My Role: User Research, UX Strategy, Wireframes, UI/Visual Design
Tools: Sketch, Adobe Illustrator, Marvel, Lots of Paper, Sharpies
The Brief
Healium allows users to complete simple mental health improvement exercises which are then used to pair them with an online mental health practitioner specifically suited to their needs. My team of three strived to create a more accessible mental health aid with Cognitive Behaviour Therapy.
We aspired to create health-related designs that improve the lives and wellbeing of others. There currently are limited digital options available to those who suffer mental health related issues. Our goal was to provide individuals tools for self-help and a system to connect them with relevant mental health practitioners for additional aid.
What is CBT?
Anxiety disorders are one of the most prevalent disorders, affecting approximately 18% of the US population, and tend to be persistent and unremitting, causing life impairments. Extensive research has demonstrated that Cognitive Behaviour Therapy (CBT), a psychotherapeutic treatment, has positive efficacy for treating anxiety disorders in adults.
When you have a negative thought or feeling, or act out a negative behaviour, it creates a maladaptive pattern of behaviour that maintains your negative mood in a vicious cycle.
Cognitive Behaviour Therapy is for individuals to
- Identify their thoughts, feelings, and behaviours
- Learn how it is all intrinsically linked together
- Learn how each one can affect the others in a cycle
The key to breaking this cycle is to recognize your behaviour and thought patterns so you can interrupt and change them.
Therapy Barriers
There are many barriers to traditional in person treatments:
- The high cost of in person sessions
- Difficulty in finding the right client-practitioner fit
- Lack of oversight over a client’s progress between sessions
- Social anxiety issues preventing face to face communications
- Living in a remote location
Current options on web and mobile are unintuitive, chaotic, and impersonal. Usability is often lacking and there are no ways to connect with an actual therapist.
How Healium Solves These Problems
We designed a product to administer CBT treatments in an accessible way with the ability to connect users to real-life support.
Features:
- Easy-to-use mental health journaling tools
- Patented client-practitioner pairing algorithm
- Effective communications platform to facilitate online client-practitioner working sessions (for subscribers)
- Clients have a primary practitioner and access to a group of on-call practitioners who can assist during a crisis
Healium allows users to achieve more significant and sustainable mental health improvements compared to the traditional method.
The Competitors
There are mobile applications on the iOS store with a similar approach in the self-help segment that prioritize ‘mindfulness’ but there are no competitors on the market that offer their users access to professional practitioners or specifically administer CBT. Most of the related apps are chaotic in structure, locked behind paywalls, or impersonal.
Competitors: Remente, Headspace, & Pacifica
Complicated & Unclear — Their products demands a large cognitive load of users due to the high level of UI noise, quantity of choices, and hidden choices. When testing competitor apps, users were uncertain of the goal of the apps and which tools to utilize with their problems.
We reduce the strain by training users to be proficient in only one tool — the Thought Journal — arguably one of the most prominent tools of CBT therapy. We will allow users full access to this feature which is typically only available to premium users of competitor apps. We anticipate users will be distressed when they reach for this app and needing our help, so the app by default will open to the Thought Journal when they have previously signed-in already.
Lack of human interaction — Research in control trials have indicated CBT administered via video-conference calls and 2-way audio calls is as effective as in-person sessions. We can offer clients support in real-time, around the clock with remotely based therapists and remove most location based accessibility barriers. We would concentrate our efforts on text messaging as the primary means of communication.
There currently are not as much research literature on CBT therapy based on text messaging; however, there has been a continuous growth of messaging apps and our survey had 70.4% of users preferred messaging to other options.
Lack of Personalized Recommendations — All our competitors have large libraries of static premium content; each category revealed more options. When given too many choices, users will experience decision paralysis — a choice is never made, potentially leading to no subscription renewal. We can create a system that leverages our users previous Thought Journal entries to provide personalized content recommendations.
Customer Insight
We conducted customer research to drive our design and planning. We began with conducting five user interviews with psychologists, mental health practitioners, mental-wellness aids and individuals. We also conducted an online survey with 27 individuals on their smartphone and journal usage and their attitude towards sharing their feelings.
Survey topics and findings:
- Smartphone usage is fairly high — 44% 1–5 hours usage and 41% 5–10 hours usage per day
- Some familiarity with keeping a journal — 48% of surveyed users have experience keeping a journal
- Surveyed users felt the two biggest obstacles preventing a given person to seek professional guidance are cost (80%) and being uncomfortable sharing feelings (42%)
- Mixed attitudes on sharing feelings with friends vs counselors
Introducing Healium
Healium is a iOS app that helps users achieve emotional balance through introspection of their thoughts and feelings based on empirically supported Cognitive Behavioural Therapy treatments.
Challenging Their Thoughts
Every user can utilize the core tool of CBT — their own personal Thought Journal — for free!
Communication With Their Practitioner
For a monthly subscription, users will be partnered with their primary Guide — a certified mental health practitioner — and 24/7 access to our team of support guides. Healium’s primary and support guides can be contacted anywhere, anytime you need immediate guidance.
The Challenge
1) Creating a Simple Engaging, Introspective digital tool to help break the ‘Cycle’
A core process to breaking the cycle is teaching individuals how to identify and challenge their thoughts successfully. Individuals are given a paper worksheet — Thought Journals — to complete on a daily basis.
However, the conspicuousness and inconvenience of paper worksheets formed the basis for our challenge: to translate this exercise into a discrete digital format for users to use whenever, wherever while minimizing privacy concerns. We prioritized simplicity to minimize the cognitive load required of users who are already in a stressed or emotional state.
2) Means of communication between practitioner-clients
While journaling is only one strategy of CBT, a certified practitioner can amend more complex user needs through strategies such as role-playing, relaxation techniques, and mental distractions.
Our customer research revealed that users preferred messaging (70%) over calling by phone (25.9%) or video (3.7%) when contacting others to share their feelings. We want to provide practitioners and individuals a professional platform to communicate in ways most comfortable for the individuals — though messaging.
We focused on creating a friendly and casual feel with all content that is related to practitioners, especially the mode of contact between practitioner and individuals. In our user interviews with practitioners, we learned that most clients change practitioners as they felt the practitioners “didn’t care” and “were cold.” Also our online survey results suggest users simultaneously identify highly:
- “I find it hard to talk to anyone about how I feel”
- “I can easily explain to a friend how I feel inside.”
We want to users to perceive our practitioners as friends to facilitate ease in communicating their feelings.
The Design Hurdles
The biggest challenge of this project was translating traditional CBT techniques into a digital platform. How could we mirror the Thought Journal, paper worksheets, and therapist-guided sessions — all of which are physical and real in nature — in an accessible and mobile-friendly product? The solution would have to be equally, if not more- engaging, effective, and usable as traditional CBT.
After the initial planning and translating of CBT worksheets to digital forms, we concentrated on pain points and usability issues. We conducted five rounds of usability testing with three to four users each round and used the data to drive change in each of the five iterations of our design.
Balance of Simplicity and Ease of Thought Journal
One page vs Pagination — Our initial translation of the Thought Journal worksheets were linear flows with pagination of each step. During testing we noticed users demonstrated the need to review and edit previous answers, sometimes having to scroll through many screens if they are at a later step. We consolidated the entire Thought Journal to one screen to increase efficiency of use and decrease recall burden.
Progress Markers & Steppers — We had users voice aloud they were uncertain of where they are in the progress of the Thought Journal when each step was an individual screen. After this feedback, we added visible progress markers to indicate the user’s progress and ceased hearing related comments during testing.
Clarity with Vertical Linear Steppers — We observed some users are very thorough in their responses to the questions in the Thought Journals; so much so, they pretty much answer all the questions in the very first question as they were unaware of the nature of the following questions. To combat this problem we implemented linear steppers that minimize content displayed to only the questions in the stepper labels. This change effectively increased clarity and readability with simplicity by using progressive disclosure to hide unnecessary information.
Navigation to “Important” Content
The circular action item on the bottom tab bar was very popular during usability tests; most users would tap there when given a task that begins on the home screen. Our testers would consistently tap on the circular button to input a new Thought Journal but we also wanted to know what other actions they expect the button to have.
We used hierarchical card sorting to learn what users considered as the three “the most important actions.” Of the 13 options, participants consistently chose actions that fell into three categories:
- Their past entries
- Their progress
- Contact their guide
In the final iteration of this button, we included only 3 links:
- New Thoughts
- My progress
- Contact my guide
Content Strategy
Progressive Disclosure
It quickly became obvious users required succinct information located in one place during our first round of testing: users swiped past information screens without reading the content and would swipe back-forth to (re)read the information. We adapted a progressive disclosure strategy to condensed each step into one screen to increase usability and reduce cognitive load and information complexity.
Readability
We also needed to be a focus on translating the language and jargons — from technical psychobabble to a casual everyday conversation. During earlier tests, participants were confused by on-screen instructions due to the technical nature of the text and felt that the tone of ‘voice’ was cold. We used A/B testing to progressively express complex content in the simplest way possible to utilize the familiarity principle.
Language Limitations
During initial usability testings we observed some of our testers had difficulty navigating and completing certain tasks; through the think-aloud process, we learned that this was due to language barriers. Once we replaced text links that require cultural context with icons, we reduced the dependency on contextual instruction and increased accessibility.
Messaging Feature
We kept the design of the messaging feature native to iOS Messages as 70% of our survey respondents use Apple smartphone. Why try to reinvent the wheel when users already demonstrate high aptitude to the existing conventions?
In future versions, we would focus on how to increase users perception of their mental health practitioners friendliness and intimacy as our survey highlighted the ease of conversing feelings with friends. Hence, the importance of users perceiving it as a conversation amongst friends — albeit one that can guide you through CBT sessions.
The Prototype
You can check out my prototype here.
Forward Thinking
- With the advancement of chat bots, it may be possible to use chat bots in addition to human therapists in the future and lower the costs for subscribers.
- In future versions, we can animate the balloons and to “pop” when tapped on for additional content (eg. quotes) to appear on the screen temporarily.
- More usability tests, More iterations.
Reflection
In these two months I enjoyed every moment working on this project and have learned how to better apply psychology to design. I have studied psychology in my undergrad and found it immensely useful in UX, so I want to pursue a career in UX and product design. This project gave me an opportunity to apply what I wanted to learn and so much more.
Thanks for reading! If you want to collaborate, chat about product design, or just want to say hello, you can reach me via LinkedIn.
