wearable-data-integration

name	wearable-data-integration
description	Ingests, interprets, and therapeutically applies data from Apple Watch, Fitbit, Garmin, and other wearable devices. Correlates physiological signals with psychological state to enhance session quality and between-session monitoring.

Wearable Data Integration Skill

Overview

Wearables provide objective physiological data that supplements what users say and what the camera sees. This skill defines how to collect, interpret, and therapeutically use this data.

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Supported Devices & Data Sources

Device	Integration Method	Data Available
Apple Watch	HealthKit (iOS) / Apple Health API	HR, HRV, SpO2, Sleep, Steps, Mindfulness minutes
Fitbit	Fitbit Web API (OAuth2)	HR, HRV, Sleep stages, Stress score, SpO2, Steps
Garmin	Garmin Connect IQ API	HR, HRV, Stress, Body Battery, Sleep, VO2 max
WHOOP	WHOOP API	HRV, Recovery score, Sleep, Strain
Google Fit / Health Connect	Health Connect API (Android)	HR, Steps, Sleep, Activity

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Key Metrics & Therapeutic Interpretation

Heart Rate (HR)

interface HeartRateInterpretation {
  resting: {
    low: number;      // < 50: athletic or bradycardia
    normal: number;   // 50-80: baseline
    elevated: number; // 80-100: stress/anxiety
    high: number;     // > 100: acute stress or medical concern
  };
  duringSession: {
    baselineIncrease: number; // % above resting during session
    interpretation: string;
  };
}

Therapeutic use:

• Elevated resting HR on session day → open with grounding, ask about anxiety
• HR spike during specific topic → flag topic as emotionally activating, note in profile
• HR drops after breathing exercise → reinforce effectiveness to user ("Your heart rate calmed down just now")

Heart Rate Variability (HRV)

HRV is the most powerful stress/recovery indicator from wearables.

HRV Status	Meaning	Therapeutic Adjustment
High HRV (> personal baseline)	Well-recovered, resilient, low stress	Can handle deeper processing
Normal HRV	Stable baseline	Standard session approach
Low HRV (< 20% below baseline)	Stress, poor sleep, physiological load	Reduce challenge, focus on stabilization
Very low HRV (< 40% below baseline)	Significant dysregulation	Consider reschedule or pure supportive session

Sleep Data

interface SleepTherapeuticRules {
  poorSleep: {
    definition: 'totalSleep < 6h OR sleepScore < 60';
    adjustment: 'Acknowledge fatigue, slower pace, avoid heavy processing';
    topicTrigger: 'Offer sleep hygiene mini-session if 3+ consecutive poor nights';
  };
  goodSleep: {
    definition: 'totalSleep >= 7h AND sleepScore >= 75';
    adjustment: 'User has capacity — appropriate for deeper work';
  };
}

Stress Score (Device-Reported)

• High stress days: therapist acknowledges physiological reality
• Prolonged stress pattern: bring into session proactively
• Low stress after therapeutic intervention: reinforce and note progress

Activity & Movement

• Sedentary for 5+ consecutive days → possible depression/withdrawal → address gently
• Activity increase correlating with mood improvement → reinforce connection
• Exercise as mood regulation tool → prescribe if appropriate (behavioral activation)

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Data Collection Architecture

Web Integration (MVP)

// Use Web Bluetooth API for direct device connection (limited)
// OR use platform-specific app bridges

interface WearableDataBridge {
  appleHealth: {
    method: 'iOS app → backend sync';
    frequency: 'daily batch + real-time during session';
  };
  fitbit: {
    method: 'OAuth2 → Fitbit Web API → backend';
    frequency: 'daily cron job + webhook for real-time HR';
  };
  garmin: {
    method: 'Garmin Connect API → backend';
    frequency: 'daily batch sync';
  };
}

Data Pipeline

Wearable Device
  → Platform API (HealthKit / Fitbit API / etc.)
    → Our Backend Sync Service (runs nightly + on session start)
      → Normalized WearableDataPoint schema
        → User Profile storage (encrypted)
          → Session Engine (read at session start)
            → Therapist context injection

Privacy First

• Request only the minimum scopes needed for therapeutic value
• Wearable data stored in user's private partition
• Users can connect/disconnect devices at any time
• Clear explanation of what data is used and why

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In-Session Real-Time Use (Advanced)

When device supports real-time HR streaming (Apple Watch with iOS app):

// During session, monitor for:
const realTimeAlerts = [
  {
    condition: 'heartRate > userBaseline * 1.5',
    action: 'Offer breathing exercise: "Your body might be working hard right now. Want to try a quick breath together?"'
  },
  {
    condition: 'heartRateSuddenDrop && topic === "crisis"',
    action: 'Flag possible dissociation, ground immediately'
  }
];

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Between-Session Monitoring

The system passively monitors wearable data between sessions and can:

• Send a gentle check-in message if stress is elevated for 3+ days
• Notify user if sleep quality has declined significantly
• Prompt mood log if HRV is very low
• Surface positive trends: "Your HRV has improved 15% this week — your body is responding to the work you're doing"

All between-session messages are optional and user-configured (notification preferences).