Depression Worskhop: c/o and with thanks to AffecTech

As posted last September I enjoyed an evening at the launch of AffecTech at Lancaster. This post is prompted by a tweet:

AffecTech Design Workshop: Discussion on Cross-disciplinary Methods for Depression Treatment: https://t.co/7xVinrvmWf #wearables #tech #innovation #research #digitalhealth #mentalhealth #depression

— AffecTech (@Affec_Tech) February 16, 2018

I should add that this post is not intended to represent an endorsement by AffecTech but there is an opportunity to reflect and show how Hodges' model can be used.  I contacted the researchers who - in the spirit just mentioned - kindly forwarded higher resolution images. Of course, not being present at the workshop a lot of information is lost. The reference to art is interesting in itself. It is difficult to capture the context of the whole workshop but - as per the tweet - a short article sets the scene:

AffecTech Design Workshop: Discussion on Cross-disciplinary Methods for Depression Treatment

I have provided two examples of Hodges' model mapping the contents of the workshop. The first,  covers Figure 1: Concept maps of depression causes and symptoms. I don't have a key so there may be the thoughts of several individuals - as per the colours and codes on the flipcharts. Some terms are immediately not only cross-disciplinary but multicontextual in terms of their everyday meaning, for example, darkness, falling, stuck-ness, negative spiral (thoughts, actions), imprisonment mentally, physically, and politically due to dependency, financial constraints.

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Unreachable hope                                     Pain                                           Weight - burdened        Immobility - motivation                   DEPRESSION    Anxiety DESPERATION                                          Stuck                 Darkness    Grief             Falling Insomnia       Negative filter         No hope Nowhere   Negative spiral                             Lack of interest and motivation Internalising rage   Suppressed emotions Anger Not being listened to                  Darkness

Pain Im-mobility  Physical decline Weight Stuck Chained/Locked to go energy imprisonment Darkness

Imprisonment – Social Isolation No support Hiding Loneliness

Imprisonment – Powerlessness? Loss of control

Next, I have examined the text immediately following and mapped this [my emphasis] to the model.

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------- THE SYSTEM --------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Identified, general state of lack of interest as a main symptom of depression (lack of energy, negative spiral), and as one of the obstacles for technology-based treatment of it. Therapist input: the emotion regulation component of the system should be suggestion-based (promoting novelty in the patient daily routine). system should be able to continuously monitor* (and predict) the user mood should have an appealing and trust-worthy interface from which it can communicate with the user and modifying his/her immediate context. If depressed - the agent engages the user in a discussion in which a range of emotion regulation techniques is proposed to him/her. Includes: (i) modifying environment (light changes, playing music); (ii) recommending activities; (iii) proposing mindfulness exercises; (iv) engaging the user in a discussion; or (v) recommending the user to look for the support of a friend. Further, at the end of each day the user and the agent discuss progress made over recent days, and define small steps that could be taken in the near future.

Requirement for a pro-active intervention system, and engage the user as soon as (or better just a bit before) a critical situation is detected. System should: *real time - 'always on'? provide daily feed-back to the user (giving a sense of incrementally overcoming problems). Low-fidelity prototype of a system that meet these requirements. Composed of two components: (i) wrist-band device worn by the user that monitors the user mood; and (ii) an assistive agent that is responsible for the emotion regulation system component. Working principle of system - wrist-band devices communicates to the agent when the user is in a depressed mood (- use of biosensors)

Should strive to connect the user with his/her close friends.  Emotion regulation techniques - (v) recommending the user to look for the support of a friend (see above).

The above is provided as a 'pause for thought'. I'm no expert on NLP, but I am acutely aware of the power of the words we use. And how what is said to patients, carers can be returned as a sizzling hot potato that may reveal: great foresight in what you have missed; a major lack of understanding of a situation and treatment plan; and (then) as follows a need for urgent educational intervention. In applications such as this - care needs to be taken in when and were particular words are used. 'Treatment' is in the title, but can be a loaded term as understood by the patient, client, carer, or user. People will say, "No it isn't - this is a 'balanced' approach." but herein risks lie.

Services should be non-ageist and yet culturally if you survey treatment and related terms - from a decennial perspective I wonder what you would find? I have patients who refer to Dr Google and will challenge and ask about their care and if not satified seek further opinions - a fresh pair of eyes; and others who are quite institutionalized in respect of passively accepting what is 'prescribed'. This may be reflected in the length of their mental 'health career' and their previous mental health history.

Please note the inclusion of THE SYSTEM above in the axes and domains of Hodges' model. This is non-trivial. 

At the end of the day (and the start of the night - for someone with depression?) what is the system? I'm not being awkward, but the 'system' in research can become a lay-by. As a compound term it is shorthand, but obviously we need to focus on the elements, constituents and what glues the system together: coherence. As an example, how often in IT project are 'Requirements' the sought after token that signifies "We are on the right track!"? The focus from the above is laudable being clearly person- patient-centred. Is there more that can be said about the system and requirements in the social and political domains? Is there a way also for the agent to figure higher up the design ecosystem (hierarchy)? This is no doubt were the hard work matters - theory, practice - the thesis!

Given the complexity of the (design, care, technical, global...) problems we face I do believe that Hodges' model may serve a purpose in helping to sustain, or ‘recover’ the context – of a situation. This is the purpose of stories of course. The aim of AffecTech's project here is no less than detecting a critical situation. Perhaps this is the truth of 'integrated health records' from wrist device, to agent, patient's record and health services'? It is brilliant to see such initiatives getting underway they are the future....

 (I may add to this post in coming days - weeks.)

With thanks to Alan Cole and Andrea Patane of AffecTech at Lancaster University.