Ride, Track, and Recover: Pilot Randomized Trial of a Wearable Digital Self-Management Intervention During a Veteran Endurance-Cycling Program

Posttraumatic stress disorder (PTSD) is a prevalent and debilitating mental health condition with significant personal and societal impacts. Current clinical assessments of PTSD often rely on subjective evaluations, which can be time-consuming, costly, and prone to human bias. This study proposes a machine learning (ML) approach based on multivariate kernel density estimation (MKDE) technique for the objective evaluation of PTSD severity. We collected heart rate (HR) and galvanic skin response (GSR) signals as well as PTSD Checklist - Military Version (PCL-M) labels from 21 participants during an immersive simulation. A fear-response model was trained on a public arachnophobia dataset, and predictive features of PTSD were extracted from the fear-response curves estimated on the military dataset. The model achieved an accuracy of 86% in classifying PTSD status, effectively distinguishing participants with and without PTSD (PCL-M threshold of 36). The average mean absolute error (MAE) of the models is 5.6, and it estimated a clinical PTSD severity scale with a mean absolute percentage error of 17%. Our algorithm demonstrates promising potential for enhancing estimation of PTSD severity and followup by offering an objective and low-effort evaluation approach using physiology. These findings suggest clinical utility in both screening and follow-up settings.

Post-Traumatic Stress Disorder (PTSD) is fundamentally a neuroplastic problem traumatic contact events encode over-reactive neural pathways through Hebbian long-term potentiation, producing hair-triggered amygdala-HPA stress cascades that fire before conscious awareness can intercept them. Existing therapeutic approaches, prolonged exposure, EMDR, cognitive behavioural therapy, operate predominantly downstream of the reactive cascade, teaching patients to tolerate or reframe distress after it has arisen. While clinically valuable, these suppression-based approaches do not produce the upstream pathway dissolution that constitutes lasting structural neural reorganisation. This paper proposes MindGap, a privacy-preserving on-device conversational AI framework that delivers structured neuroplastic rehabilitation for PTSD through the practice of dependent origination, a Buddhist psychological framework that identifies the precise moment between the pre-cognitive affective signal and the reactive elaboration that follows as the site of therapeutic intervention. MindGap guides patients through three progressive layers of observation at this feeling tone gap: noticing the bare affective signal before reactive elaboration, recognising it as self-arising rather than caused by the stimulus, and recognising the conditioned implicit belief beneath the feeling. Each layer corresponds to progressively deeper prefrontal regulatory engagement and progressively deeper long-term depression-mediated weakening of the reactive pathway, producing genuine upstream dissolution rather than downstream suppression. Running entirely on-device with no data egress, MindGap delivers daily calibrated exposure sessions through a fine-tuned lightweight large language model, making it deployable in sensitive clinical and military contexts where cloud-based solutions are not permitted.

Consumer wearables enable continuous measurement of physiological data related to stress and recovery, but turning these streams into actionable, personalized stress-management recommendations remains a challenge. In practice, users often do not know how a given intervention, defined as an activity intended to reduce stress, will affect heart rate (HR), heart rate variability (HRV), or inter-beat intervals (BBI) over the next 15 to 120 minutes. We present a framework that predicts post-intervention trajectories and the direction of change for these physiological indicators across time windows. Our methodology combines a Transformer model for multi-horizon trajectories of percent change relative to a pre-intervention baseline, direction-of-change calls (positive, negative, or neutral) at each horizon, and an empirical study using wearable sensor data overlaid with user-tagged events and interventions. This proof of concept shows that personalized post-intervention prediction is feasible. We encourage future integration into stress-management tools for personalized intervention recommendations tailored to each person's day following further validation in larger studies and, where applicable, appropriate regulatory review.