7. Experience Design Guidelines for PTSD
This article is part of a research study publication on Experience Design for PTSD. This section presents the output of the human-centred design research specified as twelve experience design guidelines in four categories: Preparation, Activation, Intervention, and Nurturing.
The following design guidelines provide recommendations on experience design requirements for digital products serving adults who have been exposed to a singular traumatic event. Complex and cumulative PTSD are not included in the scope. The focus is on trauma recovery needs and not on the type of event that caused it. The intended purpose of the guidelines is that product designers have better understanding of the specific human needs related to trauma to develop more suited products. In order to ensure validity, the guidelines are based on the principles of clinically appraised treatment approaches for PTSD and feature selected techniques which were evaluated as appropriate for digital design context.
The guidelines are meant to be used by practitioners in design development fields. Importantly, they are not intended to be used prescriptively but as a research-based foundation for ideation on assistive product/service systems for trauma. Applicable design areas include not only design for mental health, but also positive design, emotion design, and well being design among others.
The twelve principles are organised in 4 categories — Preparation, Activation, Intervention, Nurturing. Each of the principles are composed using the product emotion model by Pieter Desmet featuring three key variables — concern, stimulus, and emotion. In the context of this study concerns represent the PTSD persona’s attitudes and beliefs; emotion represents the particular human need in regard to the concern; stimulus represents the type of experience conducive to eliciting the emotion need. The central element of the model is appraisal, which represents the principle.
Overview of Experience Design Guidelines for PTSD
1. Preparation
The first phase addresses the necessity to provide users with key resources as a stable foundation for further therapeutic practice. The human needs serving as basis for this phase are sense of safety, trust and self-reliance also supported by the cognitive processing therapy rationale by Resick et al. (2007). This phase should be the onset of interaction with the system and has foundational importance for the effectiveness of following phases.
1.1. Sense of Safety
The most common pattern among the interview insights was feelings of vulnerability, insecurity, fears and nightmares of dangerous situations which all carry the essential meaning of need for safety. Lack of safety, whether from uncontrollable anxiety or other external threats, is recognised also by clinical guidelines as a core treatment need in PTSD.
The state of anxiety and hypervigilance in PTSD is explained by Levine (2008) with the damaged sense of own physical boundaries because trauma causes disconnection from the body. Hence, a basic way to establish sense of safety and protection is to create awareness of body boundaries. According to clinical guidelines it is an important good practice point to establish a sense of safety for the person prior treatment.
The experience of creating physical sense of body boundaries was prototyped with the use of the following techniques:
- Skin tapping exercise: the goal is to stimulate the neuroreceptors on the skin which is the outer body container and the first point of protection from the environment and others. It creates a sense of ownership over the body and strengthens the awareness of the first line of defence. This helps on a subtle level to neutralise the feeling of raw exposure caused by the trauma. This technique is based on somatic experiencing therapy.
String boundary exercise: an easy but powerful technique to determine the extent of personal boundaries in a radius around the body with the use of yarn or string. It is a helpful reflection on what is the comfortable distance for interpersonal interaction. The technique is part of the SE treatment approaches.
Progressive muscle relaxation The goal is to revive a sense of body boundaries by activating the parasympathetic nervous system. It involves relaxing each muscle group step-by-step to promote a strong feeling of physiological embodiment. This technique draws from anti-panic TB-CBT.
Emotion freedom technique (EFT): the underlying rationale of this technique is that traumatic emotional disturbances are caused by disruption in energetic field that can be restored by stimulating particular locations on the body. It is performed by focusing on a traumatic memory whilst lightly tapping on meridian points on the hands, face, and upper body. EFT is a recommended alternative therapy by clinical guidelines.
1.2. Sense of Trust
For most interviewed participants a consequence of experiencing traumatic event is diminishing of trust. Depending on the specific circumstances the lack of trust was expressed both in inner and outer realms by loss of trust in own ability to handle life, in others, and the world.
Sense of mistrust accentuated by the anxieties of the traumatic experience was also highlighted in the expert interview with David Bolton. Thus, it is critical when designing systems for traumatised people that they are meaningful in relation to their experiences and needs. Bolton also points out that in his practice, people found tremendous sense of relief when they could understand their symptoms within a framework. Thus, PTSD can be addressed not just with medical approaches but as an endeavor to help make sense of the common human experience in the wake of trauma and provide simple guidance for self-help to re-establish the trust in oneself and others.
Grounding and centring techniques are essential in PTSD interventions. Flashbacks lead to losing a sense of reality, ground, and self in the present moment. The mismatch of personal experience and reality disrupts the ability to trust own judgement leading to be heavily influenced by external circumstances and opinions. It is important to re-establish connection to ground and to the body’s centre of gravity which is the origin of action and feeling. This experience requirement of grounding and centring draws on resources naturally available in human body.
Digital biofeedback tools can be useful to identify the need for grounding by detecting the physical signs of fight-flight-freeze response to a flashback — rapid, shallow chest breathing, rapid heart-beat, cold, sweaty hands, and neck spasms, and then prompting the user to proceed with the recommended techniques.
The experience of creating sense of trust was prototyped with the use of the following techniques:
Breathing exercises: breathing is a powerful mechanism that regulates the ANS in a way that calms the viscera activity, alters blood circulation, hormonal and endocrine secretion, decreases cognitive arousal and affects emotion. To support grounding experience it is necessary to train diaphragmatic breathing to counter hyperventilation in stressful situations. Examples from mindfulness-based trauma therapy of breathing techniques to achieve this are the alternate nostril breathing and breath of fire. Clinical guidelines also recommend aerobic exercise as part of self-care practices for PTSD.
Physical Grounding
Yoga practice is recognised by medical professionals as an effective therapeutic intervention for its benefits to control internal emotion response, resilience to stress and equanimity as well as cultivation of ability to feel what is happening in the body and mind. This is important for behaviour change and psychological self-efficacy. Body positions featuring planting heels into the ground, stretching, extending limbs and spine, and balance poses are mentioned by both TB-CBT and SE practices.
1.3. Sense of Self-reliance
The foundational human need for this experience requirement is self-reliance which was apparent in several interviewed participants. The feelings of vulnerability and lack of trust relate to the preference to handle the situation individually which in some cases leads to isolation.
The primary goal of this experience requirement is to resource a person with positive inner feelings of strength, comfort, and optimism, as well as ability to move from learned helplessness towards internal control. Empirical studies show evidence that patients’ internal strengths and resources available in their environment are the single largest contributory factor in determining the success of interventions.
Clinical guidelines recommend that thorough assessments of relevant history, physical health, social capacity, and quality of life including assessment of strengths and resilience should be made prior to therapy . Also monitoring of progress should be undertaken throughout the duration of treatment. Considering this the system should assess needs for practical and social support based on data analytics and provide recommendations accordingly. This would allow customisation to the unique circumstances of the user and establishing collaboration supporting the sense of self-reliance.
The experience of creating a sense of self-reliance was prototyped with the use of the following techniques:
Resources box
The system should prompt user to create collection of internal resources (such as agility, strengths, talents, spiritual practices, intelligence traits), and external resources (trusted people, pets, nature, sport activities, music). This technique is suggested by SE treatment practice and TF-CBT.
The participant was asked to make a list of helpful activities she does in her external environment, a list of trusted people in her inner circle, and a list of her own inner strengths she can rely on in difficult times. As a ritual, the participant placed the lists in the centre of the wooden dolls as a symbol of the inner and outer spheres of herself.
Anxiety Avoidance Hierarchy This is another CBT technique aiming at externalising the avoided situations. The goal is to develop awareness of feared situations rated at how distressing would feel to encounter them. This resource can be used by the system to guide a gradual exposure to irrational fears.
Collection of helpful techniques
The system should store a collection of helpful techniques either entered by the user or detected through behavioural experiments . This is a CBT tool to test the validity of thoughts or beliefs, and can be used to gather evidence for new beliefs and behaviours. It aims at questioning the user’s expectation of a particular situation and comparing it to reality outcome. The cognitive model of PTSD can be used to identify mechanisms that loop trauma and prevent recovery such as unprocessed intrusive memories, beliefs regarding the trauma, the self, and the world that lead to intense emotional reactions, and dysfunctional coping strategies.
Artistic expression: Trauma is by nature incomprehensible and verbally inexplicable due to shutting down of the thinking cognition at time of the traumatic event. Hence, it is difficult for people to explain with words what and how they feel. In such cases, expressive art therapies have demonstrated positive evidence-based results. This approach helps to initiate an imagination-driven exploration of the self through role play, dramatic enactment, storytelling, mask making, etc. Psychologically, this techniques are founded on Jung’s theory of persona and the various ways it manifests itself.
Rational thinking training Most treatments for PTSD emphasise the importance of strengthening the capacity to think rationally in triggering situations as a resistance to emotional overwhelm. Exercising neocortex brain activity as a routine is helpful to develop this skill. A suited technique is the PMI method by Edward de Bono which stands for pluses — minuses — interesting points. Stimulating users to deliberately think of positive, negative, and interesting aspects of any situation is effective mechanism to cultivate ability to consider various perspectives at any given time and expanding the internal resource base. Intelligent digital systems can use the data to continually learn about the user’s values and world perspectives to use as foundation for further coping strategy recommendations in triggering situations.
2. Activation
This section of principles addresses the symptoms of numbness, detachment, and dissociation typical for PTSD and the need to re-establish feeling of ‘normalcy’ as described by the research participants. The user needs underlying the experience requirements in this phase are not directly derived from the interviews but represent the researcher’s interpretation through abductive reasoning from both the primary research data and secondary sources on the implications of PTSD. The experience design principles focus on paying attention to physical and emotional sensations in a particular way with the idea of activating a felt sense.
2.1. Felt Sense Stimulation
This experience requirement is based on the need for people with trauma to start perceiving negative emotions as states and not get identified with the negative conditioning. All of the participants reported in different ways not feeling as they used to or not being able to feel sensations as usual.
Diminished emotional responses and inability to feel sensations are typical trauma symptoms occurring in the long-term after the event (Levine, 2008). They can be explained with the systematic effort to avoid negative feelings which over time numbs the ability for general sensations. To address the need to ‘feel normal again’ this experience focuses on regaining feeling of embodiment by guiding users to identify their own felt sense of the sensory, energetic, and emotional landscape. Felt sense is a term relating to a physical experience characterised by bodily awareness of a given situation. The body awareness is an anchor to the present moment and it is important to train people with dissociative symptoms to recognise their memories as past events and their sensations as current events. According to Peter Levine the key to finding a sensation is to locate it in the body with a specific size, shape, and physical qualities such as tightness, spaciousness, constriction, heat, cold, vibration, or tingling.
The purpose of this principle is to help users identify their senses such as touch, taste, odour, visual and hearing stimulation so that they can distinguish whatever is happening now. The goal is to continuously refine and expand the nuances of the body awareness to be able to investigate what is happening with them with regard to trauma response. The desired outcome is to re-stabilise the emotional state and recognise triggers as they are occurring. Noticing these body sensation rather than getting overwhelmed in mental panic helps activate the frontal cortical centres of the brain and bring the ANS to a calmer state.
The experience of felt sense stimulation was prototyped with the use of the following techniques:
Sensory awareness: guide the user to identify and refine a nuanced sensory awareness by stimulating different senses and training the ability to tune with and describe the felt sense, the sensations occurring on subtle and overt levels in all areas of the body. This experience was prototyped by asking the participant to taste two edible materials with contrasting flavours, touch three different textures, and smell 3 different odours. The participant was instructed to perform the test with eyes closed and try to describe the type and qualities of the body sensations.
The user was asked questions such as:
- What sensation do you have in your body?
- Where in the body do you feel it?
- How do you know that it feels that way?
A list of example qualities of the felt sense was provided prior to the exercise to assist the user in the verbal description . This technique is based on the somatic trauma therapy. Over time the system should expand the sensory stimulation to encompass broader visceral sensations to include the physiological condition of the entire body in order to reach awareness and affect behaviour.
2.2. Emotion Activation Tracking
This principle focuses tracking emotional activation by connecting the sensation to its origin (e.g. thought). By recognising how certain thoughts cause certain sensations the possibility to shift between emotional states becomes apparent. The idea of this experience requirement is to train this ability. By being aware of the interaction between thoughts, sensations and emotions, one will be able to simply track the arising bodily sensations instead of getting stuck in habitual traumatic patterning as advised by Peter Levine.
The interoceptive cues mentioned in the felt sense principle are referred to as somatic markers having significant role for making re-conscious judgements about the environment. In a PTSD triggering situation the tendency is to focus on the negative cues only which increases fear reactions. The Emotion Activation Tracking experience practice draws the user’s attention from negative to non-aversive somatic markers and engages the rational thinking capacity to bring the ANS naturally to a less fearful state. This is accomplished by attention to interoceptive variance rather than cognition.
The experience of tracking emotional activation was prototyped with the following technique:
Emotional activation exercise
This technique guides the participant to notice their emotional activation as it occurs triggered by a particular situation. It was prototyped and tested by having the user listen to an audio recording of a neutral, non-trauma related story in which they are the main actor going through various situations that stimulate different emotional reactions. As a new situation occurs the user is guided to focus attention the new event and the arising sensations and emotions. This technique draws from trauma-focused mindfulness-based therapy.
2.3. Tracking Rhythms of Expansion and Contraction
This experience requirement build on the previous and is about establishing a harmonious flow in transitioning between emotional states.
In healthy nervous system there is a smooth transition between high emotion (sympathetic nervous response) and low emotion (parasympathetic nervous response) which is regulated by the ANS as explained in detail by Stephen Porges. Trauma disrupts the ANS balance which causes abrupt changes in emotional states triggered by particular situations. Getting stuck in high activation state (sympathetic system) happens when the unfinished motor response if fight or flight and is characterised by aggression, anger, rage, fury reported by 4 interview participants. Getting stuck in low activation state (parasympathetic system) happens when the unfinished motor response is freeze and is characterised by feelings of helplessness, depression, fatigue reported by 2 interview participants.
This explains why in traumatised people new situations are sometimes instinctively related to the past traumatic event which constricts the full natural experience of the new event. The key to release this constriction is to learn to stay with the sensation until it peaks and begins to change. By nature, if not rationally restricted, this cycle lasts around 10sec (Levine, 2008). However, if it is resisted, the emotion can aggravate and arouse the ANS in either direction and get stuck. In such cases it can be helpful to stimulate the vagus nerve and to calm the visceral response. The vagus nerve is the central element of the parasympathetic nervous system which controls the relaxation response in the body (van der Kolk, 2014). It originates in the brain stem and reaches almost all internal organs and glands that produce anti-stress hormones. There are many ways to stimulate the nerve among which are cold shower, breathing into a small paper bag, deep diaphragmatic breathing, and singing.
The experience of harmonious flow was prototyped with the use of the following techniques:
- Activation Flow State is a technique guides the participant to notice their emotional expansion and contraction caused by a particular circumstances. It was prototyped and tested by having the user read a neutral, non-trauma related story in which they are the main actor getting stuck in a traffic jam, and subsequently start to move. The user was guided to focus attention the the arising sensations and emotions related to stuckness and liberation. This technique is from SE therapy.
- Vocal exercise is a technique that guides the participant to track rhythms of emotional expansion and contraction. For the purpose of the experience test, a vocal exercise from SE therapy was chosen . If the emotional activation during the pendulation exercise gets too high, the participant was instructed to take a deep breath and vocalise the sound “vooo” while exhaling fully and continue several times until the emotional stuckness dissolve and the ANS is brought back to equilibrium.
- Neurofeedback is a technique that enables a person to observe and alter their brainwaves. It is based on electrical brain activity and is visualised through electroencephalogram (EEG). Neurofeedback is training in self-regulation allowing the central nervous system to function better . This technique was not part of the prototype and testing and is featured here as an example.
3. Intervention
This phase is aimed at assisting the user to re-establish balance in distressing states of triggering situations. The goal of the featured experience requirements to enable discharging of excess energy in a safe and conscious way when a person is overwhelmed by sudden emotional arousal or collapsed by feelings of helplessness. The experience requirements in this section are designed to be suitable for self-paced practice but it is mandatory to be administered, adapted to the user’s specific circumstances, and monitored by a clinical therapist. Due to ethical considerations, these experience requirements were not practically tested with a user to avoid the hazard of placing them in potentially distressing state. Example techniques were discussed with the participant to get feedback on feasibility and desirability.
3.1. Sense of Empowerment
The primary research uncovered a need for empowerment in the wake of trauma and not being treated as fragile and incapable being.
When a person is triggered by unpredictable external circumstances and get emotionally aroused the system should guide them towards discharging the built-up aggression is a natural and healthy way which serves to enable a spontaneous re-balancing of the nervous system. The hyperarousal in triggering situations is part of a biological cycle involving mobilization, successful action, exhilaration, relaxation, and a return of the nervous system to baseline functioning. In successful biological completion the exhilaration stage brings out a natural sense of empowerment, which was reported need among the participants.
- Pushing hands exercise: This technique is from SE treatment practice and requires two people: pusher and pushee. It involves placing the palm of the pusher comfortably against the palm of the trusted partner while feeling strength and force arising from their inner centre. The idea is to slowly exert pressure and push as far as possible while keeping balance. The pushee’s job is simply to provide resistance necessary for the pusher to feel their own strength and empowerment.
- Sport activities: Other feasible techniques to release natural aggression is sport activity. During the prototype discussion of these techniques the user shared that they usually resort to boxing and recognised the need to feel resistance meeting their strength in their own experience of satisfaction when hitting the boxing bag.
3.2. Sense of Liberation
In the various contexts of phenomena experienced by participants there was a common thread of feeling overwhelmed correlated with need to escape or being confined by own altered perception of life and needing to liberate oneself of own limiting beliefs.
When the biological motor mechanism for flight is not completed at the time of traumatic event, the nervous system keeps running the prompt to escape in future triggering situations. This urge could be characterised by inability to make commitments and future plans, impulsive abandonment of relationships or job occupation, moving abroad. Similar behavioural patterns were present in two of the interview participants. This experience requirement is designed to address the need for liberation from an emotionally overwhelming situation in a safe and natural way.
Sitting run exercise
This is another somatic therapy technique based on biodynamic running theory (Levine, 2008). In a triggering situation easily recognisable by biofeedback devices by increased heart rate variability, hyperventilation and increased skin conductivity by increased phasic sweat activity the system should guide the user to sit in a comfortable chair with a pillow under their feet, to close their eyes and imagine that a fierce animal (unrelated to the traumatic event) is chasing them.
This techniques can be augmented by virtual reality (VR) technology. The idea of the experience is that the user feels the strength in the legs as they make running movements on the pillow until they reach pre-defined safe place and complete the escape. By sitting calmly in the safe place the system should guide the user to settle and focus on the breathing and heartbeat. Should they begin to shake and tremble they should be encouraged to allow this to happen as this would complete the triggered motor response and bring the nervous system back to baseline functioning.
3.3. Sense of Control
All participants reflected on their varied experiences with the common interpretation of losing control — either of their rational thinking capacity, or ability to deal with previously normal activities, or not being able to contain anger and rage reactions.
In some people a triggering flashbacks may lead to dissociation and losing a sense of reality by experiencing vivid past events as if they are occurring in the present. This is reflected by the sense of losing control reported by three of the participants. This experience requirement is designed to allow the user to do whatever action was needed but impossible to do at time of triggering event. This technique could be profoundly effective to release trauma symptoms.
It must be noted that it is particularly sensitive as it requires imaginary of immersion in the context of the traumatic event and it would be inappropriate to perform by the user alone in unsupervised setting. This technique draws from the principles of SE treatment namely presence, embodied resource, titration, pendulation, discharge, and biological completion.
To facilitate this experience requirement safely and to avoid re-traumatisation by exposure, it is advisable that the user should have developed a reliable level of the skills in the previous two phases. The exposure to the traumatic memory should be evoked to user step-by-step according to the SE principle of titration and guided by trained clinical professional.
4. Nurturing
This phase of experiences is aimed to assist users in time after triggering events addressing the needs associated with moving from the vulnerable internal area and adapting to the external environment.
4.1. Sense of Orientation
Coming out of a flashback can feel perplexing, disorienting, and very vulnerable experience. The user needs to get oriented in the reality of the present moment including both inner mindful awareness of their role in a situation and also the outer perception of time, place, and social circle. This insight was identified through the reflected experiences of 4 interview participants and it can be implied by abductive reasoning based on understanding of the PTSD condition.
The experience of orientation was prototyped with the following techniques:
Mental grounding: The system should provide cues to prompt the users to focus and describe their immediate environment. This technique is based on TB-CBT . Questions and prompts might include: — Where am I? — What is today? — What is the date? — How old am I? — What season is it? — What is happening now — What is the context?
The following actions can be executed by the system to help with re-orientation in place and time:
- the system should pull up a present day article from the news, highlight the date and present to user to read it.
- the system should identify a friend that the user had recent interaction with and prompt to reconnect to talk about a recent activity have done together.
- the system should present information about the current weather, season, temperature
Inner orientation: After the completion of the natural motor reflex some people may feel inadequacy to the new state of calm because they had been conditioned to be on guard for a long time feeling intense anxiety Hence, it would be helpful to reassure the user that what they are experiencing is the natural healthy state of wellbeing supported by examples and suggestions on how to nourish the relaxed nervous system.
4.2. Sense of Inspiration
Isolation was reported consistently among all participants as a consequence of their personal dissociation and social alienation. Trauma is not only discomfort and unease for the self but can also cause feelings of separateness and non-belonging to others. An insight from the expert interview with David Bolton was that people respond favourably to therapy when they learn that many other people have been through the same experiences, having similar symptoms, and there is evidence that many have recovered.
These insights can be reframed as a need for social bond to realise that one is not alone and there are other people that can relate to the same experiences.
There is also a neurophysiological explanation why social bond reduces stress. Porges (2007) discovered that the most recently evolved part of the autonomic nervous system — the ventral vagal branch including nerves which serve eye contact, speech, hearing and feeding behaviour — is also responsible for inhibiting excess stress activation through engaging socially with others.
From the primary research, social pressure was prevalently reflected on as undesirable among the interview participants who were psychologically inclined to alienate from others. However, the need for imagining a possible future-self and someone to look up to was highlighted.
Psychosocial rehabilitation is a technique from TB-CBT aimed at facilitating independent living, socialisation, and effective life management in people with PTSD. Clinical guidelines also recommend vocational and social rehabilitation interventions to help nurture constructive behaviours, social skills and advice on trauma communication with family.
Example techniques might entail psycho-education for the user and family members, maximising existing social supports or creating new ones through community building efforts, providing vocational support to enable the user to maintain optimal work/study performance.
This experience was prototyped by providing two examples of famous and successful individuals who had similar traumatic experience as the user selected for the testing. The feedback was positive particularly because the participant knew very well the examples but was unaware of they have been traumatised in this way and nonetheless have achieved success and contributed massively to the wider community. The participant revealed their own worry about sharing with other for fear of labelling as a victim. The test to elicit inspiration through the experience of providing role models was positive.
4.3. Sense of Appreciation
This experience requirement relate to the need to integrate positive emotions and cognitions on continuous basis. It was noticeable that the participants who identify themselves as recovered from trauma emphasised positive reflections from their current state. It conveyed the need to appreciate the experience of trauma as something to learn from and grow stronger equipped with emotional intelligence about the self and others.
This experience requirement is based on a principle from EMDR therapy that requires to conclude treatment with a installing a positive cognition in regard to the traumatic event.
Example techniques to nurture the experience of appreciation may entail:
Reflection feature highlighting positive qualities gained through the experience such as persistence, compassion, inner exploration, humbleness, knowledge about the brain, psychology, and essential life skills.
Gratitude journal highlighting the good fortune to have survived any kind of traumatic experience and owning it to yourself to experience life with genuine appreciation onwards.
Evaluation
Feedback on the experience requirements was obtained by the test participant and a clinical psychotherapist.
User feedback
After the testing the user was asked to fill out a feedback questionnaire and an emotional journey map about their impressions of the experiences. Overall the participatory workshop was evaluated positively. The experience with the most significant effect was the identification of own boundaries within the Sense of Safety section. The user reported that it made her feel “very conscious and vulnerable”. Also this was the only exercise that was considered too sensitive to perform alone because it can triggering flashbacks. The user advised that the string exercise should be accompanied by a guided recording to keep the attention in the present.
The EFT had a powerful effect that “hit home”. The experiences that the user considers most useful to maintain a balanced life are the breathing techniques, tapping exercises, reflection exercises, sense activation exercises. The user states that together these techniques felt empowering and relaxing and have brought a different awareness of herself. Similar experiences from the user’s existing daily routine are physical strength training, spending time in nature, watching the ocean.
According to the user having a reliable digital tool with specific activities related to trauma is “great contribution and helpful for individual use”. It was considered particularly helpful to have a “package deal that you can personalise yourself”. It was pointed out that there is little structured guidance on helpful activities for trauma and that “the jungle of general methods is overwhelming”.
Clinical Feedback
From psychotherapist standpoint, digital-based interventions are considered inappropriate for clinical conditions such as PTSD. Particularly the psychological assessment is pointed out as indispensable aspect of therapy that cannot be mediated simply by technology. It was highlighted that the use of digital based interventions for PTSD bear considerable risk of re-traumatising the person. It was advised to limit the digital application for mental health to prevention activities such as basic emotional management and raising awareness.
Considering this feedback it should be underlined that the guidelines suggested by this study are not intended to be used for systems aimed at replacing treatment by a professional therapist. They are aimed at aiding the development of assistive devised to support self-management in triggering situations, increased emotional awareness, and integration of positive associations. Designers applying these guidelines should use their expertise and ethical judgement accordingly.
The following chapter concludes this publication with a discussion on the role of experience design in shaping mental health services.
