THE SITUATION
In the crazy pace of today’s life, people are stressed out – and they need help. They are turning more and more to a bevy of apps and online services to help manage various aspects of their lives. Yet using a different app for each aspect of life creates a fragmented view, adding to the stress and making it harder to view things holistically. Especially when it comes to health and wellness.
The Living Centerline Institute (LCI) plans to resolve this problem by uniting the three pillars of health: mind (mental wellness), body (physical wellness), and balance sheet (financial wellness). While health apps are a fast-growing category, no one has yet taken into account how important the area of finances is to the overall wellness picture because of its impact on stress.
Financial duress is the leading cause of stress in the United States.
⦁ 62% of Americans report money is a significant source of stress in their lives. 1
⦁ 48% of US employees worry about their current financial state and 59% worry about their future financial state. 2
⦁ As student load debt rises, physical well-being declines. 3
⦁ If also affects mental health. Americans are living with higher stress levels than psychologists deem to be healthy 1
Sources: 1Stress in America Survey, 2017, 2Willis Towers Watson, Global Benefits Attitudes 2017/2018 Global Survey, 3Gallup Survey, April 2018
According to an AOL poll on debt stress, 10 – 16MM people in the US have health issues due to financial stress. This also has a spillover effect to businesses, as stress causes health issues that cost U.S. companies billions of dollars in lost productivity through both absenteeism and presenteeism.
Services like Mint, Fidelity Go and a variety of budgeting and financial planning tools and apps are being born every day. They support financial fitness, but they don’t seem to realize that what they do can have a profound effect on health. They are so focused on finance; they are missing the bigger picture. Mobile health (mHealth) is also booming. And according to Grandview Research study in Aug. 2017, the mHealth app market size is expected to grow to $111.8 billion by 2025.
As important as the collection and tracking of health-related data is to the people, using mHealth apps, it’s also a highly sought-after asset for a variety of industries, from pharmaceutical brands to insurance companies, to any business with a product or service relating to healthy living. Currently, individuals and companies are not able to share, exchange, or monetize this kind of data. Additionally, no one is aggregating health data together with financial data, which would add a whole new dimension of value. No one is connecting the dots. Until now.
For most people, decisions about “wellness” are made by default. Without specific evidence-based guidance, most find it difficult to make specific long-term commitment to achieving and maintaining wellness. Proposed here is an approach to filling the information gap through “Informed spectatoring” using appropriate instrumentation and advice: a type of “feedback control”.
Human beings are complex systems having many interoperable subsystems. Neither these subsystems nor their interactions are completely understood. Further, while there are broad principles describing these subsystems and their interactions, the specifics are personal. Taken together, these factors make optimization of the human being by achieving and maintaining Wellness a challenging problem.
We describe a cloud-based system intended to provide actionable recommendations to users for improving their wellness. The recommendations are personalized for the user demographic and history. This is accomplished in three steps:
Assessment: a knowledge-based expert system ingests data from the user, and positions them on an objective, numeric multi-dimensional wellness scale in the general areas of Psychology, Physiology, and Finances. This assessment of wellness is informed by the user demographic, history, and a wearable monitoring device.
Projection: A bank of feedback controllers (pid controllers) is used to estimate user future wellness states by projecting the user wellness state forward in time. This is a prospective, rather than merely retrospective analysis. It is focused on where the user will be rather than merely where the user has been.
Recommendation: Based upon the assessment of user wellness, and the forward projection of the user wellness, a knowledge-based expert system selects a few areas of wellness that can be addressed in a unified way by simple user actions. An innovation is that the expert system makes these recommendations by automatically crafting a report in colloquial prose that reads like it was written by a human. An operational, cloud-based prototype has been built and tested on simulated data. We describe an upcoming human trial using members of the U.S. Olympic Team as subjects.
Modern medical technology provides a wide range of treatment options, each having a corresponding cost. There are established accounting procedures for quantifying costs, but a principled cost-benefit analysis for a treatment option cannot be performed without corresponding procedures for quantifying treatment benefits. Can the “quality” of lives lived under different treatment outcomes be objectively quantified?
This is the purpose of the QALY (Quality Adjusted Life Year), an internationally recognized metric designed to make possible consistent cost-benefit analyses in support of medical, pharmacological, and actuarial decision-making [Whitehead, et. al.]. Viewing health as a function of both length of life and quality of life, life quality might be mathematically summarized as the numeric product of a “life quality” measure and the time duration over which it obtains. For the QALY, the duration is one year.
A person’s life (the “subject”) can be modeled as a sequence of state vectors through time. This sequence defines a trajectory through a state space. In this work, the state vector components are values of wellness measures of various types. The resulting state space is called the Wellness Space, and the trajectory through this space we call the subject’s lifeline.
We extend the single-quality, large time-step QALY to an EQALY, a multi-factor, variable-step model using vector calculus in a scalar field. Most importantly, we describe how, given an appropriate measuring methodology whereby the EQALY can be repurposed. Instead of serving as a general population metric for informing public policy, the EQALY supports a personalized tool for monitoring and optimizing individual wellness. To achieve this personalization, the EQALY:
Generalizes the time-sampling scheme for data collection
Supports the introduction of arbitrary numeric wellness measures into the QALY
Improves the fidelity and utility of the QALY so that it can serve as a multi-factor, integrated, comprehensive wellness metric for a wide range of wellness applications, including:
Monitoring current wellness as a process
Predicting future wellness
Determining subject behaviors that will optimize the quality of life over a subject’s lifeline
The authors implemented software prototypes of these features. Feasibility and fidelity have been demonstrated on a population of simulants (simulated subjects), with a human trial using members of the U.S. Winter Olympic Team as subjects beginning in spring, 2021.
The psychological import of such an integrated personalized QALY is clear. “Eat right, exercise, learn to relax, live within your means” are all good suggestions. But without specificity, quantification, and assessment of relative costs and effects, they are easily disregarded platitudes. In short, what cannot be measured cannot be managed. The EQALY enables objective, proactive management of every facet of wellness.
The United States healthcare model has become increasingly reductive with components of a patient’s health profile dissected between isolated specialized fields. A declining primary care sector has exacerbated this compartmentalization as knowledge within these specialties becomes siloed, forcing treatment to become reactionary and sequential in the absence of a holistic perspective. This can lead to overlooked component interactions such as conflicting treatment plans or compounding illness. However, recent advancements in digital technologies may provide a solution through the facilitation of open communication between specialties. Intelligent Wellness, for instance, refers to a simultaneous optimization model of patient care which identifies and responds to imbalances in a person’s measurable stress through reference to their entire health profile. This model holistically examines three pillars of an individual’s mental, physical, and financial wellbeing. Taking inspiration from naturally and mechanically occurring negative feedback loop systems, such Intelligent Wellness would collect comprehensive, real-time data on a participant’s internal functioning state and their relevant environmental factors. Such data would then be analyzed and delivered back to the participant in the form of personalized behavioral recommendations for effectively improving baseline health. This collection, analysis, and delivery would occur through a digital twin medium that acts to accurately simulate and predict a participant’s dynamic wellbeing.
This paper presents a review of the existing literature, across fields of study, that discuss psychological stress management approaches as they relate to helping financial stressed individuals. The paper also provides a unique meta-analysis of studies that show convincing evidence that stress management and some financial planning interventions targeted at stress and psychological adjustment have a significant psychophysiological effect on financial stressed people. Based on the results from the meta-analysis, the paper provides a model of future financial planning practice that incorporates digital technologies into a model of Intelligent Wellness. This paper sets the foundation for viewing financial planning, psychological, and counseling interventions holistically as a way to help clients improve mental, physical, and financial functioning. Taking inspiration from naturally and mechanically occurring negative feedback loop systems, this paper provides a blueprint for collecting comprehensive, real-time data on a client’s internal functioning state and their relevant environmental factors and the delivering information to the client and their financial planner as personalized behavioral recommendations. The notion of using a digital twin medium is introduced in this paper as a mechanism of improving general and financial well-being.
It is known that economic problems cause psychological stress, and that psychological stress causes physiological changes that often are linked to disease. American Psychological Association surveys show that financial problems are a major source of psychological stress, while economists also are increasingly aware of the influence of psychological factors on economic behavior. Financial stress impacts the body and may affect both financial decision making and disease vulnerability, hence the development of the field of psychophysiological economics. In this paper we report a systematic review and meta-analysis on physiological effects of psychological treatment for individuals with economic problems. Of 5071 papers in our initial PsycInfo search, we identified 16 papers on physiological effects for psychological treatment of the economically stressed. Several studies also included financial counseling, mostly on people facing chronic poverty. We found twelve controlled studies, among which we found a small to moderate significant effect size, Hedges’ g = 0.383, p < 0.001. The biggest effect sizes were found for heart rate variability and measures of inflammation, and the smallest for measures involving cortisol. We note that poor populations often do not have resources for both financial and psychological counseling, while there is little data on financially stressed people who might more readily be able to access such help. The independent or additive effects of financial counseling has not been systematically studied. A model of care for both psychophysiological and financial health is proposed.
“ Psychophysiological economics research is focused on assessment and evaluation of psychological and physiological events as they pertain to economic behavior. It differs from behavioral finance and other psychological economics. It is possible that within a decade research that emerges from this field of study will have profound impacts on the way advisors work with their clients. ”
Psychophysiological economics research is focused on assessment and evaluation of psychological and physiological events as they pertain to economic behavior. It differs from behavioral finance and other psychological economics. It is possible that within a decade research that emerges from this field of study will have profound impacts on the way advisors work with their clients.
There continues to be a great need for financial guidance within American households, yet the utilization of professional financial help, despite its growing accessibility, is low. It has been suggested that physiological arousal is an important factor that influences help-seeking behaviors. This paper tests the hypothesis that help-seeking intentions at the couple level are shaped in part by physiological arousal within the couple. Although exploratory, findings suggest the greater the joint level of arousal, the more likely a couple will be to report an intention to meet with a financial planner. Couples who experience a higher level of arousal during a financial therapy session were found to be more likely to self-report an intention to engage in future financial planning services. Conversely, couples who reported less intention to seek help responded with less arousal during sessions. Implications for financial professionals working with couples are discussed.
Results from this exploratory clinical study indicated that financial anxiety—holding an unhealthy attitude about one’s financial situation—and physiological arousal—the physical precursor to behavior—play important roles in shaping consumer intention to engage in future financial planning activity. Findings suggested that those who are most likely to engage the services of a financial adviser exhibit low levels of financial anxiety and moderate to high levels of physiological arousal. The least likely to seek the help of a financial adviser were those who exhibited high financial anxiety and low physiological arousal. Results supported findings documented in the literature that high anxiety levels often lead to a form of self-imposed helplessness. In order to move those experiencing financial anxiety towards financial solutions, financial advisers ought to take steps to simultaneously reduce financial stressors and stimulate arousal as a way to promote behavioral change and help seeking. (PsycInfo Database Record (c) 2022 APA, all rights reserved)