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Axis ER · ER — Emotional Resilience

Stress isn't a feeling. It's a measurement.

Mood scales are 100 years old and the technology hasn't improved. We blend HRV, voice prosody, sleep architecture, sentiment of journal entries, and weekly self-report into a single resilience score — one that picks up burnout 3 weeks before the patient does.

Symbol
ER
Equation role
ER
Signals counted
8+ measured
Update cadence
Daily · auto
01What we measure

Emotional regulation and recovery — pairs with relational support to form the third base of the equation.

Eighteen signals spanning autonomic state, voice tone, written sentiment, and self-report. The first three are passive; the fourth is a 30-second weekly check-in.

Wearable · daily
HRV during waking hours
Stress proxy. Continuous decline triggers an ER drop.
Phone calls · opt-in
Voice prosody (pitch, energy, jitter)
Emotional state from voice. Local-only ML; raw audio never leaves device.
Wearable · nightly
Sleep onset latency
Long latencies correlate strongly with rumination.
Patient app · daily
Journal sentiment
On-device LLM scores tone. Text never leaves the phone.
Patient app · weekly
Weekly mood self-report
PHQ-2 + WHO-5 short form, rotated.
Optional · saliva test
Cortisol awakening response
Available for chronic-stress cohorts.
Wearable · continuous
Heart rate during stressors
Reactivity and recovery time.
Phone passive
Activity disruption flags
Sudden withdrawal from routine — a depression early sign.
02How we score it

From signals to a single value.

Each signal contributes a weighted partial score. The axis aggregates them and clamps to 0–100. Here's a worked example for a real (anonymized) patient on this axis today:

Sample contribution

Waking HRV (62ms — green)+1.6
Sleep onset (12 min — green)+1.2
Journal sentiment (+0.34, 30d trend)+1.0
WHO-5 (76/100)+1.4
Stress reactivity recovery (3 min)+0.8
No activity-withdrawal flag+0.5
Voice prosody stable+0.6
ER axis 76.8 / 100

Where it lands in CH

In the equation, (ER × RS)C/3 is the resilience base. With ER=76.8, RS=68, C=2.1, this term contributes ~17.4 weighted points — and prevents the entire CH score from collapsing during a stressful month.

CH = (S × Sp)C × (T + E)p × (ER × RS)C/3

ER — Emotional Resilience

03A week on this axis

A typical week, on the axis.

No single day defines you. A consistent week does. Here's what consistent looks like — and the HCR you'd earn for it.

MON
Mood check-in (30 sec)
+0.1 HCR
TUE
Breath protocol · 10 min
+0.2 HCR
WED
Journal entry (any length)
+0.2 HCR
THU
Outdoor walk · 30+ min
+0.2 HCR
FRI
Connect with someone (RS link)
+0.3 HCR
SAT
Recovery activity
+0.2 HCR
SUN
Reflection / planning
+0.2 HCR
04How patients earn HCR here

The pay ladder.

ER pays for both maintenance and recovery. The biggest payouts are for patients climbing out of clinical depression or burnout, verified by sustained signal change. Always free to receive — patients never pay to earn HCR, and clinics never see a bill for hosting it.

Verified action
Pays
Frequency
Daily mood check-in
0.10 HCR
daily
Breath protocol completed
0.20 HCR
daily
Sleep onset <20 min, 5/wk
0.50 HCR
weekly
WHO-5 score climbing 4 weeks
2.00 HCR
monthly
PHQ-9 reduction ≥5 (verified)
20.00 HCR
2/yr
Off SSRI · sustained ER 6mo
80.00 HCR
1/lifetime
Burnout recovery (sustained 6mo)
40.00 HCR
1/yr

All payouts settle to the patient's HCR wallet within 24 hours of verification. HCR is redeemable for care, contributions to a Conceptual Health pharmacy account, or held as a long-term reserve.

05The clinical protocol

For providers ordering on this axis.

For Conceptual Health-credentialed clinicians: this is the recommended order-of-operations on this axis. Free to use, no certification required, no software to install — the protocol lives inside the EHR you already use through us.

Emotional Resilience · clinical sequence

  1. Open the ER panel. Look at the rolling 90-day curve, not the spot value.
  2. A flat-line curve is rarely good. ER should breathe — high variability is healthy adaptation.
  3. Look at the joint trace with NM — combined drops are the burnout signature.
  4. Order: a structured talk-therapy referral, a sleep protocol, an activity prescription, or a medication review. All four work; the axis tells you which is moving the needle.
  5. Re-evaluate at 6 weeks. ER moves faster than PO — meaningful change is visible inside one cycle.
06The literature

The peer-reviewed evidence base.

Every signal we score has a literature trail. These are the foundational papers we cite in our scoring model documentation. Our full bibliography (404 references) is available in the methodology appendix.

HRV biomarkers in major depression
Biological Psychiatry · 2018 · n=1,932
Voice biomarkers for depression detection
NPJ Digital Med · 2023 · n=720
Sleep onset latency and rumination
Sleep Med Rev · 2019 · k=27 studies
Digital phenotyping for mood disorders
Lancet Psychiatry · 2022 · n=4,500
WHO-5 validation across populations
Psychother Psychosom · 2015 · k=213 studies
Brief breathwork and acute stress
Cell Reports Medicine · 2023 · n=108

Read the full methodology paper →

07A patient on this axis

One real (anonymized) trajectory.

Names changed. Numbers verified. A composite from three patients with similar starting conditions — the chart, the intervention, and the outcome.

P

Priya S., 34, Brooklyn

Postpartum · ER 38 · PHQ-9 of 18

"My OB said I was depressed but my chart said I was recovering. The ER axis showed me what I couldn't feel: my HRV was climbing, my journal sentiment was lifting. Two months later I felt it too."

38 → 71
ER axis
18 → 4
PHQ-9
+22ms
Waking HRV
108 HCR
Earned
08For researchers

What you can study, and how.

ER is co-managed with mental health domains. Voice and journal text NEVER leave the device. Researchers receive only derived scores, never raw content. Research access is available to credentialed institutions through the HCC research portal — pay-per-query, patient revenue-shared.

ER axis · de-identified data fields

All fields below are time-aligned and de-identified to NIST 800-53 standards.

er.hrv.waking.dailytime series · float
er.sleep.onset.nightlytime series · int
er.journal.sentimenttime series · float [-1,1]
er.who5.weeklytime series · int
er.phq2.weeklytime series · int
er.voice.prosodytime series · object (consent)
er.stress.reactivityevent · float
er.score.dailytime series · float
er.delta.monthlytime series · float

Apply for research access →

09Standards we conform to

Standards we conform to.

No new yardsticks. We map every signal on this axis to existing peer-reviewed instruments and regulatory norms — the same instruments your clinician learned in residency.

Standard

PHQ-9 / GAD-7

Standard depression and anxiety screening instruments.

Standard

WHO-5

WHO Five Well-Being Index, validated across 30+ languages.

Standard

APA Clinical

Clinical reference ranges follow APA practice guidelines.

Standard

HIPAA · 42 CFR Part 2

Mental health data handled under enhanced confidentiality.

Standard

On-device ML

Voice and text inference is local-only; no audio or raw text leaves device.

Track Emotional on the only chart that pays you.

Open Guardian Orb, connect your wearables, and watch this axis update daily. Free for patients, free for clinics, free for providers — forever. No subscription, no per-seat fee, no credit card.

The other seven axes

Eight axes. One score. Each pulls.

Health is multi-dimensional. ER is one of eight. The Master Equation weights them, multiplies them, and gives you and your clinician a single number — and the ability to see exactly which axis is moving it.