My Reviews for Nervous System Care and Wearable Technology

November 8, 2026

By Alena Neykova, LCSW, Clinical Director

Union Station Therapy | Austin, Texas

At Union Station Therapy, physiology is one of the pillars of our work. In individual and couples therapy, we pay attention to what happens in the body when a person feels criticized, unsafe, overwhelmed, or afraid of losing connection. A partner may want to stay present and find themselves defending, pursuing reassurance, or going quiet before they have time to choose a response.

Why physiology matters in relationships

John and Julie Gottman, developers of Gottman Method Couples Therapy, have dedicated decades to studying relationships and developing what I consider some of the best couples therapy work to date. Their research has helped clinicians understand how partners’ interactions—and their physiological responses during conflict—shape relationship patterns. (About the Gottman Method; John and Julie Gottman).

The Gottmans use the phrase diffuse physiological arousal (DPA) to describe the broad bodily stress response that can arise during conflict. Many couples recognize it as flooding: the heart races, muscles tense, attention narrows, and the urge to fight, escape, or shut down grows stronger. In that state, it can be hard to hear a partner accurately, think flexibly, offer compassion, or use communication skills learned in therapy.

In a small longitudinal study, John Gottman and Robert Levenson found that greater physiological arousal during couple interactions predicted declines in relationship satisfaction over time. The finding helps explain why attending to arousal matters in couples work: the body’s response can shape how partners interpret and answer one another. (Study; Gottman on stonewalling).

Stonewalling, one of the Gottmans’ Four Horsemen that do relationships in, can emerge when a person feels overwhelmed and withdraws from the conversation. The partner may experience that silence as rejection; the person pulling away may be trying to manage an internal surge of distress. In therapy, we help couples recognize flooding, agree on a respectful time-out, practice self-soothing, and set a time to return to the discussion. A break gives the body room to settle so the couple can try again with more presence.

Anxiety, anger, shame, grief, and depression are lived through both emotion and physiology. Repeated experiences of threat or disconnection can feed familiar patterns in the body and in a relationship. For someone dealing with anxiety in a relationship, anxious attachment may show up as urgently seeking reassurance; avoidant attachment may show up as retreating from the intensity. Betrayal and ruptures of trust can activate attachment systems with particular force. When flooding takes over, it becomes harder to listen, think clearly, or offer a partner the understanding that repair requires.

At Union Station Therapy, we explore these patterns in both individual therapy and couples sessions. In some sessions, we use a pulse oximeter as a simple biofeedback aid: clients can observe their pulse as they notice arousal and practice a calming skill. A pulse oximeter estimates pulse and blood oxygen saturation; we consider the pulse reading alongside the client’s breathing, sensations, and experience. (FDA overview of pulse oximeters).

For couples caught in a high-conflict cycle, I consider a regular mindfulness or meditation practice essential skill-building. Partners need practice noticing activation and finding a way back to steadiness in everyday life, not only during a therapy appointment. We’ll explore how we teach mindfulness and meditation at Union Station Therapy, it desires its own reflection.

Practices and tools to consider alongside therapy

The research is strongest for established treatments such as transcranial magnetic stimulation (TMS) for major depression and structured mindfulness approaches for depression and anxiety. Heart-rate-variability biofeedback has a particularly relevant signal as an addition to psychotherapy. Sauna research is promising, with a small controlled depression study and broader observational findings. For other consumer devices, the evidence is earlier and more uncertain.

A daily foundation: mindfulness and meditation

Mindfulness gives people a way to notice rising arousal before it takes over a conversation. With practice, that pause can make it easier to recognize the urge to criticize, defend, pursue, or withdraw—and choose what to do next. At Union Station Therapy, regular individual practice is an important part of our work with high-conflict couples, particularly when betrayal or attachment fears make conflict feel overwhelming.

A meta-analysis of 21 randomized trials found that mindfulness-based cognitive therapy reduced anxiety and depression symptoms, with improvements generally maintained at follow-up. A separate review of mindfulness interventions for couples found a small effect on relationship satisfaction after outliers were removed, though the authors rated the overall evidence as very low certainty. These findings support regular practice as a useful companion to therapy; they do not establish that a meditation app alone changes a couple’s conflict pattern.

1. TMS: the most established device treatment for depression

Repetitive transcranial magnetic stimulation uses rapidly pulsed magnetic fields to stimulate targeted brain circuits involved in mood. It is a clinician-delivered treatment with a substantial research base and FDA clearance for major depressive disorder. For someone whose depression is affecting daily life and relationships, it may be part of a broader care plan that includes psychotherapy. Austin-area information is available from UT Dell Medicine and Heading Health.

The National Institute of Mental Health notes that research is still examining how rTMS works best alongside psychotherapy or medication. TMS belongs in a clinical conversation about depression, with a qualified provider. (NIMH overview).

For someone whose depression is interfering with energy, concentration, or emotional availability, improvement could make it easier to participate in individual therapy or relationship work. That connection is a clinical inference: TMS research measures depression outcomes, and I did not find studies showing that it improves couples therapy outcomes specifically.

A related at-home option is Flow FL-100, which uses transcranial direct current stimulation (tDCS)—a gentle electrical current, rather than magnetic pulses. The FDA approved it by prescription for adults with moderate-to-severe major depression, alone or alongside medication. It is a medical treatment that requires clinical guidance, not a general-purpose wellness wearable.

2. HRV biofeedback: a practical way to train self-soothing

Heart-rate-variability biofeedback uses a sensor and visual or audio feedback to help a person practice paced breathing. As breathing slows—often to an individually determined rhythm—the intervals between heartbeats shift in a measurable pattern. The feedback helps make that change visible and gives people a way to practice regulating arousal outside the therapy session.

A meta-analysis of 24 studies involving 484 participants found a substantial reduction in self-reported anxiety and stress. A separate meta-analysis of 14 randomized trials, with 794 participants, found a smaller improvement in depressive symptoms. One small randomized study also found greater reductions in depression symptoms and increases in HRV when biofeedback was added to psychotherapy for young women with major depression.

HeartMath Inner Balance is one consumer HRV-biofeedback option. For couples, the potential value is straightforward: practicing regulation between sessions may help partners notice when they are becoming flooded and use a break to settle before returning to a difficult conversation. The psychotherapy study is encouraging, though small; couples-therapy outcomes have not been established.

At Union Station Therapy, we sometimes use a pulse oximeter as a simple in-session biofeedback cue. Clients can watch their pulse rate as they experiment with breathing and self-soothing. A standard pulse oximeter measures pulse and oxygen saturation; it does not provide the beat-to-beat HRV feedback used in HRV biofeedback research.

3. Sauna and heat therapy: an intriguing early signal

Sauna raises body temperature and places a temporary demand on the cardiovascular system. Researchers are also studying how warmth activates sensory pathways that communicate with brain regions involved in mood. The mental-health evidence is promising, though still limited.

In a randomized, sham-controlled trial, 30 adults with major depression received a single medically supervised whole-body hyperthermia treatment or a sham procedure. Depression scores in the active-treatment group were lower than in the sham group across six weeks. This was a small study of a controlled hyperthermia protocol, so it does not establish that ordinary home or commercial sauna sessions will produce the same effect.

A later pilot trial gave both groups eight sessions of cognitive behavioral therapy and assigned them to whole-body hyperthermia or sham heat. Depression symptoms improved in both groups. The study was designed to assess feasibility, not to determine whether heat adds a reliable benefit to CBT, so the additional effect remains an open question.

Sauna is also linked with broader health findings. In a Finnish cohort of 2,315 middle-aged men, sauna use four to seven times per week was associated with a lower observed risk of dementia and Alzheimer’s disease than use once per week. The study was observational and limited to men in Finland; it cannot establish that sauna itself prevented dementia or that the result applies to everyone.

For an Austin example, Perspire Sauna Studio at Hill Country Galleria offers private infrared sauna suites. Sauna may give someone a regular opportunity to rest and decompress, which could support stress recovery and sleep. Applying that benefit to couples work is an inference; the studies above did not measure relationship outcomes. People with health conditions that affect heat tolerance, or who are pregnant, should discuss sauna use with a clinician.

4. Vagus nerve stimulation: promising, with device-specific questions

Consumer vagus nerve stimulation devices apply electrical stimulation at the neck or ear with the aim of influencing vagal pathways and related autonomic activity. A study of Pulsetto enrolled 40 healthy adults, with 37 completing four weeks of use. Participants reported improvements in depression, anxiety, and sleep measures. The study compared unilateral and bilateral stimulation; it did not include a sham group, and Pulsetto funded the research. A review of transcutaneous vagus nerve stimulation trials for depression also found a possible benefit, while rating the evidence low to very low certainty.

Pulsetto could appeal to someone looking for a brief self-soothing routine between therapy sessions. That possibility needs more independent, sham-controlled research, especially in people with diagnosed anxiety or depression. No couples-therapy outcomes have been established.

5. Red and near-infrared light: an emerging area

Photobiomodulation uses visible red or near-infrared light to affect tissue. Some devices are designed for the head, with the aim of delivering light to brain tissue; that is a different intervention from a red-light panel or face mask. The wavelength, dose, and delivery method matter.

A review of 11 randomized trials found an overall reduction in depression symptoms, though the evidence quality ranged from very low to moderate. In a separate sham-controlled trial of 48 people with major depression, a wearable near-infrared headband improved sleep scores, while depression scores did not improve more than with sham. These results make the field interesting and still early. Vielight’s Neuro Duo is one example of a transcranial photobiomodulation product; the research findings should not be assumed to apply to every red-light device or to this product specifically.

If a light-based device improves sleep or mood, it could indirectly help someone bring more attention and patience to therapy. That is a possibility to explore with a clinician, not an established relationship-therapy outcome.

6. SEQEX and PEMF: interesting, with very limited evidence

SEQEX devices use low-frequency electromagnetic fields delivered through a mat and, in the depression study, an additional headband. A preliminary placebo-controlled study included 20 people, with 10 in each group, and reported improvements on depression questionnaires after five sessions. The sample was very small, and independent replication is needed before drawing firm conclusions. SEQEX research and devices and the published study are available for readers who want to examine the protocol.

A calming routine around a device could be useful to someone as a personal practice. Evidence that SEQEX changes depression reliably—or improves individual or couples therapy outcomes—remains limited.

7. Oura Ring: useful for noticing patterns

The Oura Ring tracks measures such as sleep, resting heart rate, and overnight HRV. It can help a person notice whether their sleep or recovery tends to shift during periods of stress. The ring is a monitoring tool; it does not train regulation by itself.

A 10-day randomized study combined an app-based mindfulness program with Oura tracking in 81 healthy adults and found improvements in sleep efficiency and HRV. Participants with diagnosed anxiety or depression were excluded, and the study tested the mindfulness program with wearable tracking—not the therapeutic effect of the ring itself.

For people dealing with anxiety in a relationship, anxious attachment, or avoidant attachment, tracking can invite a useful conversation about sleep and stress patterns. I would use the data to notice trends, rather than to grade a person’s emotional state or relationship.

What we know about pairing these tools with therapy

The clearest direct studies involve HRV biofeedback added to individual psychotherapy for depression and a small CBT-plus-hyperthermia feasibility trial. Couple-focused mindfulness research also suggests a possible improvement in relationship satisfaction, with substantial uncertainty. Research on TMS, sauna, consumer vagus nerve devices, Oura, and SEQEX generally measures individual symptoms or physiology; it has not established that those tools improve marriage counseling or couples-therapy outcomes.

My clinical inference is that a person who practices settling their body between sessions may have more access to listening, curiosity, accountability, and compassion during conflict. That can matter when betrayal or attachment fears activate a threat response, or when one partner pursues and the other withdraws. At Union Station Therapy, we pay close attention to physiology in both individual therapy and couples therapy in Austin. We help partners practice calming skills, take a purposeful break when they are flooded, and return to the conversation when they can engage.

For people searching for relationship therapy in Austin or marriage counseling in Austin, my answer to “what works?” begins with a therapy process that takes physiology seriously.

At Union Station Therapy, we help individuals and couples understand how their bodies respond to threat, practice ways to settle, and bring that awareness into the work of restoring connection. Learn more about couples therapy and marriage counseling in Austin or individual therapy in Austin.