Designing Chat Guidance for Positive Psychological Change

Abstract

Mental illnesses affect 25% of the U.S. population, and are the leading cause of ill health worldwide—far above physical illnesses. Common barriers of time, money, stigma, and lack of professionals to meet demand make it difficult for the majority of people to get the psychological support they need. To address this need, I engaged people experiencing mental illnesses in a study to understand the risks they face in seeking support online, and to involve them in envisioning futuristic technologies for mental health peer support online. Building on insights from this study, I designed an online peer-to-peer chat tool, called Chatback, which guides peers to have online supportive chats using prompts for reflecting on troubling emotions together. I designed these prompts—the chat guidance—by drawing on evidence-based principles from Cognitive Behavioral Therapy and Motivational Interviewing, psychotherapeutic techniques that promote change by guiding people to examine their thoughts, feelings, and motivations. This work builds on prior efforts in developing online therapy interventions by contributing a practical activity that peers can use to develop supportive relationships and reflect on immediate situations troubling them. Chatback differs from these prior efforts by not presupposing a person's knowledge of principles introduced by a therapist, or having consumed relevant instructional modules from online psychotherapy programs. It also differs from prior approaches by engaging peers in developing supportive relationships through sustained interaction during chats, rather than individual self-help courses or crowd-help microtask platforms. To investigate the potential role of Chatback in addressing everyday emotional management, I conducted the following research: (1) foundational qualitative research using interviews and design activities to understand the needs and risks of online peer support experienced by people with mental illnesses, (2) conceptual analysis to identify psychotherapy techniques that peers can readily adopt to address a range of everyday emotional concerns (3) iterative design research using low-fidelity prototypes to create minimal viable chat guidance, and (4) formative evaluation research using mixed methods to compare Chatback to unguided peer support chats in a field experiment. I present characteristics of emotionally supportive chats that real-time chat guidance should facilitate—such as guiding peers to reciprocate support, give each other strategies for addressing emotional concerns, share common interests, and build rapport over time. I demonstrate how the guided chat framework in Chatback facilitates skillful chats between peers that complement traditional therapy and other forms of mental health self-management strategies. This work informs the design of brief social interventions for peers that can bridge gaps in mental health care by empowering peers to help each other. In this work, I answer the following research questions: RQ1: What are the unmet needs of peers seeking technology-mediated support for mental health? RQ2: How can technology be designed to guide emotionally supportive interactions between peers? RQ3: What are the tradeoffs of guided versus unguided online emotional support between peers? RQ4: In what ways do guided chats affect psychological change? In the process of answering these research questions, I demonstrate the following thesis: Online chat guidance can provide low-barrier access to psychotherapy techniques, help peers to form supportive relationships through deeply insightful chats, and promote positive changes in feelings, thoughts, and motivations.