RESeT Thought Disposal (2)

Abstract

Repeated stress during adolescence has been shown to decrease cognitive function while increasing rates of anxiety and depression. Eighty-one percent of teens report stress stemming from their school environment and yet, schools are struggling to manage the increase of teen mental health needs. Virtual-reality (VR) has been shown effective at treating post-traumatic stress disorder, phobias, and pain due to its immersive experience. The following paper presents a participatory, human-centered design process utilizing teens as co-designers to develop a VR interaction intended to reduce stress.
We describe our co-design process including research, storyboarding, group interviews, and prototyping of our thought disposal interaction. In addition, we discuss our design of an immersive measurement tool to capture the immediate effect of the interaction. Finally, we describe next steps and future research related to our project.

Full text

2019 IDC ’19,June 12–15, 2019, Boise, ID, USA 978-1-4503-6690-8/19/06 hps://doi.org/10.1145/3311927.3325313
Thought Disposal: Co-Designing a
virtual interaction to reduce stress in
teens
Elin A. Björling
University of Washington
Seale, Washington
bjorling@uw.edu
Rachael Cicero
University of Washington
Seale, Washington
rcicero@uw.edu
Aditya Sankar
University of Washington
Seale, Washington
aditya@cs.washington.edu
Anand Sekar
University of Washington
Seale, Washington
anand272@cs.washington.edu
ABSTRACT
Repeated stress during adolescence has been shown to decrease cognitive function while increasing
rates of anxiety and depression. Eighty-one percent of teens report stress stemming from their school
environment and yet, schools are struggling to manage the increase of teen mental health needs.
Virtual-reality (VR) has been shown eective at treating post-traumatic stress disorder, phobias, and
pain due to its immersive experience. The following paper presents a participatory, human-centered
design process utilizing teens as co-designers to develop a VR interaction intended to reduce stress.
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specific permission and/or a fee. Request permissions from permissions@acm.org.
IDC ’19, June 12–15, 2019, Boise, ID, USA
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ACM ISBN 978-1-4503-6690-8/19/06.. .$15.00
hps://doi.org/10.1145/3311927.3325313

Thought Disposal: Co-Designing a virtual interaction to reduce stress in teens IDC ’19, June 12–15, 2019, Boise, ID, USA
We describe our co-design process including research, storyboarding, group interviews, and pro-
totyping of our thought disposal interaction. In addition, we discuss our design of an immersive
measurement tool to capture the immediate eect of the interaction. Finally, we describe next steps
and future research related to our project.
CCS CONCEPTS
•Human-centered computing →User studies.
ACM Reference Format:
Elin A. Björling, Rachael Cicero, Aditya Sankar, and Anand Sekar. 2019. Thought Disposal: Co-Designing a virtual
interaction to reduce stress in teens. In Interaction Design and Children (IDC ’19), June 12–15, 2019, Boise, ID, USA.
ACM, New York, NY, USA, 6 pages. hps://doi.org/10.1145/3311927.3325313
KEYWORDS
Participatory Design; Virtual Reality; Adoles-
cence; Perceived Stress INTRODUCTION
Teens are now the most stressed generation, with 27% percent of US teens reporting very high levels
of daily stress, and 31% reporting feeling overwhelmed as a result of stress [
1
]. Increased stress has
been shown to cause both mental and physical illness [
12
] and negatively impact cognitive function
aecting learning [
18
]. Many schools lack the resources (time and personnel) to implement and
maintain school-based mental health programs [
6
]. Virtual reality (VR) has been recognized as a
promising platform for mental health treatment [2].
Project RESeT (Relaxation Environment for Stress in Teens) is the design and development of a
self-administered, school-based stress intervention aimed to increase access by minimizing school
personnel and student burden. Through a participatory approach to human-centered design, we
Figure 1: Decentering Mechanism
have collaborated with teens as co-designers to design and develop mindfulness-based intervention
components into interactions in a virtual environment. The following paper describes our co-design
process including research, storyboarding, group interviews, and prototyping. In addition, we describe
the development of an immersive measurement tool.
BACKGROUND
Thought disposal
is an approach to label and
separate negative thoughts in an eort to im-
prove mood.
Teen Stress and School
Eighty-three percent of teens report school as their primary stressor [
17
]. Recent evidence shows
the cumulative impact of everyday sources of stress is highly prevalent and impactful on teens
[
9
]. Chronic stress is a known risk factor for both physical and mental health problems [
11
]. The
developing adolescent brain makes adolescents especially vulnerable to the cumulative insults of
chronic stress[
13
]. While eective stress reduction interventions for adolescents exist, most are

Thought Disposal: Co-Designing a virtual interaction to reduce stress in teens IDC ’19, June 12–15, 2019, Boise, ID, USA
cost-prohibitive and burdensome on sta and student time, especially for under-resourced schools
[6].
Virtual Reality and Teens
Virtual reality is as a promising platform for mental health treatment [
3
]. As an intervention tool for
adolescents, VR has been shown to treat burn pain [
15
], headaches [
16
], and spinal cord injuries [
7
].
As a self-administered, scalable virtual-reality platform, VR presents a potential, desirable solution to
improve teen mental health at schools.
METHODS
Figure 2: Participants and Activities Relaxation Environment for Stress in Teens (RESeT)
Mindfulness-based interventions (MBI) have been eective in treating mood disorders in adolescents
[
5
]. Typically these programs require a trained practitioner and multiple sessions to be successful,
making the therapy inaccessible for many adolescents. The goal of RESeT is to leverage existing
and eective MBI components [
8
] (e.g. environmental awareness or disposal of negative thoughts)
by transferring them into a virtual reality environment (Figure 1). Utilizing a self-administered VR
headset, school-based design, RESeT will increase accessibility while addressing a critical barrier to
traditional school-based interventions.
Human-centered design
is defined by ISO
9241-210:2010(E) "an approach to interactive
systems development that aims to make sys-
tems usable and useful by focusing on the users,
their needs and requirements."
Participatory approach to human-centered design
Participatory design (PD) has been shown very successful when working with teens [
4
]. PD allows for
meaningful engagement with participants, allowing them to inform each stage of the design, ideally
ensuring its success. From a participatory approach we engaged in the HCD methodology [
10
] to
iteratively design and build, while assessing acceptability. Teens were recruited through large STEM
events and the local public library. See Figure 2 for detailed information regarding each of the study
sites and activities.
STAGES AND FINDINGS
Ideation
Utilizing the data learned from research, we then engaged teens in the ideation of an interaction that
would reduce their stress. First, using storyboarding, we asked a group of teens (site 2) to work in
pairs to illustrate an interaction to reduce their stress. Interestingly, many of the interactions captured
involved a thought disposal like concept (Figure 3). Second, teens worked in pairs to modify nature
sounds and images until they formed a relaxing environment. From these data, we (1) confirmed that

Thought Disposal: Co-Designing a virtual interaction to reduce stress in teens IDC ’19, June 12–15, 2019, Boise, ID, USA
a forested nature environment in winter was preferred, (2) nature sounds needed to be subtle, but
realistic and diverse, and (3) thought disposal was a salient and desirable interaction for teens.
Research
Our research consisted of three main methods. First we reviewed existing literature to learn about
eective components of mindfulness-based interventions [
8
] which include environmental awareness
and thought disposal. Second, we invited teens to report their stressors and calmers at two public
events (site 1 and 3). From these data we found many teens find music, food, and animal interactions to
be calming. Third, we invited teens to explore existing VR environments that were designed to reduce
stress. Such environments involved simple nature seings or had relaxing, unstructured activities.
Teens found environments with unstructured activity (e.g. Tiltbrush) and realistic nature (e.g. Nature
Treks) most relaxing. We also learned that in VR, teens prefer to be active in nature, enjoy being
aentive to auditory sounds, and prefer a realistic as opposed to fantasy or cartoon design style.
Figure 3: Storyboard by a teen, illustrat-
ing feeding negative thoughts to a mon-
ster turning it into a cute animal.
Figure 4: Thought disposal transforma-
tion, as imagined by a teen.
Prototyping Thought Disposal
We began the preliminary design of thought disposal as an interaction in VR involving burning
thoughts in a fire. Immediately we learned that writing in VR was a complicated task, leading us to
the design of a tree of negative thoughts from which teens could collect leaves and burn them in a
nearby fire. To make the interaction more active, we decided to have the teens gather wood to make
the fire and then burn leaves with negative thoughts from a tree. To test this interaction in a low
fidelity environment, we asked teens (site 4) to interact with a clay environment which included a fire
and a tree that held paper leaves with negative feelings wrien on them. Teens immediately knew
to take the negative leaves and put them in the fire. As they physically played out this interaction,
a couple of teens (independently) suggested that as the leaves burn, they should transform. As one
teens said, “It would be so cool if your negative feelings burned and then suddenly became a beautiful
buerfly” (Figure 4). Another teen asked if they could use the fire wood to light the entire tree on
fire. They suggested that aer the tree of negative thoughts burned down, it would become a more
beautiful tree with flowers. From these prototyping sessions, we learned that burning leaves was a
satisfying form of thought disposal and transformation of negative thoughts is a desirable concept
for teens. Therefore, we have begun the design of the burning leaves turning into buerflies in VR.
Preliminary Design of an Immersive Assessment
In order to assess the eectiveness of our intervention, we began prototyping a visual analog scale
(VAS) user-interface which will be presented modally to the user while they are immersed in the VR
experience. The VAS scale lets the user self-report fluctuating social and ecological variables such as
stress levels, mood, anxiety, etc. Traditionally, VR measurements have been captured via pre- and

Thought Disposal: Co-Designing a virtual interaction to reduce stress in teens IDC ’19, June 12–15, 2019, Boise, ID, USA
post-assessment forms. However, research on ecological momentary assessment (EMA) indicates
that repeated, data collection as close in time to the experience as possible and within the same
environment greatly increases the accuracy and validity of the data [
14
]. Momentary data capture
appears to be even more relevant in a VR seing, since the user is visually and aurally immersed in
their environment. We hypothesize that the context switch upon exiting the VR environment might
aect the accuracy of the captured data. While some recent work [
19
] has explored multiple-choice
style questionnaires in VR, no immersive tool has been developed using visual analog scale.
Figure 5: Visual Analog Scale (VAS) VR pro-
totype, overlaid on a nature exploration
application
Our user interface (Figure 5) is currently a modal pop-up that appears over the current application
content, and can be triggered by the system based on timestamp, location, or researcher input. It
presents a question about the users current mood, along with an interactive sliding scale. The ends
of the scale are denoted by ‘emoji’ icons that were selected via the participatory design process.
With a hand-held controller, the user selects the value on the slider that represents their current
emotional state. The user’s data is logged and wrien to the device storage for later analysis. Our
current prototype is implemented on a Oculus Go, using Unity3D.
SELECTION AND PARTICIPATION OF CHILDREN
This work included teens ages 13-19. Prior to conducting the current study, we obtained university
IRB approval. Upon introduction to the study, we made sure all participating teens read, understood,
and maintained a copy of the assent/consent form. Any questions teens had were immediately
answered by researchers. The consent/assent form included research statement, study activities,
risk/stress/discomfort, and benefits of the study. The consent/assent form also stated that participation
was voluntary and teens could disengage at any time. No identifying information (names, contact
information, or photos) were collected.
LIMITATIONS AND FUTURE WORK
Our current work was limited due to our small sample of teens and our inability to test for eectiveness.
Therefore, our next step is to fully develop the thought disposal interaction into the VR environment
and conduct a longitudinal pilot study with teens. We will use the immersive VAS to measure self
reported changes in mood and stress over time to assess eicacy of the VR environment.
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