6. Human-Centred Design Process
This article is part of a research study publication on Experience Design for PTSD. This section presents the methodology adopted in the primary research exploration of the PTSD condition and discusses the methods and tools used.
The study followed the human-centred design (HCD) process. HCD is considered suitable approach to address the research question as it is primarily concerned with human needs as guiding factors for technology development. Gill (1989) defines human-centricity as “a new technological tradition which places human need, skill, creativity, and potentiality at the centre of the activities of technological systems”. HCD offers an alternative approach to traditional methods of digital product design that focus on technology and how humans interact with technology, rather than questioning how and why technology may be of service in supporting human lives. HCD has 4 phases — human research, idea generation, prototyping, and testing. The methods used for each phase in the context of the study are described in the next section.
Primary Research
Primary research was conducted using phenomenological method applied to qualitative interviewing. Phenomenology is a school of thought that focuses on people’s subjective experiences and interpretations of the world. This method was chosen because it allows for discovery of people’s natural attitude and lifeworld. Husserl (1976) explains the concepts of natural attitude as the way in which people are involved in the world and lifeworld as their consciousness of the world, including objects or experiences within a particular context. The phenomenological approach is considered appropriate because the aim of the primary research was to understand the individual experience of trauma from a personal perspective.
The selection criteria was that participants were 18 years of age or older, have experienced a traumatic event according to the diagnostic criteria of the DSM-5, and fluent in English language. The experienced traumatic events were different among the participants encompassing postnatal trauma, sexual assault, car accident, violence, war, traumatic psychedelic hallucination. The study sought to to identify common trauma-related needs regardless of the originating incident.
Qualitative semi-structured interviews were conducted with 6 people matching the criteria. The objective was to identify common behavioural and cognitive patterns and determine the basic human needs underlying the exhibited trauma symptoms. In line with Giorgi (1997) the questions are broad and open-ended to allow the participant sufficient opportunity to express their viewpoint extensively. The participants to lead the conversation sharing only as much as they are comfortable with. The interviews were audio recorded with the explicit permission from the participant under the condition that recordings will not be shared with third parties and will be used solely for data analysis within the purpose of this study.
Synthesis & Data Analysis
The aim of the synthesis inquiry was to identify the essential meaning behind the different modes of trauma symptoms among the participants. The data analysis followed the grounded theory approach — an iterative, qualitative research process of developing theory about phenomena of interest rooted in observation and data. The method of analysing data in the phenomenological tradition is reflective. This means that the primary interpretation is by the participant who has personally undergone a particular experience.
Journey Maps
The narrative interviews were transcribed and initial reading allowed to form naïve understanding of the story. The participants’ experiences as reflected by them were extracted from the transcript and laid out in order of occurrence on a journey map using the online platform Mural . The digital format for data coding was preferred due to the ethical concern of exhibiting sensitive data about participants on a wall. By using digital tools for coding, the data was protected with a password.
Following the grounded theory approach, the extractions from interviews were pasted on rectangular notes and colour-coded in the following categories:
- Yellow — neutral facts
- Orange — personal experience
- Blue — personal reflection
- Green — explicitly stated or implied need
- Red — problems, struggles, fears
- Purple — therapy information
Circle notes signify any points of interest and meaningful connections to literature.
Affinity Diagram
A secondary interpretation of the data was initiated by organising the personal experiences on an affinity matrix diagram also known as integrative diagram in the grounded theory approach.
The notes were colour-coded again but this time colours signified different participants to allow visual differentiation and identification of patterns. Following the phenomenological hermeneutical method for interpreting lived experience the raw information as conveyed by participants was divided into meaning units and clustered into themes categorised by the PTSD diagnostic criteria on one axis and typical trauma symptoms in order of appearance on the other axis. This relation between the lived experience units with the literature on trauma symptoms and diagnostics allowed to formulate a more comprehensive understanding of the raw data meaning. This structure also helped for identification of common patterns with varied symptom modality among the participants which informed the formulation of insights.
Empathy Map
The insights from the affinity diagram were then placed on an empathy map with 4 sections adapted to the study context: Thoughts & Beliefs, Struggles & Fears, Reflection, Needs. The insights were analysed using an abductive sense-making approach. Based on this analysis of interviews data twelve human needs underlying the lived experience of trauma were defined. These are presented and discussed in more detail in the next chapter.
Ideation
The second phase of the HCD process is generating ideas based on the research insights. In accordance with the goals of the study, the ideation sought to identify experiences that can elicit a sense of the twelve needs defined in the previous section and are simultaneously conducive to trauma recovery. In this section and onwards the personas being designed for will be referred to as users. The intended product/service output of design development will be referred to as system.
First, a design ideation workshop was facilitated with five team members at the design studio Common Good in Manchester. The goal was to reframe negative cognitions, symptoms and attitudes from anonymised interview data into positive aspects, activities, experiences. The team employed divergent thinking with little instruction seeking to generate multitude of ideas.
In the second ideation stage the focus was narrowed and framed by 3 factors:
- The experiences should address one of the pre-defined needs from interviews
- The experiences should be based on existing theoretically and empirically appraised practices of treating trauma
- The experiences should be feasible to facilitate with digital technology.
Secondary sources by leading psychiatric authors on healing trauma were reviewed to serve as a valid evidence-based foundation for ideation. The longest conventionally established approach for PTSD is Trauma-focused Cognitive Behavioural Therapy (TF-CBT). It underpins the highest number of studies providing evidence of efficacy. This treatment method was formulated in the 1970s and addresses just the external symptoms of PTSD. TB-CBT techniques focus primarily on verbal cognitive processes to help people build capacity to rationalise and tolerate the symptoms. The typical stages of TB-CBT treatment are:
- Crisis stabilisation
- Education about PTSD
- Strategies to manage the symptoms
- Confronting traumatic memories and fears
- Cognitive restructuring
- Relapse prevention and ongoing support
More recent neuroscientific discoveries show that trauma is not just an injury to the mental brain capacity, but to the deeper, regulatory, levels of the nervous system. Research shows that even though sometimes elements of the traumatic event are not cognitively remembered, the body holds an implicit memory with sensory details. This explains why during flashbacks people re-experience sights, sounds, flavours, odours and physical sensations as if happening in the present moment.
Novel therapeutic approaches such as Somatic Experiencing (SE) include non-verbal processes such as internal bodily sensation, sense of position and orientation, sensations of movement , and spatial sense. The key elements of SE treatment are:
- Presence
- Embodied resource
- Titration — approaching traumatic memory step-by-step
- Pendulation between emotional states
- Discharge of excess
- Biological completion
The ideation for experiences to address the pre-defined needs draws on both traditional and novel theories. The research evidence underpinning these experience recommendations is explained and cited in the next chapter.
Prototype
Once the experience requirements to support the human needs in PTSD were defined, they needed to be translated from theory to practice. Further secondary research investigation was performed to identify practical evidence-based therapeutic techniques in accordance with the experience requirements. The techniques were critically evaluated against two criteria:
- alignment with any of the 12 predefined experience requirements
- suitability for self-paced practice facilitated by digital technology
27 techniques from various treatment approaches (TF-CBT, SE, EMDR, bodywork, alternative medicinal practices) were selected and organised in 12 categories matching the experience requirements. Activities equivalent to the techniques were planned and structured in a physical prototype form.
The purpose of the prototype was to evoke particular experiences for a user and elicit feedback about effects, appropriateness and desirability in relation to the experience. The aim was not to validate technical feasibility so the low fidelity form was preferred. Paper prompting cards and supporting lo-fi materials were used to initiate, facilitate and guide the experiences for the user.
Testing
The prototype testing took form of a 1:1 co-creation workshop and lasted for 3 hours. The activities were moderated by the researcher after each experience phase (including up to 4 activities) there was a brief reflection and discussion about how the user felt during the activities, whether they consider it applicable and effective in their personal situation, and how similar techniques can fit in their daily routine to support a balanced life with trauma. Structured feedback was obtained by the participant immediately after the workshop.
Limitations
The primary research data informing the recommendations in this paper are based on a small sample size of 6 people. The project was restricted to 10 weeks which was a limitation for an in depth quantitative investigation with more research participants. The prototype test was limited to 1 participant due to the private and sensitive nature of the subject area. Allocating more time to one participant allowed for obtaining more in-depth qualitative insight in a private setting.
Due to the large body of academic and non-academic literature in the context of digital technology for mental health and the limited time allowed for review, some relevant papers may have been missed. The search was restricted to English language literature.
The next chapter presents the output of the study in form of 12 experience design guidelines for PTSD.
