PROACTIVE PSYCHOTHERAPY WITH HANDHELD DEVICES
Luís Carriço, Marco Sá, Pedro Antunes
LaSIGE & Department of Informatics, Faculty of Sciences, University of Lisbon
Campo Grande, Edifício C6,Piso 3, 1749-016 Lisboa, Portugal
Keywords: Psychotherapy, Active Applications, Building UI, Usability, PDA.
Abstract: This paper presents a set of components that support psychotherapy processes on mobile and office settings.
One provides patients the required access to psychotherapy artefacts, enabling an adequate and tailored aid
and motivation for fulfilment of common therapy tasks. Another offers therapists the ability to define and
refine the artefacts, in order to present, help and react to the patient according to his/her specific needs and
therapy progress. Two other components allow the analysis and annotation of the aforementioned artefacts.
All these components run on a PDA base. Evaluation results validated some of the design choices, and
indicate future directions and improvements.
1 INTRODUCTION
Cognitive Behavioural Therapy (CBT) is a common
form of therapy used in the treatment of patients
with anxiety and depression disorders. This
constructivist therapy relies on the therapists' ability
to understand the patient’s problems and distorted
cognitions, consequently guiding him to replace
them with more adequate ones (Mahoney, 2003).
The therapist's work includes the main on-
consultation activities (e.g. conversation and
annotation), the definition of the adequate therapies
and the analysis process. On the patient's side, the
tasks involve the filling of the various forms, as a
therapy, within or outside consultations (e.g. while
working, at school, on the way home or whenever
stressful situations arise). The resulting data also
provides the therapist the information required to
analyze and define further therapies and procedures,
either on or between sessions.
Thus, the major challenges of the therapy process
are: gathering patient's data; defining forms,
questionnaires and suitable guidelines for each
patient's specific needs; leading patients to perform
tasks and register them; and analyze those registers
and gathered data. Furthermore, these activities have
to be coped with the constant need for
patient/therapist collaboration and mobility.
Currently, used paper artefacts obstruct, in
various ways, the therapist's work and, in some
cases, a more rapid progression of the patients'
conditions. Cross-referenced and structured
annotations and expedite analysis, for example, are
awkward or time consuming. Also, the passiveness
of paper forms prevents the therapist from defining
incentives and rewards that could allow patients to
pursue their therapies in a more efficient way. These
and other problems are recurrent throughout the
entire process of diagnosis and therapy. Recently
some work emerged on the introduction of
technology on the process (Andersson, 2004; Das,
2002, Grasso, 2004; Newman, 2004). However they
tend to provide solutions for particular disorders,
without therapist control and patient specificity.
In this paper, we present several prototypes
which take advantage of the emerging mobile
technologies. They were designed to be used during
consultation settings or outside, in both patients' and
therapists' daily activities. Together, independently
or complementing each other, they support the
multiple phases of psychotherapy, emphasizing the
therapist's central role in the therapy adjustment and
the cooperation with his patients. Besides providing
both actors with common therapy tools, they aim to
bring therapists the possibility to define specific
artefacts, choosing their structure, content and even
presentation modes. All the components are
available in multiple platforms, although this article
focuses on the PDA base. They are part of tool-set
that is being designed and developed within SCOPE
project (Carriço, 2002), involving computer
engineers and psychologists. The work described
27
Carriço L., M. and Antunes P. (2006).
PROACTIVE PSYCHOTHERAPY WITH HANDHELD DEVICES.
In Proceedings of the Eighth International Conference on Enterprise Information Systems - HCI, pages 27-34
DOI: 10.5220/0002452900270034
Copyright
c
SciTePress
focuses one of SCOPE's contributions: the ability to
create and refine psychotherapy forms that actively
react to the patients' usage behaviour, to his/her
specific needs, and that can be used throughout the
day on any location.
The paper begins with an overview of the related
work in this area followed by a description of the
main requirements to support the psychotherapy
process. The following sections describe our system
and the different tools that compose it, as well as the
details of the various components, with particular
focus on those which intend to support the therapist's
work. Afterwards, the evaluation that has been
taking place and some of the results that have
already been achieved are discussed. Finally, future
work is delineated and some conclusions are drawn.
2 RELATED WORK
The introduction of new technology to overcome
some of the difficulties referred in this paper has
recently gained momentum. As in many other areas
of the health care domain, they often focus on data
gathering or visualization, analysis and especially
organizational tasks within the health care domain
(Garrard, 2000). Specific software, directed to the
psychiatric and psychological use, allows patients to
follow particular methods of therapy and even
diagnosis (Proudfoot, 2004). Excluding patient
solutions that, relying on expedite approaches of
diagnosis, have revealed strong human rejection
(Das, 2002), studies have demonstrated the
effectiveness of the computer role in the process of
anxiety and depression therapy (Gega, 2004;
Herman, 1998; Otto, 2000, Wright, 1997). However,
most of these systems provide either isolated
therapist solutions or isolated patient solutions with
no therapist control. Moreover, mostly rely on
desktop approaches, which are incompatible with
most of the really used scenarios, (e.g. work, school,
office consultation, etc) (Luff, 1998).
A number of web-based self-help applications
and websites are also emerging. For example, the
use of an internet-based therapy for depression and
anxiety caused by Tinnitius (the presence of sound
in the absence of auditory stimulation), in which
patients reproduce the face-to-face treatment
(Andersson, 2004). Overall, in spite of the common
advantages, such as remote assistance and costs
lowering, these techniques have many disadvantages
(Tate, 2004). Patient disengagement is frequent, as
well as patient misinterpretation of the sites'
objectives; sites require constant management and
monitoring; and email and telephone assistance is
often required.
More recently, handheld and overall mobile
devices, such as PDAs or TabletPCs, are available,
and new applications have appeared. However, they
only cover partial steps of the therapy process and
do not allow the customization of the patients' tasks
or artefacts. The majority is rather simple and allows
simple measurements of the severity of pathologies,
indicates drug dosage or provides therapists with
reference information about diseases or drugs
(Grasso, 2004). On the patients' side, some self-
control or relaxation procedures are available on
hand-held devices (Przeworski, 2004). Here, patients
engaged on group therapies using palmtop
computers. A palmtop was given to each patient,
before the therapy sessions started, and had to be
carried by him/her at all times. Alarms sounded
several times during the day and questionnaires
regarding their anxiety levels were popped. After the
therapy sessions started, patients were allowed to
access the entire range of features, using the
relaxation, cognitive, etc. modules. Palmtops were
intensively used during the initial stages of therapy,
but their utilization diminished during the rest of
therapy, which indicated that palmtops were mainly
used to learn and understand the therapeutic
procedures. Even so, patients improved their state in
less than 6 months. But once again, these
applications lack the possibility of adapting each
step of the procedure or application to patients'
specific needs.
3 REQUIREMENTS
Constructivist psychotherapy methods, such as CBT,
defend that humans are active participants in their
own lives, agents acting and experiencing in the
world. Based on this, individuals must be actively
involved in their change and unfolding processes,
and must be encouraged to be autonomous
(Mahoney, 2003). In therapy, the patients are
therefore motivated to perform tasks that not only
result in an active behaviour, but also permit them to
be confronted with their accomplishments. Common
tasks include:
planning activities, registering plans and
the activities, registering thoughts and
answering questionnaires.
These tasks are performed during the day,
intermingled with other daily activities, triggered by
them (e. g. a though requires a thought registration)
or at specific times (e.g. at 9 am, plan the day).
ICEIS 2006 - HUMAN-COMPUTER INTERACTION
28
Accordingly they are performed wherever the
patient is. Time, place and task characteristics, while
based on the specific disorder, should naturally
depend on the patient's life and severity state.
On the other hand, the problem often resides on
leading the patient to do something or be confronted
with something he/she does. Therefore, a central role
of the therapy is also given to therapists, for their
ability to get patients to act and gain conscience of
their problems. To accomplish this endeavour the
therapist must be able to:
gather patient data (e.g. what he/she says, or
even what gesture was done) and annotate
it.
diagnose the disorder characteristics.
select and define the therapy procedures and
artefacts, motivating the patient and
ensuring that that motivation is kept even
when the therapist is away.
get the patient registered data, analyze it
thoroughly, eventually comparing it with
previous gathered data and annotations.
The therapy cycle completes a tour when
therapist-patient conversations take place over the
registered data and new events. These cycles (data
gathering, diagnosis, prescription, task fulfilment
and thorough analysis) actually involve both actors
and usually prevail through a long period of time.
As for the patient, the therapist activities are
often accomplished in different settings and times of
the day. Motivation, data gathering and exchange are
naturally mostly done in collaboration with the
patient, within consultation sessions. Analysis, data
comparison, diagnosis, therapy planning and
prescription are usually done elsewhere, although
they also occur often within a consultation setting.
Therapy planning and prescription, for instance,
could be adjusted considering the information just
gathered in an on-going consultation session.
Moreover, since fulfilment of patient tasks is
frequently done or completed in collaboration with
the therapist, during sessions, particularly in the
initial states of therapy, that information can be of
the utmost importance on the following therapy
procedure.
3.1 Artefact Requirements
Although the procedures and therapists' instruments,
in CBT, are well defined, the latter exist mainly in
paper. This causes coding and organization
problems, obstructs co-referencing and annotation,
and most of all, wastes both therapist and patients'
time. Furthermore, it prevents therapists from
adapting the existing artefacts to the specific needs
of each patient and on motivating him.
The used forms and questionnaires may be
composed of hundred of numeric values, or, when of
free writing type, unreadable documents, rather
difficult to analyze. The notes taken during a single
session or a set of sessions are also extremely
valuable artefacts to analyze. However, it is difficult
to co-relate these annotations, the questionnaires or
even sessions they correspond to, especially having
in mind that most of them are taken during
consultations and without distracting the patient
from the conversation or task in hands.
Paper artefacts obstruct patients' tasks as well.
Questionnaires that need to be filled can be very
extensive and with questions that may not be
suitable for the patient in question. The free-text
forms, generally preferred by the patients, because
of their flexibility on writing and expressing their
feelings, may cause distress as well, since, at times,
the patient might not know how to express his
sensations or problems in an organized and
understandable way, increasing the anxiety levels.
These problems suggested the following
requirements:
Minimize the effort and time spent taking,
organizing and correlating annotations.
Provide the therapist means to easily adapt
the existing artefacts (e.g. forms,
questionnaires and activity plans) to the
specificity of patients or even create new
ones.
Offer the therapist ways to easily select and
define rewards, filling facilitators (hints),
help (on procedures and filling), and criteria
that triggers them.
Engender artefacts that can react to the
patients' entered data and scheduled events,
offering aids and rewards.
Enable the analysis of patient completed
questionnaires and forms, as well as therapist
annotations.
3.2 Architectural Requirements
One of the major challenges of the psychotherapy
activities is that they can be done anytime and
anyplace, sometimes individually and other times in
collaboration. Resources and interaction
requirements depend on the situation. Moreover,
throughout the process data is created or gathered
that must be kept available and moved trough the
PROACTIVE PSYCHOTHERAPY WITH HANDHELD DEVICES
29
different settings as needed. On consultation
settings, for instance, actors exchange information,
through conversations or defined and filled artefacts.
All these clearly impose constraints, hardly handled
by a paper based approach, which nevertheless must
be considered on the definition of a technological
solution. The following requirements are suggested:
Enable the therapist to perform deep
thorough analysis, on large amounts of data,
but also permit to define prescription and
simple analysis on the different settings of its
daily activities.
Provide means with no fixed or physical
constraints that allow patients to
accomplishing their tasks during their daily
life.
Offer ways that do not interfere with the face-
to-face consultation processes and yet support
different forms of collaborative work.
Provide simple ways to transfer artefact
definitions and information from its
completion, between actors, and also to move
information and articulate its access trough
the different settings.
4 SCOPE
SCOPE (Supporting Cognition Outlines on
Psychological Evaluation) is a project that aims at
providing computational support to psychological
therapy through all the steps of the process. It ranges
from: (1) analysis, diagnosis and prescription tools,
which the therapist uses without the patients'
company; to (2) patients' homework registering
tools, used without the therapist presence; through
(3) a set of tools that they use in co-presence, and
that include all of the above activities. Naturally, the
characteristics of the face-to-face setting tools are
different from those used individually, as they
should not interfere with the collaborative process.
Figure 1 depicts the general settings of SCOPE:
one presumes a full resource environment (called
fixed) that usually comprehends a PC, possibly a
patient record server, and peripherals (e.g. printer);
another (referred to as mobile) copes with the
mobility requirement with variable resource
capabilities and may be supported by a laptop or a
handheld device; and the last covers the co-presence
situations (named face-to-face), where TabletPC and
handheld solutions are envisioned. The first two
presume, primarily, an individual stand where
therapist and patient work isolated from each other -
collaboration through a network is also possible but
it is the subject of JoinTS, a continuation of SCOPE.
On these settings, some scenarios can be
envisioned resulting in one or more applications. In
general, each application may operate in stand alone
mode, possibly integrating a classic paper based
therapy procedure. On the other hand, applications
can be articulated with each other, covering most of
the therapy activities. Integration is accomplished
through a shared database, exchanging artifacts and
data through a synchronization process (represented
by a strait-dashed line in the figure), or through
direct communication (a curved arrowed line). Note
that direct communication also occurs between
therapist and patient in the face-to-face setting.
Applications can also be configured (depicted by a
fat arrowed symbol) to become more adequate to a
specific usage scenario.
5 THERAPIST APPLICATIONS
This section presents a more detailed description of
the components of the SCOPE tool-set that pertain
to the therapist. It focuses on the PDA platform,
although variants of the tools are also available for
the TabletPC and desktop computer platforms. The
PDA versions were developed in Java, using MIDP
1.0, and were tested on PalmOS and Pocket PCs.
Nevertheless, running the prototypes on mobile
phones or other devices that have a Java Virtual
Machine (JVM) installed should be straightforward.
A version with MIDP 2.0 was initially developed,
but (known) problems arose with functionalities ill-
implemented on the corresponding JVM for PDAs.
As PDAs offer a small screen and limited data
input possibilities, challenges increase when
designing user centred applications for such
platforms. Focused, simple user interface were
designed, where data input is facilitated as much as
possible. Lists and drop box menus are available for
use (upon therapist decision) when filling or creating
Figure 1: SCOPE overall setting and scenarios.
ICEIS 2006 - HUMAN-COMPUTER INTERACTION
30
an artefact, reducing greatly the need to write data
on the application. Lists length were condensed and
contextualized.
5.1 ScoNOTES - Annotating
Using ScoNOTES the therapist is able to gather
information and comment on previously gathered
one. From the working patient record, the therapist
selects ScoNOTES and simply writes text. The
resulting annotations are registered with the creation
dates and become automatically accessible from the
patient's record. This necessarily simple process is
particularly adequate for consultation settings. In
this context, the default free-text entry is set to the
cursive writing alternative (bitmap).
On an off-consultation setting, ScoNOTES
enables the (re)organization of annotations and the
creation of more detailed and structured ones. These,
in fact, may provide a source of meta-information
for every sort of data or artefact that exists in the
therapy process. Keywords can be included, themes
are reinforced and text entry fields are preferably
character-based. New annotations are associated
with patients as well, but can be further correlated
with every other artefact, including other
annotations.
5.2 ScoFORMS – Creating Artefacts
ScoFORMS includes three flavours of the same tool:
ScoQUE, ScoTIVITY and ScoTHOUGHTS. Each
provides therapists a way to create a specific form
used in CBT, namely questionnaires, activity
registering artefacts and thought record forms.
ScoQUE allows therapists to fetch, change or
create questions, and build questionnaires adequate
to specific patients and pathologies (Figure 3). A
pool of standard questions is always available, as
well as all those previously created by the therapist.
Different navigation arrangements (e.g. theme,
severity) and direct keyword search are supported
for question selection. The sequence of questions, or
its repetition, is decided when constructing a
questionnaire. Standard and stereotyped
questionnaires are kept and available for reuse.
Each question has associated an answering type
(e.g. keyword, text), a set of help topics and a
default interaction element (e.g. gauge, text-box).
For each question on a particular questionnaire, the
therapist is allowed to change the interaction
element or combine it with alternative ones, from a
set of compatible options. For example, a drop-box
instead of a free-text entry or in conjunction with it,
as a hint for the patient, is a common choice. Also,
the presence or absence of one or more help topics
can be adjusted, as well as the total amount of hints
and help topics available for a questionnaire.
Overall, the therapist is able to customize the
questionnaire and the questionnaire's user interface,
adapting it to the patient's capabilities.
Figure 2: Building questionnaires with ScoFORMS.
Figure 2, on the left, shows the ScoQUE
interface for selecting questions for a questionnaire.
Previously, the questions were inserted into the
system, using another interface. On the right, the
therapist is choosing a particular answering type,
namely a multiple choice. The following step is
naturally to define the selectable answers.
Finally, the therapist may also decide if and at
what points the patient should get synopsis, score
feedback, warnings, incentive words or
congratulations. The way these are presented and
combined with the patient answers is also
configurable. For example, after a task completion,
an incentive may appear as a sentence or a graphic
depicting the patient's. The application’s behaviour
can also be configured to act according to the
patients’ choices, detecting whether the patient is
answering the questions automatically or if he
concentrated in his task. Detection mechanisms
range from the amount of words used in an answer
to the time spent to answer it. Warnings are
prompted with anomalous situations.
ScoTIVITY and ScoTHOUGHTS allow the
creation of artefacts for registering activities and
activity plans and thoughts. In general, these
flavours are a subset of ScoQUE, as the units
(questions) are usually centred on text-entries,
within a simple pre-defined structure (e.g. a
classification of thought plus a free-text entry).
Nonetheless, ScoTIVITY introduces alarms as an
activity reminder or planner, and ScoTHOUGHTS
assumes units as templates, i.e. a thoughts-form is
often a single unit that will be instantiated every
time the patient registers a thought. Therapists may
also configure help, reports and rewards. A common
PROACTIVE PSYCHOTHERAPY WITH HANDHELD DEVICES
31
criterion for rewards is the number of registered
thoughts.
5.3 ScoTHERAPY – Patient’s tool
ScoTHERAPY is the tool that materializes the
artefacts to be filled by the patients. Its primary goal
is to provide a way to quickly answer questionnaires,
register thoughts and activities, or plan activities, as
part of a therapeutic process. Overall, it is driven by
a simple, easy to use interface that can provide
access to aids, such as supportive hints, choice lists,
help, reporting and rewarding. These aids can be
disabled on face-to-face setting scenarios, allowing
the therapist to actively intervene on the task
fulfilment, or enabled on the patient individual
scenarios. On the latter, it is up to the therapist to
define when, where and what kind of aids are
available. For example, after registering three
positive thoughts the patient may be presented with
a congratulations message, or, at a later therapy
stage, the patient may only have access to hint
choice-lists on five of the most complex tasks.
Another common usage is to pop a hint when a
patient is taking to much time to answer a question.
Figure 3: Filling activities with ScoTHERAPY.
Figure 3 shows an activity registry on the left
and the corresponding help screen on the right. If
allowed by the therapist, the patient may, in future
activity planning, access activities’ specifications
that he/she entered on a previous activity filling task.
For example, consider a user that on a specific day
plans a new activity like "Go out to lunch", writing it
down on a text-box. Consider also that the therapist
allowed that patient to access a dropdown-box of
activity hints. Then, on the next activity planning
task, the patient may find "Go out to lunch" on that
dropdown-box. This, naturally, reduces the time and
effort spent in this task.
The artefacts handled by ScoTHERAPY are
transferred between therapist and patient devices as
needed. Therapists usually export the forms
specifications, eventually containing data from a
previous shared-scenario session. Therapists import
the patients' filled data, eventually containing new
items in choice lists (e.g. recurring activities).
Currently the transfer is done using Bluetooth and
PalmOS synchronization tools, through a PC or
TabletPC. Alternatively ScoTHERAPY can print
results when inserted in a more classic process.
5.4 ScopALYSIS – Analysis
ScopALYSIS provides a set of components for the
analysis of patient data. Its capabilities range from
simple scoring analysis on a questionnaire, usually
applied during consultation, to more complex ones,
more adequate to after sessions. Rearranging the
scoring criteria (e.g. based on questions relevance)
or determining score evolution over multiple
questionnaires are common usage examples. On
thought and activity records ScopALYSIS is able to
find recurrent themes and keywords or determine
word frequency (Figure 4). Its corpus can also be
extended to annotations, thus building on meta-
information introduced by the therapist.
Figure 4: Defining warning rules with ScopALYSIS.
Visualization of the analysis results can be done
through tables or simple graphics, as selected by the
therapist. On larger device' platforms, diagrammatic
(graph based) presentations are available. Filtering
of results is also possible.
ScopALYSIS is articulated with all the
remaining SCOPE tools. With ScoTHERAPY it
provides a way to explicitly work the patient's data.
A limited version is integrated with the patients'
view of ScoTHERAPY, mostly as a presentation
component. To ScoFORMS, ScopALYSIS provides
the components to define rewards including reward
triggers (metrics and targets) and presentations.
Finally, ScopALYSIS is also connected with
ScoNOTES since the therapist may wish to
comment on analysis results that can be kept along
with patients' data.
ICEIS 2006 - HUMAN-COMPUTER INTERACTION
32
6 DESIGN AND EVALUATION
This project followed a contextual design approach
(Beyer, 1998). During early stage design, interviews
and meetings with different psychologists were
made. Documentation and videos (Davidson, 2000)
describing the therapy and showing real therapy
examples were thoroughly studied. Information
flows, activities, artefacts, physical settings and
cultural issues along with major breaks (complaints,
etc.) were identified, leading to the construction of
two low-fidelity prototypes.
One mimics a PDA and the other a TabletPC.
They are composed of a wooden frame where cards,
representing screens, can be replaced. The screens
are sketches of the applications later refined and
implemented on the software prototypes. Card-sets
representing the patient and the therapist tools were
created for PDA and TabletPC and refined in
consequence of successive evaluation sessions.
Low-fidelity prototypes of both platforms were
evaluated under a Wizard of Oz approach. Three
psychologists, two of them with clinical know-how
and 10 other individuals with different education
backgrounds, assessed the prototypes. The first
group provided a more thorough, domain oriented,
evaluation. The latter group was focused on
sequence and screen arrangements, as well as on the
use of such artefacts during interview conversations.
The therapy original paper forms were also provided
and procedures explained.
Results were quite encouraging. Psychologists
specially welcomed the ability to exchange forms
with the patient in a digital format, still maintaining
the facility to share and collaborate in the filling
process. The customization of forms was particularly
well received, as well as the disappearance of
breakdowns such as interruptions to get printed
forms and fetch previous session results, and editing
difficulties during the co-filling process. For the
therapist components, the TabletPC versions were
preferred due to the small screen size of PDAs when
visualizing large amounts of information and
introducing data. The psychologists' evaluation of
the patients' application was also positive although
some rearrangements were suggested for ease of use.
The requirement of customizing the patient reward
subsystem emerged from this design phase.
The non-expert group, particularly applied to the
patients' tools, also triggered the adjustment of some
components. Multiple choice questionnaires were
very easy to fill whereas free-text forms raised some
usage concerns. However, when confronted with the
paper original version, users clearly chose the
prototypes, particularly the PDA one. In simulated
therapy sessions the prototypes were not found more
intrusive than paper.
The high-fidelity software prototypes were tested
with the same group of users that tested the low-
fidelity ones, plus computer engineering students
and a group of 3 users with no experience in using
handheld devices. The main focus of these last two
groups was directed to interaction, usage and design.
The patient application was actually used during a
couple of days to perform specific form filling tasks.
Measurements were made and usability
questionnaires responded during each session.
Overall the three groups found the software
prototypes very promising.
Apart from the original expert group, another
experienced clinical psychotherapist has evaluated
the improved versions of the software prototypes.
He contributed with suggestions of new evolutions
and recent therapy practices that can extend
SCOPE's coverage. The introduction of a
positive/negative classifying field on thought records
emerged from this evaluation. Moreover, the ability
to provide a hierarchically organized selection of
thoughts and emotions was also suggested.
Interestingly, only minor changes on ScoFORMS
were required to accommodate these needs.
Currently the prototypes are being used on an
academic experimental setting (within a
psychotherapy course) and with real scenarios. On
the later, clinicians and patients are using the
prototypes on individual settings as well as real
consultations.
7 CONCLUSIONS
The use of technology in health care is evolving
quite rapidly. Psychotherapy, in particular, is one of
the most promising areas for technology application,
especially for its hand-held and collaborative
requirements. However, even if some applications
exist, they are rigid, focussed only on the therapy
itself and not considering the actors specificities, not
integrated and often missing the context it should
serve. The work described in this paper aims to
overcome these difficulties and support
psychotherapy through all the process.
The paper focuses on the PDA versions of a set
of components that cover therapist annotation,
prescription and analysis tasks. The first one
addresses fast and structured annotation. A second
central component provides the therapist with the
ability to define the artefacts used in the patient tasks
PROACTIVE PSYCHOTHERAPY WITH HANDHELD DEVICES
33
and the characteristics of his "substitute" as a patient
aid, i.e., the therapist is able to define the contents
and the look and feel of the forms to be filled by the
patient and to establish what, when and how the aids
will be available or presented to the patient. The
paper also describes the tool that enables the patient
to fill the artefacts and the therapist to browse the
patient's data. The last component pertains to the
analysis of the patient data. Overall these tools cover
most of the therapists' activities on a therapeutic
process, including the assisted filling of forms,
wherever they take place, proactively reacting to the
patients’ behaviour and evolution. This mobility and
ubiquity and the ability given to the therapist to
create and adjust active artefacts, enhancing
psychotherapy, are the major contributions of the
SCOPE project.
The work done so far has been validated, in its
various stages, by a strict collaboration with several
professionals and researchers in psychotherapy.
They have consistently provided useful input and
opinions, guaranteeing the developed prototypes'
value, and providing coherent directions for
evolution. A quite interesting observation is that
when new specific therapies were suggested, for
example weight and pain control, the creation of the
corresponding artefacts is easily accomplished with
ScoFORMS and its usage easily handled with
ScoTHERAPY.
Finally, new functionalities are planned to be
included in SCOPE. For example, voice interaction
with the mobile device, the use of different media
like videos or audio files explaining certain
procedures; alarms that alert patients or even their
therapists of specific situations; are being studied. A
new version of SCOPE, which encompasses real-
time message passing and shared/private spaces, is
also being developed.
REFERENCES
Andersson, G., Kaldo, V. (2004) Internet-Based Cognitive
Behavioural Therapy for Tinnitius. Journal of Clinical
Psychology 60 171-178
Beyer, H., Holtzblatt, K. (1998) Contextual Design: A
Customer-Centered Approach to Systems Design,
Academic Press, San Francisco, CA, USA.
Carriço, L., Reis, J., Duarte, C., Henriques, A., Guimarães,
N. (2002). Scope supporting cognition outlines on
psychological evaluation. Technical Report POSI
SRI/44247/2002 - Project Proposal, LaSIGE-
FCUL/PsiSaude.
Das, A. K. (2002). Computers in Psychiatry: A Review of
Past Programs and an Analysis of Historical Trends.
Psychiatry Quarterly, 79 (4). Winter.
Davidson, J., Persons, J.B., Tompkins, M.A. (2000).
Cognitive-behavior therapy for depression.
Psychotherapy Video Tape Series, American
Psychology Association
Garrard, C. S. (2000). Human-computer interactions: can
computers improve the way doctors work? Schweitz
Med Wochenschr, 130, pp 1557-63.
Grasso, M. A. (2004). Clinical Applications of Hand Held
Computing. Proceedings of the 17th IEEE Symposium
on Computer Based Medical Systems (CBMS). IEEE
Press.
Gega, L., Marks, I., Mataix-Cols, D. (2004) Computer-
Aided CBT Self-Help for Anxiety and Depressive
Disorders: Experience of a London Clinic and Future
Directions. Journal of Clinical Psychology 60.
Herman, S., Koran, L. (1998). In vivo measurement of
obsessive-compulsive disorder symptoms using
palmtop computers. Computers in Human Behaviour
14(3), 449-462.
Huff, A. (1990). Mapping Strategic Thought. John Wiley
& Sons, 1990.
Luff, P., Heath, C. (1998). Mobility in Collaboration.
Proceedings of Computer Supported Cooperative
Work, CSCW’98. ACM Press.
Mahoney, M. (2003). Constructive Psychotherapy. New
York; The Guilford Press.
Newman MG (2004). Technology in psychotherapy: an
introduction. Journal of Clinical Psychology 60(2).
Otto. M.L., Pollack, MH., Maki, KM. (2000). Empirically
supported treatments for panic disorder: costs, benefits
and stepped care. Journal Consult Clinical Psychology
68 (4).
Proudfoot, J. (2004). Computer-based treatment for
anxiety and depression: is it feasible? Is it effective?
Neuroscience and Biobehavioral Reviews 28.
Przeworski, A., Newman, M.G. (2004). Palmtop
computer-assisted group therapy for social phobia.
Journal of Clinical Psychology 60(2). 179-188.
Tate, D., Zabinski, M. (2004) Computer and Internet
Applications for Psychological Treatment: Update for
Clinicians. Journal of Clinical Psychology 60.
Wright, J.H., Wright, A. (1997) Computer-assisted
psychotherapy. Journal of Psychotherapy Practice
Research 6, 315-319.
ICEIS 2006 - HUMAN-COMPUTER INTERACTION
34