LINK ― an eyeryday tool to help fight depression

UX, UI & Product Design ✕ Psychotherapy
Summary
In my M.A. thesis I collaborated with therapists and patients to develop LINK ― a therapy-accompanying app to help fight depression. LINK leverages the principles and effects of outpatient therapy by supporting patients in everyday, therapy-related tasks as a practical tool to bridge the gap between content of therapy sessions and their everyday lives.
university | Type | grade
my roles & responsibilities
research
UX design
product design
ui design
concepting
prototyping
user testing
academic report
How might we support depression patients in outpatient therapies in their daily lives?
goals
The goal of this project was to create a mobile app that can be used in conjunction with outpatient psychotherapy (Cognitive Behavioral Therapy as well as Psychodynamic Psychotherapy) to accompany patients with personally relevant content and thus support the effect of therapy and inter-session processes in their daily lives.

challenges
There is a flood of apps in the underregulated mHealth app market, many of which are not suitable as support for outpatient treatment of depression. Many apps are too general, while others are designed specifically for the disease but are not user-friendly. Most of the available apps work with "cookie-cutter" content and do not integrate well with existing therapies. Apps to support inter-session processes in therapies are missing.


opportunities
Smartphones are suitable companions in everyday life for performing therapy-related tasks and recording events in a timely manner so as not to distort memories. Since most of the services on offer are presented as independent treatment methods and apps that can be integrated into the therapy are largely lacking with a focus on cross-session processes, LINK could close this gap. As laws on digital health care are currently being pushed forward strongly in Germany, now is the best time to address this issue.
Primary & Secondary Research
Apart from extensive literature and online research around treatment methods and current mHealth solutions I had the chance to gain first hand insights around psychotherapies from both therapists and patients perspectives.
initial research fields
Research on depression, psychotherapy and inter-session processes
Market analysis of the mHealth market and strongest competitors
User interviews with patients and therapists from CBT and PDT
Depression and Ambulant Treatment
Depression is one of the main causes of incapacity for work and contributes significantly to the global burden of disease. Nevertheless, it remains one of the most underestimated diseases. In Germany, every 5th person eventually falls ill once in their lifetime.
psychotherapy as effective treatment
For ambulant treatment, psychotherapy is the most important pillar in the treatment of depression, with Cognitive Behavioural Therapy (CBT) and Psychodynamic Psychotherapy (PDT) being the most widespread forms in Germany.
patient collaboration as key success factor
Apart from the therapeutic alliance, the patients' collaboration is crucial for therapy success: Strategies for problem-solving have to be implemented into everyday-life while emotions and experiences occuring between appointments have to be brought back into the sessions.
Main User Insights and Needs
Therapy success highly depends on the patient's homework compliance and the transfer of information between everyday life and therapy sessions. However, many patients struggle with these inter-session processes.
inaccessible or missing tools
Lots of patients struggle with reporting emotions and contextual information and implementing resolutions from therapy. Supporting materials, which are sometimes provided (e.g. worksheets or notebooks), are considered hard to access or unsuitable for everyday use.
Slow therapy progress
Missing tools lead to biased, incomplete or inaccurate insights slowing down the identification of triggers and dysfunctional schemes, which ultimately leads to prolonged therapy duration and an increased likelihood of future relapses.
main inter-session user needs
Understanding and capturing emotions, thoughts and contextual information
Understanding correlations between emotions, contextual information and personal strategies
Transferring and applying personal strategies discussed in therapy into everyday life
User Journey maps, HMW questions and Archetype Users that were used for structuring input and guiding ideation.
Design Principles
After gaining important insights into the fields of depression, psychotherapy and patient collaboration, I extracted design principles to guide the ideation.
practicability
The tool must always be available when the users need it and should already create added value with minimal effort.  
Accessibility
It must be adaptable to different preferences and should respond to different physical and mental states e.g. by using multi-channel inputs and outputs.
Unbiasedness
It should not feel like a medical tool that increases feelings of illness, but spread a positive feeling with the help of a neutral, simple and contemporary design that shouldn't seem forced.
personal content reflecting therapy progress
All content of an app should be fed in by the users in consultation with their CBT or PDT therapists, ensuring that the app is an individual, living tool reflecting individual progress and current content of psychotherapy.
data sovereignty
Patients should be able to decide with their therapist which data they wish to pass on in encrypted form throughout the treatment. Patients should also be able to download all data themselves.
Exploration
In the course of ideation I explored different emotion models, their visual derivations and the importance and role of visual representations in an app. Furthermore I examined methods of behavioral change and habit formation in relation to depression.
After feedback patients and therapists, the translations and visualisations of Plutchik's 8 basic emotions (left side) developed into seven emotion categories based on the most relevant emotions in patient's daily lives: 'Nothing', 'joyous', 'awesome', 'angry', 'scared', 'sad' and 'inferior' (right side).
Snippets from the process of finding suitable visualizations for an overview in which the frequency of the emotion categories are put into relation to each other as well as derivates for other features and functions.
Prototyping & Testing
Several prototypes were developed in Flinto and tested with various experts in iterative cyles.
build early, test often
was the motto to check hypotheses as early as possible and not to spend much time in dead ends. Regular feedback from therapists and patients helped to sharpen the focus of the app, improve important features and discard some of them, such as the chat function. It was originally developed to channel communication to prevent parallel or miscommunication on different channels, but was discarded because therapists feared inviting patients to engage in constant communication instead of encouraging independent daily decisions.
latest design prototype
The latest prototype is only available in German. You can find a video of a walkthrough here. In order to try out a simplified version of the prototype on your iPhone, the following steps must first be completed, as Flinto does not support online testing:

1 | Download the mobile Flinto App (Flinto, LLC.) in the Apple Store

2 | Download the prototype file to your iPhone

3 | Open the file with the Flinto App on your iPhone
Parts of different prototypes along the way. Features like the chat were dismissed after feedback.
The LINK concept
LINK is a therapy-accompanying app for people with depression who are undergoing outpatient psychotherapy. The app can be used in conjunction with CBT or PTD and enhances patient-therapist collaboration. As a practical tool, the app supports patients in everyday, therapy-related tasks and helps to better link contents from therapy and everyday life.
THERAPY SESSION →  EVERYDAY LIFE
All contents are 100% tailored to the individual needs of the patient and reflect the current state of therapy: LINK enables the user to create and save strategies developed in therapy and supports their implementation in everyday life.
EVERYDAY LIFE →  THERAPY SESSION
LINK offers intuitive, easily accessible and structured tracking of emotions, thoughts and context-related information that can be securely shared with their therapist via an encrypted end-to-end communication channel.
precise INFORMATION LEAD TO IMPROVED INSIGHTS
By obtaining much more detailed information about the thoughts and experiences of their patients during the week, therapists gain better insights and thus enable highly concentrated and effective therapy sessions.
LEVERAGE THERAPY PROGRESS
Over time, LINK provides both the therapist and the patient with a detailed understanding of the relationships between the data collected, making it easier to identify triggers that influence depressive episodes and to develop individually helpful strategies.
Information flow of the data entered by patients between the features' different functions .
Design and Main Features
The app consists of the three main user facing features, that will be described in more detail below: The Emotion Diary, the Insights Summary and the personal Strategy Collection. Furthermore the app offers serveral functions around Privacy and Sharing management.
The Emotion Diary
Identify and track emotions and contextual information in an intuitive and simple way.
tag suggestions in new entries
A new entry consists of several steps that include smart suggestions of tags that can be chosen to refine an emotion category or to describe contextual information. Tags that have been connected to an emotion category most frequently in the recent past can be used with minimal effort to cater to poor physical and mental states.
1 | name your emotion
In a new entry patients first need to choose between seven different basic emotion categories and can refine their choice by selecting from suggested tags or add new ones.
2 | context, strategies & thoughts
In the second step, users can add contextual information as tags. They can either choose from the proposed tags or add different ones. Contextual tags can be anything from names, activities, circumstances to places or other things. If personal strategies are relevant to the current entry, they can as well be selected. Users can also freely record their thoughts by either typing or using a speech-to-text option, depending on their current state of mind.
Calendar & therapy week view
Users can view their entries on a page including a calendar and their current therapy week. Single entries can be accessed from there and be securely shared with the therapist.
The Insights Summary
Untangle your emotions by understanding what influences them.
overview with timeline
The overview shows the frequency of the different basic categories of emotions in relation to each other in a certain time period in an abstract way. The time period can be adjusted using the timeline. By zooming in and out the length of the displayed time period is changed, by swiping the desired time period can be selected. To avoid over analysis, the shortest period of time one can choose is two weeks. Shorter periods can be reviewed as individual days in the calendar overview.
contextual information
Connections between emotions, contextual information and strategies are revealed in the second step. By tapping on one of the piles of symbols or by dragging the bottom tab up, the user can see contextual tags and most relevant personal strategies that were mentioned in the selected time period most oftenly.


The strategy collection
Create and save helpful strategies that you want to implement in your everyday life.
two categories for different purposes
The collection of personal strategies enables the structured recording of plans and exercises that were discussed in the session and are to be integrated into the patients' everyday life. There are two categories for this purpose: Unique memos, which can be accessed as needed, and exercises, with self-determinable running time and memory patterns, which can be used to try out short term tasks or long term habit-forming.
Promoting self-reflection and self-responsibility
To reduce the pressure to succeed or the impression of failure, the app does not work with progress visualizations. Progress bars only show exercises' duration. Before the end of an exercise, the app sends a message that encourages users to reflect on their perceived progress and asks them to renew it if they feel like it. It also provides fully customizable reminders and integrates methods, such as implementation intentions, that help to remember intentions in relevant situations which cannot be timed.
System question triggering thoughts on renewal of an ending exercise.
Privacy & sharing
Manage your privacy and be in control of the data you securely share with your therapist.
password protected content
For a therapy it is vital to protect the contents from the outside world. For this reason LINK offers password protection and integrates security standards such as TouchID.
personalized reminder appearance
The use of therapeutic services is a sensitive issue for many patients. In order to respect their desire for discretion, all LINK reminders can be customized according to the user's preferences.
secure sharing with therapist
Patients can choose which part of their data they want to share with their therapist via secure end-to-end encryption.
Conclusion
experiences
During the time I have been working on the topic of depression, I was able to learn a lot about the disease and its outpatient treatment and I am very happy to have dedicated my master thesis to this exciting and highly relevant topic. Even though it was sometimes not easy to decide which path to take in the course of development or things had to be discarded last minute, the project always remained exciting and motivating. Trougout the process I was absolutely amazed by the openness of both therapists and patients.
learnings
With a topic as sensitive as this, it is important to start looking for interview partners and people who are willing to give feedback on design, mockups and prototypes in good time. Patients are sometimes unable to plan appointments well in advance or to keep them at the planned time due to their illness. It is also important to find the right approach and wording to create an environment where patients feel comfortable and relaxed enough to provide insight, contribute and do so repeatedly.
Outlook
Lots of positive expert feedback has led us to dedicate ourselves as a small group of designers, psychologists and business economists to the further development and implementation of the concept and the desktop app aimed at therapists.

Feel free to drop a line if you're interested in the future of this project!
First idea visualization for the therapists' web app that will be developed in conjunction to the patients' mobile app.
Mustermann
ally