Our work involves the development and testing of a standalone app for people with depression and I would
like to motivate in the first couple of slides why this work is important and how we approach to solve this
and lastly the results from our interviews with the patient who use this app
so first depression is the leading cause, worldwide, of disease burden both on
a societal level with the loss of workdays but also on a more personal level where you
start to like cancel your appointment with friends or simply lose the energy for
trivial tasks such as cooking and the thing is that actually one out
of five will experience a depressive episode which make this
disorder most likely to have influenced all of us
either directly or indirectly so these patients are mostly treated with medicine
it is easily acquired but it is associated with severe side effects
and alternatively or in combination you can be enrolled in psychotherapy
with a therapist. There is no side effects with that and its proven to be as
effective as medicine but it requires trained clinical staff and is very time consuming
it has a high cost for the clinic but more severely it has low accessibility
particularly in rural areas and I have underlined accessibility here because of our
current situation with the corona outbreak which makes 1-to-1 meetings
with the staff even more difficult. One particular subtype of therapy is called
Behavioral Activation. It has proven very effective. In Behavioral Activation the patient together with the therapist they plan and schedule concrete doable activities that will drive the patient..
well back to life with
positive rewarding behavior and they basically made such a plan on paper and the patience is told
just to follow this and to support Behavioral Activation Lewinsohn back in 1972 he developed
the Pleasant Event Schedule which is a list of 320 pleasurable activities which the patient could
pick from and do one a weekly basis and as Behavioral Activation is very straightforward method
which is only centered around activities, it carries a lot of potential to be embedded in a mobile application
and with a mobile application we could eliminate some of those
previously mentioned accessibility issues and actually provide a
quality of care which can be scaled indefinate. So the main goal for our study here
was to develop such a Behavioral Activation app. As a unique feature for this app was to include recommendations
which could introduce novel activities that are personalized to the individual user - mimicking
the role of the therapist when they suggest activities together. So our approach started
with bi-weekly meeting with an interdisciplinary team of clinicians mostly and us from a
more engineering part and HCI designers, and we set up workshops with patients. In this presentation
I would like to emphasize on one outcome from the workshops which involved the UX design part of the recommender part of the system
the patients raised two concerns. First - they are aware
they are conscious about their clinical disorder - but there are not fond of tools, digital life tools
that stigmatize their.. or somewhat display special needs. In this case, with an app that literally tells them what to do, it is, unfortunately, the case
secondly, they expressed strong concern of the types of feelings that could be induced if they were unable to commit
or engage in whatever kind of recommendation that the app was giving them, and it could potentially have a harmfull effect of course
With this in mind - We developed the app. I show here some simple screenshots from it
In the first, we see the main overview that the patient see which includes their planned activities divided in
morning afternoon and evening and with this plus sign they can go in and
actively pick a recommendation that is given to them. When they press we will give them recommendations and we list top 10
They could also go and browse this catalog [second screenshot] that is the same as Lewinsohns [PES] but we have added more activities
That is more in line with this more digital lifestyle we have now in the 2020 than back in 1972
such as "writing a positive commentary to an internet article"
With the app we ran a feasibility study.
It was a 8 week-long feasibility study with
17 patients diagnosed with an affective disorder. As we recruited from both the
clinic and from a national recruitment webpage we got really good heterogenous...
really good mix group of people both young and older adults up to 56
also from almost none to severe depressive symptoms at study onset
for the next slides here I will show what kind of results we got from the interviews
first of all, as this was a in-the-wild study, which is very uncontrolled,
we were thrilled to hear experiences from the patient that they had a positive influence on the fact of
planning activities, as this is a core Behavioral Activation
value you could say. So let me read one of the quotes here: It is more likely that
you get activated if you have planned activities. When you wake up and you
nothing to do, it can make you feel bad, But when you wake up and you already have a
plan, it is really nice" So the fact that they had
this kind of activities visually organized before them in the app,
was an incentive for them - or a notch as they explained - to initiate the activity
Another strong result of the app usage was the ability to provide inspirations..
like MUBS's ability to provide inspiration the fact of displaying concrete
precise activity in a catalog is very helpful, and let me read one of these
quotes: "I used to wake up and watch TV series. It [MUBS] helping me to go out more. be more social
I planned it more. I learned to knit, and I want to learn to sew in winter. I did not think about
adding this kind of hobbies to my life before, but now I do"
so as you can see a bit
with this quote is that the problem is usually - which is also explained in the interview -
is when their decision-making, basically their ideation, is impaired when they are
in these bad day so they tend to follow more passive activities such as reaching out for the
remote control and turn on the TV when nothing is planned. But when engaged in
pleasurable activities they will initiate a positive loop because they become aware
of the performed activity, telling themselves:
"Hey, yeah, I actually did something!"
and that is also
another result that I bring up here now is the activity awareness when engaged in activities
which is a fundamental outcome of Behavioral Activation
so what we learn from,
the interviews, of awareness ,was that it
was triggered simply by browsing the list of pleasurable activities - our catalog
let me read one quote here:
"every morning I take a shower put on perfume, and put créme on my face
and that is never something I think about... I have learned to appreciate this"
so in that sense
It had a really positive outcome for the patients
last result I want to mention is the recommendation part
When we observed how it was used and what kind of activities were used, we quickly saw
that the feature was used very little.
When we dig deeper in the interview to find out why
we understood that it was mostly easy and less time-wise activities
that were picked
basically it was something they wanted to do in-the-moment like here-and-now
usually they were sitting in the couch or in the bed and they took up the phone and then they looked at the recommendations
and this kind of scenario is unfortunately not effective for
Behavioral Activation, so for recommendations to be effective they basically need to be design
as part of the planning phase, it should be something scheduled for them
precisely like the therapist recommends the patient to schedule specific activities for the upcoming week
So, in conclusion, we learned that the personalized recommendations in its current design was not the important factor for the
successful of MUBS, here, it was inspirational of concrete specific activities
and the scheduling, or planning, of these activities. Overall for the patient, we observed that they
learned to appreciate the smaller everyday activities they became aware of the positive daily input cell that was
otherwise overlooked during depressive days they managed to plan more enjoyable activities and felt rewarded when they followed their plan