THE DESIGN SPACE OF MOBILE MENTAL HEALTH INTERVENTIONS FOR ANXIETY MANAGEMENT

Abstract

Digital mental health is a rapidly growing area within Human-Computer Interaction. Mental health problems will affect one-third of the population worldwide during their lifetime. At the present moment, anxiety disorders are highly prevalent and are among the most common psychological disorders with an estimated 264 million adults experiencing anxiety worldwide. The significant effects of anxiety disorders make mental health a public health priority. One of the most evidence-based treatments for anxiety disorders is cognitive-behavioral therapy (CBT).

Technology advances have created the opportunity to deliver psychological interventions in daily life - a type of intervention described as ?ecological momentary interventions? (EMI?s). In addition, such advances have opened up possibilities for the delivery of "just-in-time interventions" that adapt treatment delivery over time to provide interventions most likely to be effective, using information gathered through ecological momentary assessment (EMA) or sensing. The widespread availability of smartphones has led to a proliferation of mobile apps for anxiety. Such systems can be used in conjunction with therapy, as standalone treatments, or for use in the prevention of mental illness. As such, they provide an accessible solution to many barriers to care. Designing digital technologies for mental health requires navigating a complex design space, for which various design components have remained unexplored.

In addition, despite the potential benefits of using such technologies, the majority of them fail to gain traction, the attrition rates of people using them are high, and sustained use is even rarer. Insights into consumer perspectives regarding how mobile health can best support anxiety disorder management, and how to design mobile technologies to provide an engaging experience for users are lacking. Personalizing intervention content to individual users could lead to sustained use. Yet, currently available technology-based interventions are not tailored to account for variability in different characteristics and we know little about the design options for such systems.

This thesis investigates the design of mobile interventions for mental health disorders and their potential to improve engagement for anxiety management apps. It unveils the different components that comprise such interventions, the enablers, and barriers to engagement with applications designed for that purpose, the desired features, and the possibilities of enhancing care by personalizing content to individual clients. It asks which are the technological and interaction possibilities of such systems, why users engage and disengage from mobile apps for anxiety management, and how health professionals might tailor intervention content for users of such systems. As a result, I developed a model of the various possibilities and explored the tailoring possibilities to address the issues and challenges faced by those populations.

This thesis contributes to knowledge concerning the design of mobile interventions for mental health, user engagement, and personalization. It provides insights into the design options available in those technologies and the experiences of users of mobile applications for anxiety management. First, the thesis starts with an exploration of the state of the art of EMIs by identifying the components that comprise mental health mobile interventions both in academic literature and consumer apps in practice, with a focus on the engagement and tailoring features offered through the use of these applications. This exploration allowed me to map out the different technological and interaction possibilities of these interventions. A mixed-methods study reviewed app store reviews and interviewed app consumers to unveil the reasons for users engaging with and abandoning mobile apps targeted for anxiety disorders and provided suggestions for improvement. A user study explored daily perspectives and uncovered challenges and opportunities for the long-term engagement of participants with mobile applications of this kind. Lastly, I conducted interviews and ideation activities with mental health professionals in order to understand therapists? current practices and identify new possibilities for delivering intervention content in between face-to-face CBT therapy sessions. Through collaboration with mental health professionals, I unveiled the possibilities for tailoring intervention content in between face-to-face CBT therapy sessions. The qualitative outcomes of these evaluations assert the potential of mobile technology to support the individual needs of people for anxiety management.

This thesis enriches the HCI field by providing a better understanding of the design space of ecological momentary interventions, including different options and perspectives on how to design engaging personalized mobile interventions in the context of digital mental health and anxiety management.