for use in the clinical setting. Their efficacy in chronic pain care is unknown. Junghaenel et al. assigned 94 patients with chronic musculoskeletal pain to standard, psychosocial, or educational VH telehealth interviews. Satisfaction with the VH and telehealth format was generally high. Interactive VH interviewers hold promise for improving chronic pain care, including probing for psychosocial risk factors and providing pain-related education.

Pages 627–638; https://doi.org/10.1097/PSY.0000000000001228

Riva et al. developed the COVID Feel Good intervention, a free virtual reality self-help protocol to reduce the psychological burden of the COVID-19 pandemic-related challenges such as social restrictions. Participants (n = 136) watched a 10-minute, 360° video titled “The Secret Garden” each day for 1 week and supplemented it with daily social exercises designed to be experienced with another person. Findings indicated that the COVID Feel Good Intervention was effective in reducing psychological distress.

Pages 639–650; https://doi.org/10.1097/PSY.0000000000001198

Digital mental health interventions (DMHI) include a diverse group of treatments and delivery modalities, ranging from self-guided smartphone applications to therapist-supported platforms. Many DMHIs now incorporate evidence-based strategies like cognitive behavioral therapy, mindfulness, and psychoeducation. They can be an effective treatment for symptoms of depression and anxiety, although less is known about whether participants who engage more frequently exhibit better clinical outcomes. In a study of 4978 participants, Aschbacher et al. conducted hierarchical cluster analysis to derive four patient subpopulations based upon frequency of engagement during a therapist-supported DMHI. A dose-response relationship was observed between engagement and depression symptom remission, while the pattern was partially evident for anxiety symptom remission.

Pages 651–658; https://doi.org/10.1097/PSY.0000000000001230

Patient care through digital health interventions has made accessible, personalized care more available to a wide range of people. However, the risk of worsening overall health inequities requires continued attention. Using the World Health Organization Commission on Social Determinants of Health conceptual framework, Goldstein et al. present a comprehensive perspective on the ways recent advances in technology and research design might be adjusted to serve equitable digital health intervention and implementation of technological innovation. The authors suggest that the methods to develop, validate, deploy, sustain, and integrate technology into the everyday lives of marginalized communities can be as innovative as the technology itself.

Pages 659–669; https://doi.org/10.1097/PSY.0000000000001176