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"Actually I Can Count My Blessings": User-Centered Design of an Application to Promote Gratitude Among Young Adults
Abstract
Regular practice of gratitude has the potential to enhance psychological wellbeing and foster stronger social connections among young adults. However, there is a lack of research investigating user needs and expectations regarding gratitude-promoting applications. To address this gap, we employed a user-centered design approach to develop a mobile application that facilitates gratitude practice. Our formative study involved 20 participants who utilized an existing application, providing insights into their preferences for organizing expressions of gratitude and the significance of prompts for reflection and mood labeling after working hours. Building on these findings, we conducted a deployment study with 26 participants using our custom-designed application, which confirmed the positive impact of structured options to guide gratitude practice and highlighted the advantages of passive engagement with the application during busy periods. Our study contributes to the field by identifying key design considerations for promoting gratitude among young adults.
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Background
Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives.
Objective
The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure.
Methods
We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA’s real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants.
Results
In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants’ subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations.
Conclusions
This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles.
Adopting new psychological strategies to improve mental wellness can be challenging since people are often unable to anticipate how new habits are applicable to their circumstances. Narrative-based interventions have the potential to alleviate this burden by illustrating psychological principles in an applied context. In this work, we explore how stories can be delivered via the ubiquitous and scalable medium of text messaging. Through formative work consisting of interviews and focus group discussions with 15 participants, we identified desirable elements of stories about mental health, including authenticity and relatability. We then deployed story-based text messages to 42 participants to explore challenges regarding both the stories' content (e.g., specific versus generalized) and format (e.g., story length). We observed that our stories helped participants reflect on and identify flaws in their thinking patterns. Our findings highlight design implications and opportunities for mental wellness interventions that utilize stories in text messaging services.
Recent years have seen a surge of interest in the field of explainable AI (XAI), with a plethora of algorithms proposed in the literature. However, a lack of consensus on how to evaluate XAI hinders the advancement of the field. We highlight that XAI is not a monolithic set of technologies---researchers and practitioners have begun to leverage XAI algorithms to build XAI systems that serve different usage contexts, such as model debugging and decision-support. Algorithmic research of XAI, however, often does not account for these diverse downstream usage contexts, resulting in limited effectiveness or even unintended consequences for actual users, as well as difficulties for practitioners to make technical choices. We argue that one way to close the gap is to develop evaluation methods that account for different user requirements in these usage contexts. Towards this goal, we introduce a perspective of contextualized XAI evaluation by considering the relative importance of XAI evaluation criteria for prototypical usage contexts of XAI. To explore the context dependency of XAI evaluation criteria, we conduct two survey studies, one with XAI topical experts and another with crowd workers. Our results urge for responsible AI research with usage-informed evaluation practices, and provide a nuanced understanding of user requirements for XAI in different usage contexts.
The Covid-19 pandemic has had many negative consequences on the general public mental health. The aim of this study was to test the effectiveness of and satisfaction with an app with gratitude exercises to improve the mental health of people with reduced mental well-being due to the Covid-19 pandemic, as well as potential mechanisms of well-being change and dose–response relationships. A two-armed randomized controlled trial design was used, with two groups receiving the 6-week gratitude intervention app either immediately (intervention group, n = 424) or after 6 weeks (waiting list control group, n = 425). Assessments took place online at baseline (T0), six weeks later (T1) and at 12 weeks (T2), measuring outcomes (i.e., mental well-being, anxiety, depression, stress), and potential explanatory variables (i.e., gratitude, positive reframing, rumination). Linear mixed models analyses showed that when controlled for baseline measures, the intervention group scored better on all outcome measures compared to the control group at T1 (d = .24–.49). These effects were maintained at T2. The control group scored equally well on all outcome measures at T2 after following the intervention. Effects of the intervention on well-being were partially explained by gratitude, positive reframing, and rumination, and finishing a greater number of modules was weakly related to better outcomes. The intervention was generally appealing, with some room for improvement. The results suggest that a mobile gratitude intervention app is a satisfactory and effective way to improve the mental health of the general population during the difficult times of a pandemic.
Young adults (ages 18-25) experience the highest levels of mental health problems of any adult age group, but have the lowest mental health treatment rates. Text messages are the most used feature on the mobile phone and provide an opportunity to reach non-treatment engaged users throughout the day in a conversational manner. We present the design of an automated text message-based intervention for symptom self-management. The intervention comprises: (1) psychological strategies (i.e., types of evidence-based techniques leveraged to achieve symptom reduction) and (2) interaction types or the form that intervention content takes as it is delivered to and elicited from users.
In this paper, we introduce a framework that conceptualizes a multi-stage process through which technology can promote sustained wellbeing. Intentional wellbeing-enhancing activities form the centerpiece linking direct product interaction to, ultimately, wellbeing. The framework was developed following a bottom-up–top-down approach by integrating theoretical knowledge from positive psychology, behavioral science and human–computer interaction (HCI)/design with empirical insights. We outline (a) the framework, (b) its five main stages including their multidisciplinary theoretical foundations, (c) relations between these stages and (d) specific elements that further describe each stage. The paper illustrates how the framework was developed and elaborates three major areas of application: (design) research, design strategies and measurement approaches. With this work, we aim to provide actionable guidance for researchers and IT practitioners to understand and design technologies that foster sustained wellbeing.
Researchers have emphasized the detrimental effects of COVID-19 on mental health, but less attention has been given to personal strengths promoting resilience during the pandemic. One strength might be gratitude, which supports wellbeing amidst adversity. A two-wave examination of 201 college students revealed anxiety symptom severity increased to a lesser extent from pre-COVID (January–March 2020) to onset-COVID (April 2020) among those who reported greater pre-COVID gratitude. A similar trend appeared for depression symptom severity. Gratitude was also correlated with less negative changes in outlook, greater positive changes in outlook, and endorsement of positive experiences resulting from COVID-19. Thematic analysis showed “strengthened interpersonal connections” and “more time” were the most commonly reported positive experiences. Overall findings suggest gratitude lessened mental health difficulties and fostered positivity at the onset of the pandemic, but more research is needed to determine whether gratitude and other strengths promote resilience as COVID-19 continues.
Despite the increasing number of mental health applications (apps), the perceived usability of these apps from the viewpoint of end users has rarely been studied. App usability can impact users’ acceptance and engagement with a self-guided mobile health intervention. This study aims to evaluate the usability of a gratitude application called Be Grateful from the perspective of end-users to identify existing design, functionality, and usability issues and elicit users’ views and experiences with the app. We designed the app and conducted usability testing, a combination of interview and questionnaire study of 14 participants who have experienced mental health issues based on self-diagnosis. Participants used Be Grateful app for ten days, completed the System Usability Scale (SUS) validated measure of system usability, and were interviewed at the end of the study. We found that the end-user appreciated the simplicity, straightforwardness of the app and provided positive feedback about the layout. Participants also gave the system high scores on the SUS usability measure (mean = 83.93). Results indicated that the Be Grateful app is usable and will be more likely to be adopted and used by users. Participants were generally excited about the app and eager to use it. This paper reports the lessons learned from the design and evaluation of the app’s usability. We discuss design implications for future work in the area of designing interactive mobile apps for health and wellness, with a focus on mental health interventions.
Background:
Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people.
Objective:
This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents.
Methods:
The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing.
Results:
This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use-related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend.
Conclusions:
The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program.
Background
The acute impacts of COVID-19-related mental health concerns on cognitive function among middle-aged and older adults are unknown. We investigated whether between-person (BP) differences and within-person (WP) changes in loneliness, anxiety, and worry about COVID-19 were related to cognitive function and abilities in a longitudinal cohort of middle-aged and older United States (US) adults over a nine-month period during the COVID-19 pandemic.
Methods
Data were from bimonthly questionnaires in the nationwide COVID-19 Coping Study from August/September 2020 through April/May 2021 (N = 2262 adults aged ≥55). Loneliness was assessed with the 3-item UCLA Loneliness Scale, anxiety with the 5-item Beck Anxiety Inventory, and COVID-19 worry on a 5-point Likert-type scale. Cognitive outcomes were assessed with the 6-item Patient Reported Outcomes Measurement Information System (PROMIS®) Cognitive Function and Abilities scales. Marginal structural models incorporating inverse probability of treatment and attrition weights as well as sampling weights estimated the BP and WP relationships between the mental health predictors and PROMIS® cognitive scores over time.
Results
In any given month, experiencing a loneliness, anxiety symptom, or COVID-19 worry score higher than the sample mean (BP difference) or higher than one's personal mean across the nine-month period (WP change) was negatively associated with cognitive function and abilities in that month. The observed magnitudes of associations were stronger for BP differences than for WP changes and were the strongest for anxiety symptom scale scores.
Conclusions
Elevated loneliness, anxiety symptoms, and worry about COVID-19, both relative to other adults and to one's usual levels, were acutely associated with worse perceived cognitive function and abilities over a nine-month period during the COVID-19 pandemic in the United States. The long-term impacts of mental health symptoms experienced during the pandemic for population cognitive health should be explored.
Efficacy of the traditional individualistic viewpoint towards mental health is questionable, particularly in the context of the Global South countries. Past works in psychology have rarely incorporated people's background and surroundings in dealing with mental health. In contrast, we argue that many mental health problems of people living in the Global South countries are rooted in underdevelopment. Analyzing 1,000 call data of a telephone crisis helpline in Bangladesh, we found that 91% of the cases where callers shared their problems were impacted by failure to meet one of the 17 sustainable developed goals proposed by United Nations. Challenges towards ensuring gender equality, good health and well-being, quality education, and decent work and economic growth among a few others were causing mental health problems among callers. Our findings demonstrate the need to revise support behavior models followed by helplines in the Global South and advocate for a shift in viewing mental health problems from an individualistic to a social approach.
Employee engagement has become a critical issue in Japanese companies. One way to develop it is to improve the relationship among employees through gratitude expressions. In the post-COVID-19 remote work environment, digital devices are essential. This paper confirms that expressions of gratitude delivered via digital devices enhance the relationship between employees. We experimented in a small-town government office where participants (n = 88) were asked to (1) use the Thanks App, an app we developed to express gratitude, for two months and (2) respond to an engagement survey we developed before and after the experimental period. Through cross-analysis of the data from the app and questionnaire, we found that the “trust in colleagues” factor had a strong correlation (r = 0.80, p < 0.001) with our new index computed by the app’s data. The results suggest that the use of the Thanks App may help visualize the trust relationship among teams. This study has a practical value in providing a new team management tool for visualizing team trust. In addition, it provides a new research method for emotional and social psychology using digital devices.
Gratitude and optimism are positive psychological dispositions associated with beneficial outcomes. To examine their associations with physiological and psychological experiences in daily life, we examined data from an Ecological Momentary Assessment study (N = 4,825), including blood pressure, heart rate, and reports of stress, health behaviors, and thoughts. Trait gratitude and trait optimism both predicted lower heart rate and blood pressure, better sleep quality, more exercise, less stress, more positive expectations and reflections, and greater feelings of appreciation toward others. However, gratitude and optimism were not completely overlapping constructs: Gratitude was a stronger predictor of felt appreciation toward others and pleasantness when reflecting on the best part of the day, whereas optimism was a stronger predictor of sleep quality, lower stress, and lower unpleasantness when reflecting on the worst part of the day. These associations reveal both similar and differential influences of positive dispositions on psychological and physiological outcomes that provide insight into health consequences. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
It is known that social support and empathy are beneficial for mental health. As a result of the widespread development of social media, online social support and empathy could also influence user behaviors during the development of online communities. However, few studies have examined these effects from the perspective of online mental health communities. These communities appear to be a crucial source for mental health related support, but the spread of online empathy in these communities is not well-understood. This study focused on 22 mental health related subreddits, and matched and compared users (1) who received social support with those who did not receive social support, and users (2) who received more empathic social support with those who received less empathic social support. The results showed that social support and empathy are “contagious”. That is, users who received social support at their first post would be more likely to post again and provide support for others; in addition, users who received more empathic support would subsequently express a higher level of empathy to others in the future. Our findings indicate the potential chain reaction of social support and empathy in online mental health communities. Our study also provides insights into how online mental health communities might better assist people to deliver social support that can help others to deal with mental problems.
There is widespread public and academic interest in understanding the uses and effects of digital media. Scholars primarily use self-report measures of the quantity or duration of media use as proxies for more objective measures, but the validity of these self-reports remains unclear. Advancements in data collection techniques have produced a collection of studies indexing both self-reported and log-based measures. To assess the alignment between these measures, we conducted a pre-registered meta-analysis of this research. Based on 106 effect sizes, we found that self-reported media use correlates only moderately with logged measurements, that self-reports were rarely an accurate reflection of logged media use and that measures of problematic media use show an even weaker association with usage logs. These findings raise concerns about the validity of findings relying solely on self-reported measures of media use.
Facebook and other social networking sites allow observation of others’ interactions that in normal, offline life would simply be undetectable (e.g., a two-voice conversation viewable on the Facebook wall, from the perspective of a real, silent witness). Drawing on this specific property, the theory of social learning, and the most direct implications of emotional contagion, our pilot experiment (N = 49) aimed to test whether the exposure to others’ grateful interactions on Facebook enhances (a) users’ felt gratitude, (b) expressed gratitude, and (c) their subjective well-being. For the threefold purpose, we created ad hoc Facebook groups in which the exposure to some accomplices’ exchange of grateful messages for 2 weeks was experimentally manipulated and users’ felt/expressed gratitude and well-being were consequently assessed. Results partially supported both hypotheses. Observing others’ exchange of grateful posts/comments on Facebook appeared to enhance participants’ in-person expression of gratitude (i.e., self-reported gratitude expression within face-to-face interactions), but not their direct and subjective experiences of gratitude. Similarly, exposure to others’ grateful messages improved some components of subjective well-being, such as satisfaction with life, but not negative and positive affect. Taken together, however, our preliminary findings suggest for the first time that social networking sites may actually amplify the spreading of gratitude and its benefits. Implications of our results for professionals and future research in the field of health, education, and social media communication are discussed.
Background: Recent advances in mobile technology have created opportunities to develop mobile apps to aid and assist peoplein achieving various health and wellness goals. Mental health apps hold significant potential to assist people affected by variousmental health issues at any time they may need it, considering the ubiquitous nature of mobile phones. However, there is a needfor research to explore and understand end users’perceptions, needs, and concerns with respect to such technologies.
Objective: The aim of this paper is to explore the opinions, perceptions, preferences, and experiences of people who haveexperienced some form of mental health issues based on self-diagnosis to inform the design of a next-generation mental healthapp that would be substantially more engaging and effective than the currently available apps to improve mental health andwell-being.
Methods: We conducted six focus group sessions with people who had experienced mental health issues based on self-diagnosis(average age 26.7 years, SD 23.63; 16/32, 50% male; 16/32, 50% female). We asked participants about their experiences withmental health issues and their viewpoints regarding two existing mental health apps (the Happify app and the Self-Help AnxietyManagement app). Finally, participants were engaged in a design session where they each sketched a design for their ideal mentalhealth and well-being mobile app.
Results: Our findings revealed that participants used strategies to deal with their mental health issues: doing something todistract themselves from their current negative mood, using relaxation exercises and methods to relieve symptoms, interactingwith others to share their issues, looking for an external source to solve their problems, and motivating themselves by repeatingmotivational sentences to support themselves or by following inspirational people. Moreover, regarding the design of mentalhealth apps, participants identified that general design characteristics; personalization of the app,including tracking and feedback,live support,and social community;and providing motivational contentand relaxation exercisesare the most important featuresthat users want in a mental health app. In contrast, games, relaxation audio, the Google map function, personal assistance toprovide suggestions, goal setting,and privacy preservationwere surprisingly the least requested features.Conclusions: Understanding end users’needs and concerns about mental health apps will inform the future design of mentalhealth apps that are useful to and used by many people
The current study examined the relationship between empathy, resilience, and gratitude. Specifically, the study investigated the potential mediating role of resilience between empathy and gratitude. The study involved 214 participants who completed the Gratitude Resentment and Appreciation Test-Revised (GRAT-R), the Questionnaire of Cognitive and Affective Empathy (QCAE), and the Resilience Measurement Scale (SPP-25). The results showed significant positive correlations among resilience, empathy, and gratitude. Multiple regression analysis confirmed that resilience, gender, and affective empathy were direct predictors of the level of gratitude. Structural equation modeling (SEM) analysis supported the hypothesis that resilience played a mediating role between empathy and gratitude. Implications for research and the promotion of positive psychology programs for adults are discussed.
Today eSports gaming is enjoying growing popularity in the world and much attention from various research areas, including CSCW. eSports gaming is a highly competitive environment commonly associated with negative emotions such as anxiety and stress. However, little attention has been paid to emotion regulation in eSports gaming. In this study, we empirically investigated how players experience emotion and regulate emotions in League of Legends, one of the largest eSports games today. We identify four emotive factors, as well as emotion regulation strategies that players deploy to manage the emotions of their selves, teammates, and opponents. We further report on how they use emotion regulation in emotional self-care and emotional leadership. Building upon this set of findings, we discuss how the competitive eSports gaming context conditions emotion regulation in League of Legends, foreground emotion regulation expertise in competitive gaming, and derive implications for designing emotion regulation technologies. CCS Concepts: • Human-centered computing → Collaborative and social computing → Empirical studies in collaborative and social computing • Human-centered computing → Human computer interaction (HCI) → Empirical studies in HCI
Compared to other cities in Indonesia, DKI Jakarta, as one of the largest urban areas, is ranked quite high in divorce rates. It is known that parental divorce has several impacts on children. For example, adolescents with divorced parents have a greater risk of various psychological problems. Previous studies have shown that gratitude enhances positivity and optimism, and it also helps individuals through difficult times, including parental divorce. This non-experimental study aims to determine the role of gratitude in resilience among adolescents (12 – 21 years old) based in the Jakarta metropolitan area (Jabodetabek), whose parents are divorced. Non-probability sampling was used to recruit the participants (n = 109). The measurements used in this study are the Connor-Davidson Resilience Scale (α = 0.896) and Gratitude Scale Indonesian Version (Skala Bersyukur Versi Indonesia (SBI)) (α = 0.896). Simple linear regression showed that gratitude plays a significant role in a participant’s resilience (p < 0.05). Further, 28.9% of the variance in resilience can be explained by gratitude. These findings highlight the importance of gratitude interventions to enhance resilience among adolescents with divorced parents.
Background:
There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible.
Objective:
This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs.
Methods:
A literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts "child and adolescent mental health," "digital intervention," and "engagement." Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively.
Results:
This study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP's engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs.
Conclusions:
The development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs.
Research suggests gratitude interventions—designed to increase appreciation of positive qualities, situations, and people in one’s life—may improve psychological well-being (e.g., Seligman et al. in Am Psychol 60:410–421, 2005. 10.1037/0003-066X.60.5.410). Accordingly, mental health practitioners have promoted gratitude interventions as a means of self-help. However, results from previous reviews suggest that well-being improvements associated with gratitude interventions may be attributable to placebo effects (Davis et al. in J Couns Psychol 63:20–31, 2016. 10.1037/cou0000107; Wood et al. in Clin Psychol Rev 30:890–905, 2010, 10.1016/j.cpr.2010.03.005). With this meta-analysis, we examined the efficacy of gratitude interventions (k = 27, N = 3675) in reducing symptoms of depression and anxiety at post-test and follow-up periods. Gratitude interventions had a small effect on symptoms of depression and anxiety at both post-test (g = − 0.29, SE = 0.06, p < .01) and follow-up (g = − 0.23, SE = 0.06, p < .01). Correcting for attenuation from unreliability did not change results. Moderation analyses indicated effect sizes were larger for studies using waitlist, rather than active, control conditions at post-test and follow-up. We did not find consistent evidence for effects of other moderator variables (e.g., risk of bias, depressive symptom severity, or type of intervention used). Our results suggest the effects of gratitude interventions on symptoms of depression and anxiety are relatively modest. Therefore, we recommend individuals seeking to reduce symptoms of depression and anxiety engage in interventions with stronger evidence of efficacy for these symptoms.
Digital mental health interventions (DMHIs) have potential to provide effective and accessible care to entire populations, but low client uptake and engagement are significant problems. Few prior studies explore the lived experiences of non-engagers, because reaching this population is inherently difficult. We present an observational inquiry into the barriers to sign-up and early use of a DMHI, along with reasons for initial interest in the DMHI. We collected 205 online questionnaire responses and 20 interviews from self-referring participants across four healthcare ecosystems in the UK and US. Questionnaire results revealed that uncertainty about DMHI usefulness and usability were the main barriers to uptake, whereas forgetting about it, not finding time for it and not finding it useful were the main barriers to early engagement. Participants reported multiple reasons for considering the DMHI, reflecting the contextual, subjective nature of mental health. Our thematic analysis generated themes around 1) the need for human connection, 2) the impact of self-stigma on help-seeking, 3) the lack of knowledge around DMHIs and psychological therapy, 4) the desire for personally relevant care, and 5) the fluctuating, perennial nature of mental health. We discuss implications for DMHI design, implementation and future research, as well as transdisciplinary opportunities.
Without a nuanced understanding of users' perspectives and contexts, text messaging tools for supporting psychological wellbeing risk delivering interventions that are mismatched to users' dynamic needs. We investigated the contextual factors that influence young adults' day-to-day experiences when interacting with such tools. Through interviews and focus group discussions with 36 participants, we identified that people's daily schedules and affective states were dominant factors that shape their messaging preferences. We developed two messaging dialogues centered around these factors, which we deployed to 42 participants to test and extend our initial understanding of users' needs. Across both studies, participants provided diverse opinions of how they could be best supported by messages, particularly around when to engage users in more passive versus active ways. They also proposed ways of adjusting message length and content during periods of low mood. Our findings provide design implications and opportunities for context-aware mental health management systems.
Researchers investigating the impacts of social media on mental health must consider where exactly adolescents are in their cognitive and social development. Researchers investigating the impacts of social media on mental health must consider where exactly adolescents are in their cognitive and social development.
This study describes and examines the impact of a novel Reflective Practice program tailored to the multidisciplinary clinical workforce at an inpatient forensic mental health setting. Surveys assessing wellbeing, self-efficacy and reflective practice capacity were administered to all clinical staff prior to commencement of the Reflective Practice program, as well as six months post-implementation. Interviews were also conducted with key clinical stakeholders to obtain detailed feedback regarding the impact of the program across the organization following six-eight months of implementation. Staff who participated in post-implementation surveys reported significantly higher confidence in their work when compared to staff at baseline, while clinical stakeholders observed improvements in the cohesion of the multidisciplinary team. In spite of the limitations of the pragmatic study design and small sample size, results suggest the novel Reflective Practice program offers an acceptable model for adoption in an inpatient forensic mental health setting, with potential to improve the wellbeing, learning and morale of a forensic mental health workforce. The findings also highlight the need to support practice development and wellbeing in early career clinicians, where low confidence and high stress are predominant.
Goal setting is critical to achieving desired changes in life. Many technologies support defining and tracking progress toward goals, but these are just some parts of the process of setting and achieving goals. People want to set goals that are more complex than the ones supported through technology. Additionally, people use goal-setting technologies longitudinally, yet the understanding of how people's goals evolve is still limited. We study the collaborative practices of mental health therapists and clients for longitudinally setting and working toward goals through semi-structured interviews with 11 clients and 7 therapists who practiced goal setting in their therapy sessions. Based on the results, we create the Longitudinal Goal Setting Model in mental health, a three-stage model. The model describes how clients and therapists select among multiple complex problems, simplify complex problems to specific goals, and adjust goals to help people address complex issues. Our findings show collaboration between clients and therapists can support transformative reflection practices that are difficult to achieve without the therapist, such as seeing problems through new perspectives, questioning and changing practices, or addressing avoided issues.
One-way text messaging services have the potential to support psychological wellbeing at scale without conversational partners. However, there is limited understanding of what challenges are faced in mapping interactions typically done face-to-face or via online interactive resources into a text messaging medium. To explore this design space, we developed seven text messages inspired by cognitive behavioral therapy. We then conducted an open-ended survey with 788 undergraduate students and follow-up interviews with students and clinical psychologists to understand how people perceived these messages and the factors they anticipated would drive their engagement. We leveraged those insights to revise our messages, after which we deployed our messages via a technology probe to 11 students for two weeks. Through our mixed-methods approach, we highlight challenges and opportunities for future text messaging services, such as the importance of concrete suggestions and flexible pre-scheduled message timing.
Just-in-Time Adaptive Interventions (JITAIs) are envisioned to harness rich data on users' contexts. However, many JITAIs fall short in leveraging the value of the data while sculpting the interventions. Investigating the literature reveals a lack of user-centered design (UCD) methods in designing JITAIs. Our case study of applying a UCD process revealed that even without deploying a JITAI, UCD could uncover user interactions that inform critical design decisions of a JITAI's components. We reflect on our experiences engaging in a user-centered JITAI design process and urge the broader human-computer interaction (HCI) community to devise concrete design guidelines for JITAIs. We take the first step toward that goal by proposing a checklist of key design considerations for future JITAIs. Together, this case study contributes insights on applying UCD to the design of all components of a JITAI, which can help capture users' needs and provide actionable interventions.
Young adults have high rates of mental health conditions, but most do not want or cannot access formal treatment. We therefore recruited young adults with depression or anxiety symptoms to co-design a digital tool for self-managing their mental health concerns. Through study activities-consisting of an online discussion group and a series of design workshops-participants highlighted the importance of easy-to-use digital tools that allow them to exercise independence in their self-management. They described ways that an automated messaging tool might benefit them by: facilitating experimentation with diverse concepts and experiences; allowing variable depth of engagement based on preferences, availability, and mood; and collecting feedback to personalize the tool. While participants wanted to feel supported by an automated tool, they cautioned against incorporating an overtly human-like motivational tone. We discuss ways to apply these findings to improve the design and dissemination of digital mental health tools for young adults.
Decades of research demonstrate that expressing gratitude has various psychological and physical benefits. At the same time, gratitude routines run the risk of being a hassle activity, which diminishes the positive outcome. Speech assistants might help to integrate gratitude routines more easily in an intuitive way using voice input. The results of our 8-day field study with two experimental groups (Alexa group vs. Paper group, N = 8) show that users see the benefits, that Alexa was effective in reducing participants’ stress and that both groups express their gratitude differently. The positive effect of Alexa was restricted by a security setting (limiting user input to eight seconds) imposed by Amazon, which has now been repealed. The findings give practical and theoretical implications of how verbal gratitude expression affects participants’ well-being.
Although gamification has received considerable attention from both researchers and practitioners, its influence on consumers remains ambiguous. This paper proposes that a negative process through decreased attention and a positive process through increased enjoyment explain the effects of gamification on different outcome variables. Study 1 examines these two processes and gamification’s downstream consequences on purchase intention and product information recognition. For purchase intention, the two processes operate in parallel and produce a null effect of gamification. For product information recognition, only the negative process emerges, resulting in a negative effect of gamification. Studies 2 and 3 focus on the negative effect of gamification on product information recognition and show that the negative effect disappears in gamification designs that link the game elements with meaningful information about the product (Study 2) or make consumers aware of the distraction potential of game elements (Study 3). The studies’ findings provide managerial insights into why not all gamification endeavors yield the desired results; they also specify two boundary conditions (i.e., meaningfulness and disclosure) that may help managers avoid potentially detrimental effects of gamification.
Objective
Gratitude interventions are easy-to-deliver, offering promise for use in clinical-care. Although gratitude interventions have consistently shown benefits to psychological wellbeing, the effects on physical health outcomes are mixed. This systematic review aims to synthesize gratitude intervention studies which assessed physical health and health behavior outcomes, as well as evaluate study quality, comment on their efficacy, and provide directions for future research.
Methods
Relevant studies were identified through searches conducted in PsycINFO, MedLine, Embase and Cochrane Library databases, up until August 2019. Only studies that evaluated a gratitude intervention, randomly assigned participants to gratitude and control conditions, and assessed objective and subjective measures of physical health and health behaviors were included. The Revised Cochrane risk-of-bias (RoB2) tool was used to assess risk of bias.
Results
Of the 1433 articles found, 19 were included in the review. Subjective sleep quality was improved in 5/8 studies. Improvements in blood pressure, glycemic control, asthma control and eating behavior were understudied yet demonstrated improvements (all 1/1). Other outcome categories remain understudied and mixed, such as inflammation markers (1/2) and self-reported physical symptoms (2/8). The majority of studies showed some risk of bias concerns.
Conclusions
Although it was suggested gratitude interventions may improve subjective sleep quality, more research is still needed to make firm conclusions on the efficacy of gratitude interventions on improving health outcomes. Further research focusing on gratitude's link with sleep and causal mechanisms is needed, especially in patient populations where more ‘clinically-usable’ psychosocial interventions are urgently needed.
While the HCI field increasingly examines how digital tools can support individuals in managing mental health conditions, it remains unclear how these tools can accommodate these conditions' temporal aspects. Based on weekly interviews with five individuals with depression, conducted over six weeks, this study identifies design opportunities and challenges related to extending technology-based support across fluctuating symptoms. Our findings suggest that participants perceive events and contexts in daily life to have marked impact on their symptoms. Results also illustrate that ebbs and flows in symptoms profoundly affect how individuals practice depression self-management. While digital tools often aim to reach individuals while they feel depressed, we suggest they should also engage individuals when they are less symptomatic, leveraging their energy and motivation to build habits, establish plans and goals, and generate and organize content to prepare for symptom onset.
Gratitude interventions have been consistently found to enhance individuals’ gratitude level. However, most of the existing gratitude interventions require handwriting that is difficult to sustain among young adults who often use social networking sites. This study thus proposed and tested a social media-based gratitude intervention. Thirty-three undergraduate students aged between 18 and 24 years were randomly assigned to gratitude group and control group. Participants in the gratitude group were instructed to post one picture with a caption related to gratitude on Instagram for 7 days. Likewise, the control group was to post a picture with caption related to colour. All participants answered Big Five Inventory short version before the intervention as well as the Gratitude Questionnaire-Six-Items Form, Perceived Stress Scale, and Satisfaction with Life Scale before and after the intervention. Analysis of covariance (controlling personality traits, pre- and post-measured stress and life satisfaction) indicated that students in the gratitude condition reported higher levels of gratitude than those in the control group. No significant difference was observed for post-measured stress and life satisfaction. Overall, the preliminary findings support that the gratitude intervention through Instagram is a promising method to increase gratitude among young adults.
Millions of Americans struggle with depression, a condition characterized by feelings of sadness and motivation loss. To understand how individuals managing depression conceptualize their self-management activities, we conducted visual elicitations and semi-structured interviews with 30 participants managing depression in a large city in the U.S. Midwest. Many depression support tools are focused on the individual user and do not often incorporate social features. However, our analysis showed the key importance of sociality for self-management of depression. We describe how individuals connect with specific others to achieve expected support and how these interactions are mediated through locations and communication channels. We discuss factors influencing participants' sociality including relationship roles and expectations, mood state and communication channels, location and privacy, and culture and society. We broaden our understanding of sociality in CSCW through discussing diffuse sociality (being proximate to others but not interacting directly) as an important activity to support depression self-management.?
There is a mental health crisis facing universities internationally. A growing body of interdisciplinary research has successfully demonstrated that using sensor and interaction data from students' smartphones can give insight into stress, depression, mood, suicide risk and more. The approach, which is sometimes termed Digital Phenotyping, has potential to transform how mental health and wellbeing can be monitored and understood. The approach could also transform how interventions are designed, delivered and evaluated. To date, little work has addressed the human and ethical side of digital phenotyping, including how students feel about being monitored. In this paper we report findings from in-depth focus groups, prototyping and interviews with students. We find they are positive about mental health technology, but also that there are multi-layered issues to address if digital phenotyping is to become acceptable. Using an acceptability framework, we set out the key design challenges that need to be addressed.