Designing technology to promote mental health and wellbeing

PhD ThesisMental health and wellbeing are fundamental to our quality of life, enabling us to be resilient against everyday stresses, work productively, to have fulfilling relationships, and experience life as meaningful. While HCI research has recently begun to address important challenges in the treatment of mental illness, approaches to promote and protect mental wellbeing, as positive emotional, psychological and social health, have received far less attention. Besides, the design space for technology innovation for people with severe mental health problems and as hospital inpatients is largely under-explored. The research presented in this thesis investigates how technology can promote the mental health and wellbeing of a group of women, living in the medium secure services of a forensic hospital in the UK. These women present a difficult to treat group due to the complexity of their mental health problems, extremely challenging behaviours, and a mild-tomoderate Learning Disability. Following an Experience-centred Design (ECD) approach in this context, the thesis describes how I worked collaboratively with hospital staff to gain a rich understanding of the women, their treatment regime, and constraints of their secure care; my approach to sensitively engaging this vulnerable group of women into a co-creative process to personalise their technology, and to carefully build up a relationship with them; and how the design of the technology builds upon qualities of creativity, physicality and personal significance for promoting engagement in mental health and wellbeing enhancing activities. In response to the design context I introduce the concept of the Spheres of Wellbeing, a set of three artefacts designed to collectively offer opportunities for engagements that are stimulating, enjoyable and personally meaningful; contribute to the formation of a positive sense of self; assist in tolerating emotional distress; and help familiarise the women with therapeutic concepts of mindfulness. Furthermore, in presenting the findings of a real-world deployment and evaluative study of the Spheres, this thesis contributes to current discourse in HCI on how empathy can be enabled with vulnerable populations, and provides rich insights into the complexities and challenges of conducting design-led research within hospital settings.Microsoft Research through its PhD Scholarship Programme and was partly been funded by the RCUK Digital Economy Hub on Social Inclusion through the Digital Economy (SiDE)

Sprite Catcher: A Handheld Self Reflection and Mindfulness Tool for Mental Healthcare

This paper describes the rationale behind the ongoing development of Sprite Catcher - a handheld, tangible interactive tool for treating depression and anxiety. The current design, which is intended to encourage the user to practice self-reflection and mindfulness, is the product of participatory design conducted with counsellors from a local mental health charity and with a university psychology researcher. Through a review of previous work in this area, a description of a use scenario and an overview of the design's functions and concepts, we illustrate where the project is heading and which research questions we aim to respond to

Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

Mindfulness based childbirth and parenting program : Supporting a good beginning

Introduction: Considering the scale of population mental health problems and the risk of transmission of mental health vulnerability within families, it is urgent to find and implement efficient preventive interventions starting early in life. In line with this rationale, this thesis evaluates a Swedish version of the Mindfulness Based Childbirth and Parenting Program (MBCP). Objectives: This thesis aims to: 1) test the short- and long-term efficacy of MBCP in reducing pregnant women’s perceived stress and preventing perinatal depression; 2) evaluate effects on infant social-emotional development; and 3) explore MBCP-participants’ experiences of the program. Methods: Pregnant women (n = 193) at risk for perinatal depression were randomized to MBCP or an active control condition (a Lamaze childbirth class). Self-reported data on perceived stress, depressive symptoms, positive states of mind, and levels of mindfulness were provided by the women at baseline, postintervention and at three, nine, and twelve months postpartum. At three months postpartum, the mothers also reported estimates of their infants’ social-emotional development. At the same timepoint, 16 in-depth interviews were carried out with mothers and fathers who had participated in the MBCP program. Results: From pre- to postintervention, the women who were randomized to MBCP reported significantly larger reductions in perceived stress and depressive symptoms and larger increases of positive states of mind and level of mindfulness compared to the women randomized to the control condition. The treatment effects of MBCP on perceived stress, depressive symptoms, and positive states of mind seemed to be mediated by increased levels of mindfulness. These initial effects were not sustained at longer-term follow-up assessments during the first year postpartum. However, the mothers in the MBCP-arm, who continued to practice mindfulness during the follow-up period retained the interventioneffects to a higher degree than the mothers in the MBCP-arm who did not continue to practice. At three months, mothers in the MBCP-arm perceived that they could understand their infants’ cues to a higher degree and that their infant had a better capacity to selfregulate, compared with mothers in the Lamaze-arm. Mothers and fathers who were interviewed, experienced that participating in the MBCP program increased their capacity to cope with stress, anxiety, pain, and distress. A number of parents also experienced becoming more self-compassionate, insightful, better at communicating and having a stronger sense of being present in nature and with their infant. Conclusion: The crucial developmental phase humans go through, in the womb, in infancy, and during pregnancy and early parenting – men and women alike, gives us a window of opportunity to support a positive development in ways that can have far-reaching effects. MBCP is a promising intervention for seizing that opportunity. The intervention promotes well-being and builds resilience to deal with challenges in pregnancy, childbirth, infant-care, co-parenting and life in general

Working with parental mental health problems in complex parent-infant relationships: a study on the power implications of approaches used in infant services in Western Sweden

In psychological, science and social research, infancy has been highlighted as a period of rapid cognitive, psychological and physical development in response to the environment the infant grows up in. In addition, these traditions of research have also emphasized how parental mental health problems can affect a parent’s ability to meet their infant’s needs. The approaches used in this practice area have not been analysed in the Swedish context considering their power implications to date. Following a qualitative research strategy, this thesis analysed descriptions of the approaches used in infant services work from the perspective of the workers. The four research questions focused on the descriptions of the circumstances around the families’ attendance to the service, ideal parent-infant relationships, the approaches used, the challenges encountered and the power implications for the parentinfant and worker-parent relationships. Semi-structured interviewing in English and Swedish was used to gather the data and thematic analysis to analyse it. The data was analysed using attachment theory, the motherhood constellation, the social approach to mental distress, the four modes of power and the concepts of care and control in social work. The data was coded into 7 themes that revealed a strong link between structural disadvantage and individual problems in relation to parental mental health problems, an eclectic approach to social work practice in infant services, focusing both on the internal representations of and on the behaviours in relationships. The study also revealed the strong effect of the care and control tensions on relationship building between workers and parents, intervention and on the emotional well-being of both parents and workers. The underlying themes of social control elements in infant services were interpreted as an example of the risk rhetoric in social work, while infant services practices also demonstrated elements of intuitive social work knowledge production evident in flexible role perception and the promotion of bonding and bridging in infant group sessions. The study advocates for a stronger emphasis on power relations analysis, on reflection about risk and for a more active dialogue between practice and research in social work with families facing parental mental health problems

MANTRAM FOR MAMAS: A PILOT STUDY FOR POSTPARTUM WOMEN

Objective: This pilot study launched an online Mantram Repetition Program (oMRP) using a virtual health portal that aimed to explore online portal accessibility, oMRP acceptance, and overall interface satisfaction among a sample of postpartum women. Background: Postpartum depression remains one of the most common and severe childbirth complications, affecting more than 13% of women during the first three months after childbirth. Cognitive or behavioral talk therapy sessions and medication are the most frequently recommended treatments to alleviate symptoms. Although effective, women tend not to enroll or adhere to these modalities, suggesting they need alternative treatment plans. A possible alternative, mirroring the adoption of online platforms and patient portals in many areas of healthcare delivery, is to examine if an online treatment method is acceptable for women in the postpartum period. Methods: To explore whether newly postpartum women would log on, navigate the portal, accept the virtual program, and enjoy the overall experience, participants were invited to access four oMRP learning modules through a HIPAA-compliant portal during a 30-day study period. Participants provided sociodemographic data and completed satisfaction surveys throughout the study. Questions from the Technology Acceptance Model (TAM) and the Client Satisfaction Questionnaire (CSQ-8), in combination with open-ended questions, were used to evaluate participant acceptance and satisfaction with the technology, portal, and program. Results: Among this sample of seven women, five completed the program in its entirety, shared their satisfaction, and even expressed gratitude for the program. The women accepted the technology as indicated by a 6.0 mean TAM score (out of a possible 7.0) and had moderate to high levels of program satisfaction indicated by a 27 mean CSQ score (out of a possible 32). The qualitative and quantitative results indicated that the pilot study positively impacted its participants. Conclusion: The oMRP for postpartum women has the potential to be a patient-centered modality to treat postpartum symptoms and support overall well-being. This study provided a foundational empirical understanding of the acceptability and use of the oMRP interface, resulting in recommendations for future research, interface design, and clinical implementation

Perinatal pathways : a mixed methods study of specialist services for women at risk for poor perinatal mental health outcomes

Pregnancy is usually a time of celebration and excitement. It can also be a time of increased emotional and social vulnerability, as women enter a state of personal transition. Women with pre-existing physical or psychosocial needs enter motherhood with additional challenges. Poor perinatal mental health, for example anxiety and depression, stressful life events and poor social health, are associated with adverse outcomes for women, their children and their families. Pregnancy, birth and the postnatal period can therefore be marred by the experience of mental ill-health. Women experiencing complex health and social needs during the perinatal period (conception until 12 months post birth) benefit from early identification, integrated care pathways and comprehensive management plans to improve their emotional wellbeing and prevent mental health problems. Psychosocial assessment and depression screening has been incorporated into policy in New South Wales (NSW), Australia to assist health professionals to identify and refer women at risk of poor perinatal mental health outcomes to specialised or secondary services. Perinatal and infant mental health (PIMH) services are an emerging specialty area in mental health care in Australia. This convergent, embedded, mixed methods study aims to explore and describe two specialist PIMH services in NSW. The research questions in this study address: 1. the characteristics and risk factors of women referred to a specialist PIMH service, 2. the engagement practices of PIMH clinicians, 3. the therapeutic interventions that PIMH clinicians use, 4. collaboration between PIMH clinicians and other service providers, and 5. women's experiences of engaging with a PIMH service. Data were collected by reviewing 244 medical records of women who had been referred to the two PIMH services, transcribing textual illustrations from the medical records, and by interviewing six PIMH clinicians, two PIMH managers, five key stakeholders (four midwives and one social worker) and 11 women service-users. The quantitative data were analysed using SPSS (Statistical Package for the Social Sciences). The qualitative data were analysed in two phases: directed content analysis of all qualitative data and then thematic analyses of the interview data. Integration occurred during the design, data analyses, interpretation and reporting phases of the study. In mixed methods research designs, both the quantitative and qualitative data are synthesised or integrated to report the findings or inferences of a study. The women referred to the PIMH services have multiple and complex needs, indicating that the referral processes and referrals are appropriate. The PIMH clinicians focus on the infant and the mother-infant relationship, and are woman-led to enhance engagement. Clinicians underpin the therapeutic interventions they use with Attachment Theory by modelling a secure-base for women to emulate for their infants. There is a disconnection between the PIMH clinicians' and the key stakeholders' perspectives pertaining to collaboration, PIMH clinicians require support to work in more collaborative ways. Women service-users value their time with the PIMH service, however discharge practices leave some women feeling abandoned. Clinicians enjoy working with women who have been referred to the PIMH service, however they require ongoing support from colleagues and managers to negotiate an emotionally challenging environment and remain effective clinicians. In addition, the review of medical records revealed a lack of documentation about the attachment focus of the PIMH clinicians. Without clear documentation an important component of the clinicians' work remains invisible. The meta-inferences from this study progress from Attachment Theory to a Theory of Attachment Based Exploratory Interest Sharing (TABEIS). In this thesis TABEIS is presented as a model for PIMH clinicians to conceptualise their work with women who have been referred to their service but also as a way of relating to and understanding the actions of their colleagues, engaging with other professionals and working with them in more collaborative ways. The importance of knowledge translation and implications for clinical practice are also discussed. The importance of the perinatal period for the health and wellbeing of future generations has growing international recognition. The inferences and meta-inferences of this study add to the extant literature to promote the further development of policy, education and clinical practice for professionals who work with women and their infants at risk of poor perinatal mental health outcomes

Common trust and personal safety issues: a systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness

Background: Persons experiencing homelessness and vulnerable housing or those with lived experience of homelessness have worse health outcomes than individuals who are stably housed. Structural violence can dramatically affect their acceptance of interventions. We carried out a systematic review to understand the factors that influence the acceptability of social and health interventions among persons with lived experience of homelessness. Methods: We searched through eight bibliographic databases and selected grey literature sources for articles that were published between 1994 and 2019. We selected primary studies that reported on the experiences of homeless populations interacting with practitioners and service providers working in permanent supportive housing, case management, interventions for substance use, income assistance, and women- and youth-specific interventions. Each study was independently assessed for its methodological quality. We used a framework analysis to identify key findings and used the GRADE-CERQual approach to assess confidence in the key findings. Findings: Our search identified 11,017 citations of which 35 primary studies met our inclusion criteria. Our synthesis highlighted that individuals were marginalized, dehumanized and excluded by their lived homelessness experience. As a result, trust and personal safety were highly valued within human interactions. Lived experience of homelessness influenced attitudes toward health and social service professionals and sometimes led to reluctance to accept interventions. Physical and structural violence intersected with low self-esteem, depression and homeless-related stigma. Positive self-identity facilitated links to long-term and integrated services, peer support, and patient-centred engagement. Conclusions: Individuals with lived experience of homelessness face considerable marginalization, dehumanization and structural violence. Practitioners and social service providers should consider anti-oppressive approaches and provide, refer to, or advocate for health and structural interventions using the principles of trauma-informed care. Accepting and respecting others as they are, without judgment, may help practitioners navigate barriers to inclusiveness, equitability, and effectiveness for primary care that targets this marginalized population

Symposium Poster Session Presentations: 2014 Community Engagement and Research Symposium

Complete list of Poster Session presentations with abstracts for the 4th annual Community Engagement and Research Symposium, held Friday, November 7, 2014 at the University of Massachusetts Medical School, Worcester, MA