So welcome everyone my name is Ellie Burgess I'm a fourth-year PhD Candidate
In the Media, Technology and Society program here at Northwestern and today
I'll be presenting on research conducted alongside Jordan Eschler, formerly a
Postdoc here at Northwestern, and advised by professors Madhu
Reddy and David Mohr, both professors here at Northwestern. So as many of you
may seen, mental health has been a hot topic of discussion during this pandemic. For
instance, for individuals managing depression, day to day mental health
routines have been significantly disrupted. And in this space, technology-
mediated forms of care like telemedicine and also using social media or other
digital technologies to connect with loved ones have really come to the
forefront. But this raises the longer-running question around 'what are the effects
of digital technologies on mental health?' For digital mental health
researchers, they've long viewed technology as a positive avenue to expand coverage
to people who couldn't access it otherwise and to support day-to-day
mental health management often from a smartphone this fits in your pocket.
However, where a lot of this research focuses is on a single platforms. So, the
benefits and and cons of one app or one online community, when in fact that's not
really how people use technologies day-to-day. People use all sorts of technologies,
often simultaneously. And so, for our population of individuals managing
depression, we want to know how they made decisions about their technology use
across the variety of technologies they use in everyday life and our research
objectives and doing this was to understand participants' lived
experiences both positive and negative around their technology use and mental
health management.
To understand participants' reflections and behaviors we use the theory of
self-regulation from psychology which Straumann defines as a process of
improving cognitive, emotional, and behavioral habits for individuals
managing depression, and the key here is the focus on first reflecting on behaviors
and thoughts and then creating short and long term personal goals within these
three areas. To understand people's reflections and behaviors we carried out
semi-structured interviews with 30 participants who had diagnosed
depression between the ages of 18 and 72. All participants lived in a large
city in the U.S. Midwest and once we'd collected the data we analyzed it through
the thematic analysis process. So what did we find? Well, firstly we found that
people used all sorts of technology as part of their mental health
self-management. About 50% of our participants used apps that were
specifically developed for mental health management, things like the meditation apps
Calm and Headspace. But also, we saw tons of other technologies that are part of
people's mental health management process. Things like games and TV, texting,
music -- you name it! And so from these diversity of technologies we saw that
people were using them in three main ways. The first was around cognitive
self-regulation and so this was how participants began to think about their
technology use, and how they use technology to address their negative thought
patterns and secondly people discussed emotional self-regulation
which is participants' work to formulate and or maintain healthier emotional
states related to their technology use, and thirdly, people also described behavioral
self-regulation in our study which were their efforts to design new behavioral
habits around technology use, and I'll spend the rest of the findings digging
into each of these three categories. So firstly people described over time
realizing that sometimes when they used technology it negatively influenced their
mental health, and so this was particularly around passive use or consumption of
technology. This looked like endlessly scrolling through social media or
sitting down and watching tons of TV for a whole day and when participants used
technologies in these ways, for instance, social media, this could amplify their
feelings of being separate or different from others; would often create pressure
to show continual achievement; made people feel lonely or feel like they're
missing out; and all those people reflected on these processes over time
many people came to realize that it was wasting their time that they would
rather spend on more enriching activities. P19 speaks to this. She realized over time
that she's going on Facebook when it would have been more beneficial for her to
do some exercise and she says, "but on the whole also so much better to exercise
versus go on Facebook. Sometimes it's hard to give up this short-term pleasure
for a longer-term pleasure." And so over time she's realized that, you know, in
thinking and reflecting on her technology use, that there things that she would rather
do instead of scrolling through Facebook. And for participants once they realized
that they were falling into these negative patterns they began to find
creative ways to break them and people did this primarily through becoming more
intentional about how they're using technology, and there are two main strategies to do
this. The first was limiting or controlling access to certain technology
platforms also known as 'keeping the bad out' and secondly, through seeking
positive content, or 'inviting the good in.' As an example of limiting or
controlling access, a number of participants were using Snapchat and
found that over time it actually caused a lot of anxiety because they see amazing
cool things their friends are posting constantly when they were suffering with
motivation and energy issues. And so for these participants they often carried
out a blunt approach -- simply deleting the technology. Other people would delete
a technology off of their phone but would still log in every now and then on
their browser, and this made it a little bit harder to
access the platform day to day. Finally, some participants even if they wanted to
get off of a technology found that for different reasons that they couldn't. So
for instance one participant was a sorority president and she described how
she needed to be on Facebook for sorority business so what she did was she
created other strategies like only spending one hour per day on Facebook
and only using it for the purposes of sorority business. Other people take a
different approach, really trying to re-frame what they were seeing on social
media platforms and so for P18, he described going and finding pages that
posted cute animals and motivational sayings, saying, "you find these little
gold mines, you follow them, like them and you get postings from them on a regular
basis." Through this process, he completely reconfigured what would have
been his off-the-shelf Facebook experience which would have been mostly
content from his friends and instead filled it with content that he thought
better supported his mental health. Now, in addition to these cognitive
self-regulation findings people also use technology as part of their emotional
self-regulation and people describe primarily using technology in this way
as a mental reset. As an example P02 describes how when she
gets frustrated at work she'll "take two minutes take a break, look at something
else -- laugh at a kitten video or something, and then get back to what I
was doing," and so what's key about this activity versus that passive scrolling
behavior that we saw earlier was that use as a mental reset was an
intentional discrete choice to prevent or to halt the negative mood. People
often would watch one video or one show to help transition activities or to
relax. People also used music for this purpose or
would go on online support groups to also help kind of stop that negative
mood in its tracks and then carry on with their goals for the rest of the day.
Finally, people also used technology as part of their behavioral
self-regulation. And what's really interesting is that participants
described using general use technologies and this looks like technologies that
weren't developed for the purposes of mental health management but they're
appropriating them for those purposes so as a part of planning,
participants described using calendar apps to plan out their social engagement
throughout the week so that they had some social engagement but not too much
to feel overwhelmed. Regarding tracking behaviors they found a really
creative use from P21 who's an artist and posts a lot on Instagram. She said,
you know I could "go back and see the different moods or times of my life
going on based on my artwork," so in this way, P21 is showing us a really creative use
of a platform not developed for a mood tracking but she's able to use it for
that purpose as part of her mental health management. So what have we
learned? First we learned the importance of intentional technology use.
And this looks like a process where first people began to consider how the
ways they were using technologies might be influencing their mental health and
then over time people began to monitor and creatively adjust their technology use.
Now what's important to remember here is that not everybody is at the same place
in this process. Some participants we talk to were just beginning to think
about how their technology and their mental health self-management might be
intersecting, and other people had been thinking about this for years and had
many different strategies for this management so people could be at any
point in this process. One important thing regarding implications for design
that we want to drive home is the reality that for our participants who are
managing depression, they did not necessarily have a positive view of
technology. In fact, many of our participants viewed their smartphones as
a temptation or a trap and so as digital mental health designers we need to have
a self-awareness that the mode of intervention -- in our case technology -- can
be a part of the problem and a part of the solution. However, one way that we
might move forward is to be able to use some of what we've learned about
self-regulation theory in our design of future digital mental health technologies.
For some concrete examples of how we might do this we're thinking
about perhaps integrating reflection exercises to help users understand their
cycle of using technology, their thoughts, and their mood. We're already seeing
things like Facebook's developed a dashboard we can see how long you're
spending on various technologies. We think this is a really great first step in
being intentional and reflective about the technologies that we're using day to
day. A particular example of how we could maybe prompt reflection is to have
participants rate the effects of apps on their mood and can reflect on both the
positive and negative perceived effects of using these
technologies. And secondly. once people have reflected, this is an a great
opportunity to set new goals for technology use. So some examples of goals
that we heard in our study are things like "Use Snapchat less" or "Build
a support network." Creating goals is one great step but also we know from
our study that is many participants need different strategies to reach these
technology goals and so we want to support designers and users
in trying out different strategies based on their need, preferences, and
abilities. Finally, this is a lot of reflection work to ask users to do
themselves and so we see a huge opportunity to discuss technology use
within formal mental health care. Of our
30 participants, we only had one person who talked about technology is
with their therapist and everybody else despite spending a lot of time on
these online interactions didn't talk about it at all so we think that within
formal mental healthcare is a great opportunity to reflect on technology use
and also to set new goals. And so, in conclusion, our work highlights the
creative work of individuals managing depression as they reflect on and make
adjustments to their technology use to manage their mental health. Secondly, we show that
active intentional use of a diversity of technologies could enable participants
to reach new goals. And finally, regarding future design and education, we support
solutions that empower people living with depression to be thoughtful and to
create their own goals about technology and social media use. And with that, if
you'd like to read a blog post or the full paper please see my Twitter. We just
posted both of those and thanks to our participants and our reviewers. I'll open
for questions.