David Coyle

Computers in talk-based mental health interventions

The cost to society of mental illness is substantial. A large scale international study has identified mental illnesses as the second leading cause of disability and premature mortality in the developed world [Murray, C.L., Lopez, A.D. (Eds.), 1996. The Global Burden of Disease: A comprehensive assessment of mortality and disability from disease, injuries, and risk factors in 1990 and projected to 2020. Harvard University, Cambridge, MA]. Unfortunately, research also suggests that the majority of people suffering from treatable mental health disorders do not have access to the required treatment. Furthermore, even when treatment is accessible many sufferers are unable to successfully engage with professional services [Surgeon General, 1999. Mental Health: A Report of the Surgeon General - Executive Summary, Department of Health and Human Services, Washington, DC, Retrieved August 2006, from http://www.surgeongeneral.gov/library/mentalhealth/home.html; WHO World Mental Health Survey Consortium, 2004. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association, 291(21)]. Computer assisted mental health interventions have the potential to help in addressing this imbalance. However, a review of literature shows that to date this potential has been largely unexplored. One of the primary reasons for this is that few researchers from a HCI or technical background have engaged in this area. The primary purpose of this paper is to provide a foundation and set an agenda for future research on the design of technology for talk-based mental health interventions. Theoretical approaches to the treatment of mental illness are reviewed, as is previous research on the use of technology in this area. Several significant factors effecting design and evaluation are identified and based on these factors a broad set of design guidelines are proposed to aid the development of new technologies. Of the issues identified, ethical requirements along with the sensitivity and stigma associated with mental illness pose particular challenges to HCI professionals. These factors place strict limitations on access to mental health care (MHC) settings by non-MHC professionals and create difficulties for the direct application of traditional HCI methods, such as participatory, user-centred and iterative design. To overcome these difficulties this paper proposes a model for collaborative design and evaluation, involving both HCI and MHC professionals. The development of adaptable technologies is an important element of the proposed approach. The final contribution of the paper is to suggest future research directions and identify ways in which HCI researchers can contribute to this work.

Design and evaluation guidelines for mental health technologies

It is increasingly recognised that technology has the potential to significantly improve access, engagement, effectiveness and affordability of treatment for mental health problems. The development of such technology has recently become the subject of Human-Computer Interaction research. As an emerging area with a unique set of constraints and design concerns, there is a need to establish guidelines which encapsulate the knowledge gained from existing development projects. We present an initial set of design guidelines extracted from the literature and from a series of development projects for software to support mental health interventions. The first group of guidelines pertain to the design process itself, addressing the limitations in access to clients in mental healthcare settings, and strategies for collaborative design with therapists. The second group considers major design factors in the development of these technologies, including therapeutic models, client factors, and privacy. The third group concerns conduct of the evaluation process, and the constraints on evaluating mental healthcare technologies. We motivate and explain these guidelines with reference to concrete design projects and problems.

Personal Investigator: A therapeutic 3D game for adolecscent psychotherapy

Although mental health problems increase markedly during adolescent years, therapists often find it difficult to engage with adolescents. The majority of disturbed adolescents do not receive professional mental health care and of those who do fewer still will fully engage with the therapeutic process (Offer et al. 1991; US Surgeon General 1999). Personal Investigator (PI) is a 3D computer game specifically designed to help adolescents overcome mental health problems such as depression and help them engage more easily with professional mental health care services. PI is an implementation of a new computer mediated model for how therapists and adolescents can engage. The model has its theoretical foundations in play therapy and therapeutic storytelling and applies current research on the educational use of computer gaming and interactive narrative systems to these foundations. Previously demonstrated benefits of computer games and interactive narrative systems in education include increased motivation, increased self-esteem, improved problem solving and discussion skills and improved storytelling skills (Bruckman 1997; Bers 2001; Robertson 2001; Robertson and Oberlander 2002; Bers et al. 2003; Squire 2003). PI aims to take advantage of these benefits in a mental health care setting. PI incorporates a goal-oriented, strengths based model of psychotherapy called Solution Focused Therapy (SFT). By engaging adolescents, in a client-centred way, it aims to build stronger therapeutic relationships between therapists and adolescents. PI is the first game to integrate this established psychotherapy approach into an engaging online 3D game. Results of trials of PI with four adolescents, referred to clinics for issues including anxiety and behaviour problems, attempted suicide, and social skills difficulties, are presented.

Using crowdsourcing to support pro-environmental community activism

Community activist groups typically rely on core groups of highly motivated members. In this paper we consider how crowdsourcing strategies can be used to supplement the activities of pro-environmental community activists, thus increasing the scalability of their campaigns. We focus on mobile data collection applications and strategies that can be used to engage casual participants in pro-environmental data collection. We report the results of a study that used both quantitative and qualitative methods to investigate the impact of different motivational factors and strategies, including both intrinsic and extrinsic motivators. The study compared and provides empirical evidence for the effectiveness of two extrinsic motivation strategies, pointification - a subset of gamification - and financial incentives. Prior environmental interest is also assessed as an intrinsic motivation factor. In contrast to previous HCI research on pro-environmental technology, much of which has focused on individual behavior change, this paper offers new insights and recommendations on the design of systems that target groups and communities.

Engagement with online mental health interventions: an exploratory clinical study of a treatment for depression

Online mental health interventions can benefit people experiencing a range of psychological difficulties, but attrition is a major problem in real-world deployments. We discuss strategies to reduce attrition, and present SilverCloud, a platform designed to provide more engaging online experiences. The paper presents the results of a practice-based clinical study in which 45 clients and 6 therapists used an online Cognitive Behavioural Therapy programme for depression. Pre and post-treatment assessments, using the Beck Depression Inventory, indicate a statistically significant improvement in depressive symptoms, with a large effect size, for the moderate-to-severe clinical sub-sample receiving standalone online treatment (n=18). This group was the primary target for the intervention. A high level of engagement was also observed compared to a prior online intervention used within the same service. We discuss strategies for design in this area and consider how the quantitative and qualitative results contribute towards our understanding of engagement.

Clinical evaluations and collaborative design: developing new technologies for mental healthcare interventions

Ethical requirements, severe constraints on access to end users and the necessity of real-world clinical evaluations represent significant challenges to designers of new technologies in mental healthcare (MHC) settings. This paper describes the collaborative approaches, incorporating HCI methods with input for MHC professionals and MHC theory, which were applied in the development of Personal Investigator (PI), a 3D computer game developed to support adolescent mental health interventions. Different stages in the evaluation of PI are discussed and the lessons learned through a multi-site clinical evaluation are presented. This evaluation has provided strong initial evidence that games such as PI offer the potential to improve adolescent engagement in talk-based interventions. It has also provided an insight into factors which should be considered in future designs in the MHC domain, e.g. the need to incorporate high levels of adaptability in future systems. Based on the difficulties encountered and lessons learned critical aims for future research are outlined.

RepliCHI: the workshop

The replication of, or perhaps the replicability of, research is often considered to be a cornerstone of scientific progress. Yet unlike many other disciplines, like medicine, physics, or mathematics, we have almost no drive and barely any reason to consider replicating the work of other HCI researchers. Our community is driven to publish novel results in novel spaces using novel designs, and to keep up with evolving technology. The aim of this workshop is to trial a new venue that embodies the plans made in previous SIGs and panels, such that we can begin to give people an outlet to publish experiences of attempting to replicate HCI research, and challenge or confirm its findings.

Qualitative meta-synthesis of user experience of computerised therapy for depression and anxiety

Objective Computerised therapies play an integral role in efforts to improve access to psychological treatment for patients with depression and anxiety. However, despite recognised problems with uptake, there has been a lack of investigation into the barriers and facilitators of engagement. We aimed to systematically review and synthesise findings from qualitative studies of computerised therapies, in order to identify factors impacting on engagement. Method Systematic review and meta-synthesis of qualitative studies of user experiences of computer delivered therapy for depression and/or anxiety. Results 8 studies were included in the review. All except one were of desktop based cognitive behavioural treatments. Black and minority ethnic and older participants were underrepresented, and only one study addressed users with a co-morbid physical health problem. Through synthesis, we identified two key overarching concepts, regarding the need for treatments to be sensitive to the individual, and the dialectal nature of user experience, with different degrees of support and anonymity experienced as both positive and negative. We propose that these factors can be conceptually understood as the ‘non-specific’ or ‘common’ factors of computerised therapy, analogous to but distinct from the common factors of traditional face-to-face therapies. Conclusion Experience of computerised therapy could be improved through personalisation and sensitisation of content to individual users, recognising the need for users to experience a sense of ‘self’ in the treatment which is currently absent. Exploiting the common factors of computerised therapy, through enhancing perceived connection and collaboration, could offer a way of reconciling tensions due to the dialectal nature of user experience. Future research should explore whether the findings are generalisable to other patient groups, to other delivery formats (such as mobile technology) and other treatment modalities beyond cognitive behaviour therapy. The proposed model could aid the development of enhancements to current packages to improve uptake and support engagement.

An evaluation of a solution focused computer game in adolescent interventions.

Many adolescents experience difficulties with traditional face-to-face mental health care approaches. Personal Investigator (PI) is a 3D computer game specifically designed for use in adolescent interventions. The game implements a model of Solution Focused Therapy. It aims to assist in easing the difficulties experienced by adolescents with direct face-to-face approaches. In sessions a therapist and adolescent sit together at a computer and play PI. Issues raised in the game serve as a context for more detailed discussions between the therapist and client. This article describes a study in which PI was used with 22 adolescent clients, attending mental health care services due to a variety of difficulties. Whilst further trials are required, results indicate positive benefits of using PI. PI can help in building an effective client—therapist relationship, can assist in structuring sessions, and can assist in improving client engagement in the therapeutic process.

Gamification of Cognitive Assessment and Cognitive Training: A Systematic Review of Applications and Efficacy

Background Cognitive tasks are typically viewed as effortful, frustrating, and repetitive, which often leads to participant disengagement. This, in turn, may negatively impact data quality and/or reduce intervention effects. However, gamification may provide a possible solution. If game design features can be incorporated into cognitive tasks without undermining their scientific value, then data quality, intervention effects, and participant engagement may be improved. Objectives This systematic review aims to explore and evaluate the ways in which gamification has already been used for cognitive training and assessment purposes. We hope to answer 3 questions: (1) Why have researchers opted to use gamification? (2) What domains has gamification been applied in? (3) How successful has gamification been in cognitive research thus far? Methods We systematically searched several Web-based databases, searching the titles, abstracts, and keywords of database entries using the search strategy (gamif* OR game OR games) AND (cognit* OR engag* OR behavi* OR health* OR attention OR motiv*). Searches included papers published in English between January 2007 and October 2015. Results Our review identified 33 relevant studies, covering 31 gamified cognitive tasks used across a range of disorders and cognitive domains. We identified 7 reasons for researchers opting to gamify their cognitive training and testing. We found that working memory and general executive functions were common targets for both gamified assessment and training. Gamified tests were typically validated successfully, although mixed-domain measurement was a problem. Gamified training appears to be highly engaging and does boost participant motivation, but mixed effects of gamification on task performance were reported. Conclusions Heterogeneous study designs and typically small sample sizes highlight the need for further research in both gamified training and testing. Nevertheless, careful application of gamification can provide a way to develop engaging and yet scientifically valid cognitive assessments, and it is likely worthwhile to continue to develop gamified cognitive tasks in the future.