Stephanie Balters
Instructor, Psychiatry and Behavioral Sciences - Interdisciplinary Brain Sciences
Bio
Dr. Stephanie Balters is an instructor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. She is the director of the Empowerment Neuroscience Laboratory and studies how social factors such as interpersonal trauma and cultural biases impact brain function and mental health outcomes. Dr. Balters develops evidence-based interventions to improve well-being, work productivity, and team performance. She is passionate about embracing authenticity, vulnerability, and individual differences, and leveraging adverse experiences towards self-growth and achieving one’s full potential. Dr. Balters holds a Bachelor's and Master's degree in Mechanical Engineering and has earned a Ph.D. in Engineering Design. Her diverse career journey includes experiences at the Center for Design Research and Computer Science at Stanford University before transitioning to the School of Medicine. Dr. Balters is a Human Factors Specialist at NATO and facilitates Empowerment Workshops at Stanford University.
Academic Appointments
Honors & Awards
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Stanford Postdoc JEDI Champion Award (Justice, Equity, Diversity, and Inclusion), Stanford University (2023)
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K99/R00 Pathway to Independence Award, National Institute of Mental Health (NIMH) (2023)
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Stanford Postdoc JEDI Champion Award (Justice, Equity, Diversity, and Inclusion), nominated, Stanford University (2022)
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Jump Start Award for Excellence in Research, Stanford University (2021)
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Postdoctoral Fellowship from the Center for Automotive Research, Stanford University (2019)
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Postdoctoral Fellowship, Norwegian Centres of Expertise (2018)
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Predoctoral Fellowship from the Scandinavian Consortium for Organizational Research, Stanford University (2017)
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Predoctoral Fellowship from the Vice Dean of Education, Norwegian University of Science and Technology (2014)
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Thesis award, Best Master’s Thesis in Automotive Engineering in the Academic year 2012/2013, RWTH Aachen University (2013)
Boards, Advisory Committees, Professional Organizations
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Founding Director, Stanford Women Empowerment Initiative (2022 - Present)
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Peer Review Committee Member, NSF (2020 - Present)
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Women Empowerment Coach, Stanford Grant Writing Academy (2021 - Present)
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Human Factors Specialist, NATO (2019 - Present)
Professional Education
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Postdoc, Stanford University, School of Medicine, Interaction Neuroscience (2021)
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Postdoc, Stanford University, School of Medicine, Precision Health (2019)
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Visiting Researcher, Stanford University, Computer Science, Human Computer Interaction (2017)
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Visiting Researcher, Stanford University, Center for Design Research, Human Machine Interaction (2017)
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Ph.D., NTNU, Mechanical Engineering (2017)
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M.Eng., RWTH Aachen University, Mechanical Engineering and Business Administration (2012)
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B.Eng., RWTH Aachen University, Mechanical Engineering and Business Administration (2008)
All Publications
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A month in review: longitudinal dynamics between daily PTSD symptom networks, affect, and drinking behaviors in female college students
Frontiers in Psychology
2024; 15
View details for DOI 10.3389/fpsyg.2024.1388539
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Neural responses to gender-based microaggressions in academic medicine.
Journal of neuroscience research
2023
Abstract
Gender-based microaggressions have been associated with persistent disparities between women and men in academia. Little is known about the neural mechanisms underlying those often subtle and unintentional yet detrimental behaviors. Here, we assessed the neural responses to gender-based microaggressions in 28 early career faculty in medicine (N = 16 female, N = 12 male sex) using fMRI. Participants watched 33 videos of situations demonstrating gender-based microaggressions and control situations in academic medicine. Video topics had been previously identified through real-life anecdotes about microaggression from women faculty and were scripted and reenacted using professional actors. Primary voxel-wise analyses comparing group differences in activation elucidated a significant group by condition interaction in a right-lateralized cluster across the frontal (inferior and middle frontal gyri, frontal pole, precentral gyrus, postcentral gyrus) and parietal lobes (supramarginal gyrus, angular gyrus). Whereas women faculty exhibited reduced activation in these regions during the microaggression relative to the control condition, the opposite was true for men. Posthoc analyses showed that these patterns were significantly associated with the degree to which participants reported feeling judged for their gender in academic medicine. Lastly, secondary exploratory ROI analyses showed significant between-group differences in the right dorsolateral prefrontal cortex and inferior frontal gyrus. Women activated these two regions less in the microaggression condition compared to the control condition, whereas men did not. These findings indicate that the observation of gender-based microaggressions results in a specific pattern of neural reactivity in women early career faculty.
View details for DOI 10.1002/jnr.25240
View details for PubMedID 37654210
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Virtual (Zoom) Interactions Alter Conversational Behavior and Inter-Brain Coherence.
The Journal of neuroscience : the official journal of the Society for Neuroscience
2023
Abstract
A growing number of social interactions are taking place virtually on video conferencing platforms. Here, we explore potential effects of virtual interactions on observed behavior, subjective experience, and neural "single-brain" and "inter-brain" activity via functional near-infrared spectroscopy (fNIRS) neuroimaging. We scanned a total of 36 human dyads (72 participants, 36 males, 36 females) who engaged in three naturalistic tasks (i.e., problem-solving, creative-innovation, socio-emotional task), in either an in-person or virtual (Zoom®) condition. We also coded cooperative behavior from audio recordings. We observed reduced conversational turn-taking behavior during the virtual condition. Given that conversational turn-taking was associated with other metrics of positive social interaction (e.g., subjective cooperation and task performance), this measure may be an indicator of prosocial interaction. In addition, we observed altered patterns of averaged and dynamic inter-brain coherence in virtual interactions. Inter-brain coherence patterns that were characteristic of the virtual condition were associated with reduced conversational turn-taking. These insights can inform the design and engineering of the next generation of video conferencing technology.Significance StatementVideo conferencing has become an integral part of our lives. Whether this technology impacts behavior and neurobiology is not well understood. We explored potential effects of virtual interaction on social behavior, brain activity, and inter-brain coupling. We found that virtual interactions were characterized by patterns of inter-brain coupling that were negatively implicated in cooperation. Our findings are consistent with the perspective that video conferencing technology adversely affects individuals and dyads during social interaction. As virtual interactions become even more necessary, improving the design of video conferencing technology will be crucial for supporting effective communication.
View details for DOI 10.1523/JNEUROSCI.1401-22.2023
View details for PubMedID 36868852
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Expressing appreciation is linked to interpersonal closeness and inter-brain coherence, both in person and over Zoom.
Cerebral cortex (New York, N.Y. : 1991)
2023
Abstract
Expressing appreciation is essential for establishing interpersonal closeness, but virtual interactions are increasingly common and create social distance. Little is known about the neural and inter-brain correlates of expressing appreciation and the potential effects of virtual videoconferencing on this kind of interaction. Here, we assess inter-brain coherence with functional near-infrared spectroscopy while dyads expressed appreciation to one another. We scanned 36 dyads (72 participants) who interacted in either an in-person or virtual (Zoom) condition. Participants reported on their subjective experience of interpersonal closeness. As predicted, expressing appreciation increased interpersonal closeness between dyad partners. Relative to 3 other cooperation tasks (i.e. problem-solving task, creative-innovation task, socio-emotional task), we observed increased inter-brain coherence in socio-cognitive areas of the cortex (anterior frontopolar area, inferior frontal gyrus, premotor cortex, middle temporal gyrus, supramarginal gyrus, and visual association cortex) during the appreciation task. Increased inter-brain coherence in socio-cognitive areas during the appreciation task was associated with increased interpersonal closeness. These findings support the perspective that expressing appreciation, both in-person and virtually, increases subjective and neural metrics of interpersonal closeness.
View details for DOI 10.1093/cercor/bhad032
View details for PubMedID 36848244
- A Neuroscience Approach to Women Entrepreneurs’ Pitch Performance: Impact of Inter-Brain Synchrony on Investment Decisions Design Thinking Research Springer. 2023
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Design science and neuroscience: A systematic review of the emergent field of Design Neurocognition
DESIGN STUDIES
2023; 84
View details for DOI 10.1016/j.destud.2022.101148
View details for Web of Science ID 000914428800002
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Current opinions on the present and future use of functional near-infrared spectroscopy in psychiatry.
Neurophotonics
2023; 10 (1): 013505
Abstract
Functional near-infrared spectroscopy (fNIRS) is an optical imaging technique for assessing human brain activity by noninvasively measuring the fluctuation of cerebral oxygenated- and deoxygenated-hemoglobin concentrations associated with neuronal activity. Owing to its superior mobility, low cost, and good tolerance for motion, the past few decades have witnessed a rapid increase in the research and clinical use of fNIRS in a variety of psychiatric disorders. In this perspective article, we first briefly summarize the state-of-the-art concerning fNIRS research in psychiatry. In particular, we highlight the diverse applications of fNIRS in psychiatric research, the advanced development of fNIRS instruments, and novel fNIRS study designs for exploring brain activity associated with psychiatric disorders. We then discuss some of the open challenges and share our perspectives on the future of fNIRS in psychiatric research and clinical practice. We conclude that fNIRS holds promise for becoming a useful tool in clinical psychiatric settings with respect to developing closed-loop systems and improving individualized treatments and diagnostics.
View details for DOI 10.1117/1.NPh.10.1.013505
View details for PubMedID 36777700
View details for PubMedCentralID PMC9904322
- Priming Activity to Increase Interpersonal Closeness, Inter-brain Coherence, and Team Creativity Outcome Design Thinking Research Springer. 2023
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Conflicting spatial representations impairs object tracking performance in an aerospace environment
INTERNATIONAL JOURNAL OF HUMAN-COMPUTER STUDIES
2022; 167
View details for DOI 10.1016/j.ijhcs.2022.102883
View details for Web of Science ID 000835091100005
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Cortical activation predicts posttraumatic improvement in youth treated with TF-CBT or CCT.
Journal of psychiatric research
2022; 156: 25-35
Abstract
BACKGROUND: Identifying neural activation patterns that predict youths' treatment response may aid in the development of imaging-based assessment of emotion dysregulation following trauma and foster tailored intervention. Changes in cortical hemodynamic activity measured with functional near-infrared spectroscopy (fNIRS) may provide a time and cost-effective option for such work. We examined youths' PTSD symptom change following treatment and tested if previously identified activation patterns would predict treatment response.METHODS: Youth (N=73, mean age=12.97, SD=3.09 years) were randomly assigned to trauma-focused cognitive behavioral therapy (TF-CBT), cue-centered therapy (CCT), or treatment as usual (TAU). Parents and youth reported on youth's PTSD symptoms at pre-intervention, post-intervention, and follow-up. Neuroimaging data (N=31) assessed at pre-intervention were obtained while youth engaged in an emotion expression task. Treatment response slopes were calculated for youth's PTSD symptoms.RESULTS: Overall, PTSD symptoms decreased from pre-intervention through follow-up across conditions, with some evidence of relative benefit of TF-CBT and CCT over TAU but significant individual variation in treatment response. Cortical activation patterns were correlated with PTSD symptom improvement slopes (r=0.53). In particular, cortical responses to fearful and neutral facial stimuli in six fNIRS channels in the bilateral dlPFC were important predictors of PTSD symptom improvement.CONCLUSIONS: The use of fNIRS provides a method of monitoring and assessing cortical activation patterns in a relatively inexpensive and portable manner. Associations between functional activation and youths' PTSD symptoms improvement may be a promising avenue for understanding emotion dysregulation in clinical populations.
View details for DOI 10.1016/j.jpsychires.2022.10.002
View details for PubMedID 36228389
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Towards assessing subcortical "deep brain" biomarkers of PTSD with functional near-infrared spectroscopy.
Cerebral cortex (New York, N.Y. : 1991)
2022
Abstract
Assessment of brain function with functional near-infrared spectroscopy (fNIRS) is limited to the outer regions of the cortex. Previously, we demonstrated the feasibility of inferring activity in subcortical "deep brain" regions using cortical functional magnetic resonance imaging (fMRI) and fNIRS activity in healthy adults. Access to subcortical regions subserving emotion and arousal using affordable and portable fNIRS is likely to be transformative for clinical diagnostic and treatment planning. Here, we validate the feasibility of inferring activity in subcortical regions that are central to the pathophysiology of posttraumatic stress disorder (PTSD; i.e. amygdala and hippocampus) using cortical fMRI and simulated fNIRS activity in a sample of adolescents diagnosed with PTSD (N=20, mean age=15.3±1.9years) and age-matched healthy controls (N=20, mean age=14.5±2.0years) as they performed a facial expression task. We tested different prediction models, including linear regression, a multilayer perceptron neural network, and a k-nearest neighbors model. Inference of subcortical fMRI activity with cortical fMRI showed high prediction performance for the amygdala (r>0.91) and hippocampus (r>0.95) in both groups. Using fNIRS simulated data, relatively high prediction performance for deep brain regions was maintained in healthy controls (r>0.79), as well as in youths with PTSD (r>0.75). The linear regression and neural network models provided the best predictions.
View details for DOI 10.1093/cercor/bhac320
View details for PubMedID 36066436
- Interpersonal Trust Activity to Increase Team Creativity Outcome: An fNIRS Hyperscanning Approach. In Design Thinking Research. Springer. 2022
- The NATO Guidebook for Human Experimentation with Unmanned Aerial Systems NATO Headquarters. 2022
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Functional near-infrared spectroscopy brain imaging predicts symptom severity in youth exposed to traumatic stress.
Journal of psychiatric research
2021; 144: 494-502
Abstract
Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with the potential to enable the assessment of posttraumatic stress disorder (PTSD) brain biomarkers in an affordable and portable manner. Consistent with biological models of PTSD, functional magnetic resonance imaging (fMRI) and fNIRS studies of adults with trauma exposure and PTSD symptoms suggest increased activation in the dorsolateral prefrontal cortex (dlPFC) and ventrolateral PFC (vlPFC) in response to negative emotion stimuli. We tested this theory with fNIRS assessment among youth exposed to traumatic stress and experiencing PTSD symptoms (PTSS). A portable fNIRS system collected hemodynamic responses from (N=57) youth with PTSS when engaging in a classic emotion expression task that included fearful and neutral faces stimuli. The General Linear Model was applied to identify cortical activations associated with the facial stimuli. Subsequently, a prediction model was established via a Support Vector Regression to determine whether PTSS severity could be predicted based on fNIRS-derived cortical response measures and individual demographic information. Results were consistent with findings from adult fMRI and fNIRS studies of PTSS showing increased activation in the dlPFC and vlPFC in response to negative emotion stimuli. Subsequent prediction analysis revealed ten features (i.e., cortical responses from eight frontocortical fNIRS channels, age and sex) strongly correlated with PTSS severity (r=0.65, p<.001). Our findings suggest the potential utility of fNIRS as a portable tool for the detection of putative PTSS brain biomarkers.
View details for DOI 10.1016/j.jpsychires.2021.10.020
View details for PubMedID 34768071
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Individualized stress detection using an unmodified car steering wheel.
Scientific reports
2021; 11 (1): 20646
Abstract
In-car passive stress sensing could enable the monitoring of stress biomarkers while driving and reach millions of commuters daily (i.e., 123 million daily commuters in the US alone). Here, we present a nonintrusive method to detect stress solely from steering angle data of a regular car. The method uses inverse filtering to convert angular movement data into a biomechanical Mass Spring Damper model of the arm and extracts its damped natural frequency as an approximation of muscle stiffness, which in turn reflects stress. We ran a within-subject study (N=22), in which commuters drove a vehicle around a closed circuit in both stress and calm conditions. As hypothesized, cohort analysis revealed a significantly higher damped natural frequency for the stress condition (P=.023, d=0.723). Subsequent automation of the method achieved rapid (i.e., within 8 turns) stress detection in the individual with a detection accuracy of 77%.
View details for DOI 10.1038/s41598-021-00062-7
View details for PubMedID 34667184
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Dynamic Inter-Brain Synchrony in Real-life Inter-Personal Cooperation: A Functional Near-infrared Spectroscopy Hyperscanning Study.
NeuroImage
2021: 118263
Abstract
How two brains communicate with each other during social interaction is highly dynamic and complex. Multi-person (i.e., hyperscanning) studies to date have focused on analyzing the entire time series of brain signals to reveal an overall pattern of inter-brain synchrony (IBS). However, this approach does not account for the dynamic nature of social interaction. In the present study, we propose a data-driven approach based on sliding windows and k-mean clustering to capture the dynamic modulation of IBS patterns during interactive cooperation tasks. We used a portable functional near-infrared spectroscopy (fNIRS) system to measure brain hemodynamic response between interacting partners (20 dyads) engaged in a creative design task and a 3D model building task. Results indicated that inter-personal communication during naturalistic cooperation generally presented with a series of dynamic IBS states along the tasks. Compared to the model building task, the creative design task appeared to involve more complex and active IBS between multiple regions in specific dynamic IBS states. In summary, the proposed approach stands as a promising tool to distill complex inter-brain dynamics associated with social interaction into a set of representative brain states with more fine-grained temporal resolution. This approach holds promise for advancing our current understanding of the dynamic nature of neurocognitive processes underlying social interaction.
View details for DOI 10.1016/j.neuroimage.2021.118263
View details for PubMedID 34126210
- Inter-Brain Synchrony and Innovation in a Zoom World Using Analog and Digital Manipulatives Design Thinking Research Springer. 2021
- The NATO Human-System Integration Guidebook NATO Headquarters. 2021
- Inter-brain Synchrony and Innovation in a Zoom World Using Analog and Digital Manipulatives. In Design Thinking Research. Springer. 2021
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A Methodological Review of fNIRS in Driving Research: Relevance to the Future of Autonomous Vehicles.
Frontiers in human neuroscience
2021; 15: 637589
Abstract
As automobile manufacturers have begun to design, engineer, and test autonomous driving systems of the future, brain imaging with functional near-infrared spectroscopy (fNIRS) can provide unique insights about cognitive processes associated with evolving levels of autonomy implemented in the automobile. Modern fNIRS devices provide a portable, relatively affordable, and robust form of functional neuroimaging that allows researchers to investigate brain function in real-world environments. The trend toward "naturalistic neuroscience" is evident in the growing number of studies that leverage the methodological flexibility of fNIRS, and in doing so, significantly expand the scope of cognitive function that is accessible to observation via functional brain imaging (i.e., from the simulator to on-road scenarios). While more than a decade's worth of study in this field of fNIRS driving research has led to many interesting findings, the number of studies applying fNIRS during autonomous modes of operation is limited. To support future research that directly addresses this lack in autonomous driving research with fNIRS, we argue that a cogent distillation of the methods used to date will help facilitate and streamline this research of tomorrow. To that end, here we provide a methodological review of the existing fNIRS driving research, with the overarching goal of highlighting the current diversity in methodological approaches. We argue that standardization of these approaches will facilitate greater overlap of methods by researchers from all disciplines, which will, in-turn, allow for meta-analysis of future results. We conclude by providing recommendations for advancing the use of such fNIRS technology in furthering understanding the adoption of safe autonomous vehicle technology.
View details for DOI 10.3389/fnhum.2021.637589
View details for PubMedID 33967721
- Dyadic Sex Composition and Task Classification Using fNIRS Hyperscanning Data 20th IEEE International Conference on Machine Learning and Applications (ICMLA) 2021
- Unobtrusive stress sensing via a commercial steering wheel. Scientific Reports 2021
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Capturing Human Interaction in the Virtual Age: A Perspective on the Future of fNIRS Hyperscanning
FRONTIERS IN HUMAN NEUROSCIENCE
2020; 14: 588494
Abstract
Advances in video conferencing capabilities combined with dramatic socio-dynamic shifts brought about by COVID-19, have redefined the ways in which humans interact in modern society. From business meetings to medical exams, or from classroom instruction to yoga class, virtual interfacing has permeated nearly every aspect of our daily lives. A seemingly endless stream of technological advances combined with our newfound reliance on virtual interfacing makes it likely that humans will continue to use this modern form of social interaction into the future. However, emergent evidence suggests that virtual interfacing may not be equivalent to face-to-face interactions. Ultimately, too little is currently understood about the mechanisms that underlie human interactions over the virtual divide, including how these mechanisms differ from traditional face-to-face interaction. Here, we propose functional near-infrared spectroscopy (fNIRS) hyperscanning-simultaneous measurement of two or more brains-as an optimal approach to quantify potential neurocognitive differences between virtual and in-person interactions. We argue that increased focus on this understudied domain will help elucidate the reasons why virtual conferencing doesn't always stack up to in-person meetings and will also serve to spur new technologies designed to improve the virtual interaction experience. On the basis of existing fNIRS hyperscanning literature, we highlight the current gaps in research regarding virtual interactions. Furthermore, we provide insight into current hurdles regarding fNIRS hyperscanning hardware and methodology that should be addressed in order to shed light on this newly critical element of everyday life.
View details for DOI 10.3389/fnhum.2020.588494
View details for Web of Science ID 000589689700001
View details for PubMedID 33240067
View details for PubMedCentralID PMC7669622
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Functional Near-Infrared Spectroscopy (fNIRS) in an Aerospace Environment: Challenges and Considerations
AEROSPACE MEDICINE AND HUMAN PERFORMANCE
2020; 91 (10): 833–35
View details for DOI 10.3357/AMHP.5723.2020
View details for Web of Science ID 000576377300011
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Mayday, Mayday, Mayday: Using salivary cortisol to detect distress (and eustress!) in critical incident training
INTERNATIONAL JOURNAL OF INDUSTRIAL ERGONOMICS
2020; 78
View details for DOI 10.1016/j.ergon.2020.102975
View details for Web of Science ID 000551530500012
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Calm Commute: Guided Slow Breathing for Daily Stress Management in Drivers
Interactive, Mobile, Wireless, Ubiquitous Technologies
2020
View details for DOI 10.1145/3380998
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Back to School: Impact of Training on Driver Behavior and State in Autonomous Vehicles
IEEE. 2020: 1189-1196
View details for Web of Science ID 000653124200178
- The Neuroscience of Team Cooperation versus Team Collaboration Design Thinking Research Springer. 2020
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On-road Guided Slow Breathing Interventions for Car Commuters
ASSOC COMPUTING MACHINERY. 2019
View details for DOI 10.1145/3290607.3312785
View details for Web of Science ID 000482042102073
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On-road Stress Analysis for In-car Interventions During The Commute
ASSOC COMPUTING MACHINERY. 2019
View details for DOI 10.1145/3290607.3312824
View details for Web of Science ID 000482042102072
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Breath Booster! Exploring In-Car, Fast-Paced Breathing Interventions to Enhance Driver Arousal State
ASSOC COMPUTING MACHINERY. 2018: 128-137
View details for DOI 10.1145/3240925.3240939
View details for Web of Science ID 000614057600015
- Just Breathe: In-Car Interventions for Guided Slow Breathing Journal of ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies 2018
- Driving with the Fishes: Towards Calming and Mindful Virtual Reality Experiences for the Car Journal of ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies 2018
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Capturing emotion reactivity through physiology measurement as a foundation for affective engineering in engineering design science and engineering practices
JOURNAL OF INTELLIGENT MANUFACTURING
2017; 28 (7): 1585-1607
View details for DOI 10.1007/s10845-015-1145-2
View details for Web of Science ID 000411158400007
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Learning-by-Doing: Using Near Infrared Spectroscopy to Detect Habituation and Adaptation in Automated Driving
ASSOC COMPUTING MACHINERY. 2017: 134-143
View details for DOI 10.1145/3122986.3123006
View details for Web of Science ID 000414279600016
- Towards New Affect Integrated Interaction Design: Papers on Theory, Instrument, and Context of Affective Engineering. Doctoral Thesis. Norwegian University of Science and Technology 2017
- Assessing Driver Cortical Activity during Varying Levels of Automation with Functional Near Infrared Spectroscopy 2017
- Smell – Forgotten yet Critical Dimension in Product Development? 2016
- Introducing the Wayfaring Approach for the Development of Human Experiments in Interaction Design and Engineering Design Science 2016
- Experimental studies in interaction design and engineering design science - a repository for experiment setups. 2016
- Impact of road- and vehicle-related parameters on the energy efficiency of hybrid city buses. International Journal of Electric and Hybrid Vehicles 2015
- Photography - A New Tool in Needfinding. 2015
- Distributed Experiments in Design Sciences, A Next Step in Design Observation Studies? 2015
- Measuring Prototypes – A Standardized Quantitative Description of Prototypes and their Outcome for Data Collection and Analysis. 2015
- Physiology and sensorial based quantification of human-object interaction - the QOSI matrix. 2015
- Physiological Data Acquisition for Deeper Insights into Prototyping. 2014
- Decision-Making in engineering—A call for affective engineering dimensions in applied engineering design and design sciences. 2014