R03 – Supporting Iterative Design of Homework in Problem Solving Therapy
Principal Investigators
Elena Agapie, PhD Candidate, Predoctoral Research Associate
Pat Arean, PhD, Professor, Department of Psychiatry & Behavioral Sciences
Project Description
A critical element of learning-based evidence-based psychosocial treatments is goals setting and out-of-session action plans, known as homework. This research will employ Human Centered Design (HCD) methods to identify challenges patients and clinicians face in the use of homework. The research will identify opportunities for clinicians and patients to iteratively design, plan, implement and revise homework tailored to patient needs. This research applies expertise in mental health and in HCD to address usability and sustained quality of delivery of therapy homework in the context of Problem Solving Therapy (PST), an evidence-based treatment for depression. This pilot will focus on the first two phases of the Discover, Design, Build and Test model. Data from this pilot will inform potential modifications to how homework is managed in interventions like PST.
| Setting | Clinical Setting |
| Population | Patients receiving Problem Solving Therapy (PST) for depression and clinicians delivering PST |
Intervention and/or Implementation Strategy Designed or Redesigned
| Intervention | Human Centered Design (HCD) methods to identify challenges and opportunities for iteratively designing, planning, implementing and revising therapy homework tailored to patient needs |
| Implementation Strategy | Analysis of patient and clinician interactions during PST therapy sessions, interviews with clinicians, and interviews with patients. This data will surface how clinicians and patients engage with homework during and between therapy sessions, and the challenges they encounter in this process. Based on these insights, the research team will design prototypes, and together with clinicians and patients, assess the feasibility of prototypes to support the designing, planning, implementing and revising of therapy homework. |
Impact
Data from this pilot will inform potential modifications to how homework is managed in interventions like PST. The research will identify opportunities for clinicians and patients to iteratively design, plan, implement and revise homework tailored to patient needs, addressing usability and sustained quality of delivery of therapy homework in the context of Problem Solving Therapy.
Project Publications
Technology’s Role in Fostering Therapist-Client Collaboration and Engagement with Goals
Proceedings of the ACM on Human-Computer Interaction, Volume 8, Issue CSCW2 · Publisher
Authors
Bruna Oewel, Nadia Azizan, Patricia A. Aréan, Elena Agapie
Abstract
Psychosocial therapies play a crucial role in effectively treating anxiety and depression. An integral aspect of these therapies involves setting goals that clients engage in outside therapy, known as therapy homework or between-session goals. Yet, clients overwhelmingly do not complete between-session goals. This study explores mental health therapists’ and clients’ challenges in collaborating to set and manage engagement with between-session goals and discusses how technology could better support them. We interviewed 13 therapists and 14 clients about their experiences with between-session goals. We identified therapists’ needs for information to support their clients, challenges in collaboration, and how technology can support client-therapist collaboration. Therapists need in-the-moment information about clients’ engagement with goals to inform their decision-making. Clients may feel reluctant to share information due to a lack of trust, embarrassment, or not knowing what to share. Clients could use technology to asynchronously communicate about sensitive topics with their therapists. Technologies could facilitate gathering in-the-moment data that supports client-therapist collaboration on goals.
Approaches for tailoring between-session mental health therapy activities
CHI ’24: Proceedings of the 2024 CHI Conference on Human Factors in Computing System · PubMed · Publisher
Authors
Bruna Oewel, Patricia A. Aréan, Elena Agapie
Abstract
Mental health activities conducted by patients between therapy sessions (or “therapy homework”) are a component of addressing anxiety and depression. However, to be effective, therapy homework must be tailored to the client’s needs to address the numerous barriers they encounter in everyday life. In this study, we analyze how therapists and clients tailor therapy homework to their client’s needs. We interviewed 13 therapists and 14 clients about their experiences tailoring and engaging in therapy homework. We identify criteria for tailoring homework, such as client skills, discomfort, and external barriers. We present how homework gets adapted, such as through changes in difficulty or by identifying alternatives. We discuss how technologies can better use client information for personalizing mental health interventions, such as adapting to client barriers, adjusting homework to these barriers, and creating a safer environment to support discomfort.
A Longitudinal Goal Setting Model for Addressing Complex Personal Problems in Mental Health
Proceedings of the ACM on Human-Computer Interaction, Volume 6, Issue CSCW · PubMed · Publisher
Authors
Elena Agapie, Patricia A Areán, Gary Hsieh, Sean A Munson
Abstract
Goal setting is critical to achieving desired changes in life. Many technologies support defining and tracking progress toward goals, but these are just some parts of the process of setting and achieving goals. People want to set goals that are more complex than the ones supported through technology. Additionally, people use goal-setting technologies longitudinally, yet the understanding of how people’s goals evolve is still limited. We study the collaborative practices of mental health therapists and clients for longitudinally setting and working toward goals through semi-structured interviews with 11 clients and 7 therapists who practiced goal setting in their therapy sessions. Based on the results, we create the Longitudinal Goal Setting Model in mental health, a three-stage model. The model describes how clients and therapists select among multiple complex problems, simplify complex problems to specific goals, and adjust goals to help people address complex issues. Our findings show collaboration between clients and therapists can support transformative reflection practices that are difficult to achieve without the therapist, such as seeing problems through new perspectives, questioning and changing practices, or addressing avoided issues.