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

Carriço L., Sá 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

 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

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

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

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

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,

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

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

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.

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ICEIS 2006 - HUMAN-COMPUTER INTERACTION