Through Chronicles, we wanted to explore whether interactive storytelling and other gamification mechanisms can increase the efficacy of a self-guided mHealth app, while drawing from empirically supported Cognitive Behavioral Therapy protocols. We designed a gamified mHealth application with contextualized storylines to help students learn psychological concepts and better identify the negative patterns in their thoughts.
Chronicles
A mobile health application using the power of storytelling to provide insights into users’ mental health by allowing them to better understand the negative patterns in their thoughts.
Role
- Project Lead
- UX Specialist
- CHISEL
Overview
Barriers to Mental Health Care Among College Students
The prevalence of depression and anxiety among college students is increasingly alarming, often described as a rising epidemic. Despite the urgent need for mental health support, many students face significant barriers to accessing appropriate care, leaving the majority without treatment. Key obstacles include privacy concerns, high treatment costs, limited time, and a lack of emphasis on mental well-being. Additionally, there is a severe shortage of available resources, especially in the Global South, where stigma around mental health remains a particularly pressing issue.
Understanding Cognitive Behavioral Therapy (CBT)
Digital CBT
Cognitive Behavioral Therapy (CBT) is traditionally delivered in clinical settings by psychotherapists through multiple sessions. While therapist-guided CBT apps have demonstrated effectiveness comparable to in-person therapy, self-guided interventions are generally less effective. A strong therapeutic alliance, a crucial element in successful therapy outcomes, is often lacking in digital interventions. Enhancing the effectiveness of fully self-guided interventions could greatly expand access to psychotherapy, making it more available to a broader audience while preserving the anonymity that is especially valuable in the Global South, where stigma around mental health remains a significant barrier.
RESEARCH GOAL: Investigate whether the incorporation of gamification elements to emulate a therapeutic alliance would increase the efficacy of self-guided CBT interventions.
Using Gamification to Increase User Engagement
The Power of Storytelling
Storytelling is a powerful learning tool that presents information in a meaningful way, making abstract and complex concepts more accessible. Stories are vivid, engaging, and relatable, allowing individuals to connect them to personal experiences, which enhances memorability and significance. Narratives can effectively influence cognition, emotion, and even behavior, offering a unique opportunity to explore possible selves and foster internal motivation. These distinct advantages make storytelling a promising medium for optimizing the delivery of mental health information, enhancing both understanding and impact.
The Solution
Data-Driven Narratives through Unstructured User Interviews
To contextualize the storylines and present scenarios relevant to users, we conducted extensive user research to collect stories and gain in-depth insights into the various situations students face. This research involved questionnaires and interviews, with participants representing a diverse demographic range, ensuring an inclusive array of perspectives in the narrative development process. The collected data was then analyzed using thematic analysis (right image) to identify key themes, which then served as the foundation for crafting our narratives.
Narrative Design: Cognitive Appraisal Model
The narratives within each chapter are structured using the Cognitive Appraisal Model which is based on the principles of CBT, and suggests that the way someone interprets any situation or event has an impact on how they feel and what they do. Therefore it is important to understand the appraisals, and this is what we aim to shed light on through our narratives. The image below shows an example of a narrative designed using the Cognitive Appraisal Model.
Landscape Design: Realism vs. Fantasy
The visual design of the application was also an important factor in increasing engagement with the storylines. To complement the contextualized narratives, the landscapes were set in the college campus. We took an iterative approach to the visual design, relying on research to inform our initial decisions and rapid user testing to improve further versions of our design.
The image below is an example landscape of a popular hangout spot on campus, Khoka. I took pictures of certain spots on campus at specific angles and gave them to our visual designer as a reference for the designs. The first iteration of the landscape leans more towards a fantastical approach which we learned through user testing resulted in a disconnect with the campus. Our final iteration (right most image) was a combination of realism and fantasy with a greater emphasis on realism which users found to me more immersive as they were able to imagine themselves in those locations.
