20120123 design calming tech for recently injured individuals chi 2012 habif et al2

8/2/2019 20120123 Design Calming Tech for Recently Injured Individuals CHI 2012 Habif Et Al2

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Designing Calming Technologies toIncrease Coping Among RecentlyInjured Individuals

Abstract

Physical injury is a powerful source of stress and a

public health concern for physically active people.

Individuals who are injured face a multitude ofpsychosocial risk factors and therefore require specific

emotional and social support. Interactive calming

technologies can increase coping among injured

individuals by delivering just-in-time messages to

mitigate injury specific stress. This paper aims to

explore a mobile technology designed to deliver calm to

injured individuals by outlining modalities for inducing

calm, a theoretical model of calming technology, and a

calming technology prototype.

Author Keywords

Injury; coping; interactive design; calming technology

ACM Classification Keywords

H.1.2. User/Machine Systems: Human Factors

Introduction

Sport and recreational-related injuries are a significant

public health concern for physically active persons

[[6][7][13]. Physical injury is a source of stress, which

exacerbates the negative consequences of injury [17].

Injury-related stress comes in many forms including

Copyright is held by the author/owner(s).

CHI12, May 510, 2012, Austin, Texas, USA.

ACM 978-1-4503-1016-1/12/05.

Steph Habif, EdD

Calming Technology Lab

Stanford University

Stanford, CA [email protected]

Neema Moraveji


Stanford University

Stanford, CA 94305

[email protected]

Marily Oppezzo


Stanford University

Stanford, CA [email protected]


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pain, depression, anxiety, anger, insomnia, and social

isolation. These stressors prevent successful healing.Known methods of treating physical injury focus almost

exclusively on the physical condition, often ignoring the

psychosocial component. However, decades of research

provide evidence that psychosocial stress is a primary

determinant of injury rehabilitation [2][15][3]. Mind-

body science has illustrated that injury conditions are

exasperated by stress and that the parasympathetic

system induces healing processes [18]. As such, a

person who can more successfully manage stress

during injury rehabilitation will more successfully

recover. What needs to be understood, and has been

studied, is how a person copes while injured [1][11].

Coping includes internal factors such as general coping

behaviors (i.e., self-care), psychological coping skills

(i.e., management of thoughts, energy, attention) and

stress management strategies, as well as external

factors such as social support. In general, coping

resources reflect strengths and vulnerabilities in

managing the demands of stress. Huge opportunities

exist to use interactive mobile technologies to increase

coping among people dealing with injury.

For the purpose of this paper, we are most interested in

exploring how to use technology to fortify psychological

coping skills among recently injured individuals.

Specifically, we aim to provide social support by

influencing thoughts, attention, and emotional energy

by increasing levels of calm during injury recovery. We

operationalize calm as restful alertness, or a state

where one is present and able to function in a

sustainable manner. Therefore, we refer to these types

of technologies as calming technologies (CTs): systems

that induce cognitive, physiological, or affective states

of calm.

Modalities for Inducing Calm

CTs may sacrifice on task efficacy or efficiency for the

sake of ensuring the desired state change. Therefore,

traditional HCI methods of evaluating interfaces using

efficiency, effectiveness, and even usability as

outcomes are less applicable; instead, the outcome of

the users calm state must be used in evaluation. This

section outlines the three areas of ones life in which

calming technologies could impact: cognition,

physiology, and affect.

Cognition

Stress can have a number of negative effects on

cognition [11, 12]. Even mild acute uncontrollable

stress can cause a rapid and dramatic loss of prefrontal

cognitive abilities [13]; more prolonged stress exposure

has been shown to cause architectural changes to the

prefrontal cortex (PFC), impacting working memory,

behavior regulation, and attention regulation [14]. CTs

can promote calm by sustaining ones attention or

eliminating distractions, increasing self-regulation,

increasing the salience of foreground tasks, augmenting

working memory, reframing thoughts, and increasing

focus on solutions (rather that roadblocks) when

solving problems. The benefits of CTs delivering

physiological calmers, for example, can be cognitive in

nature.

Physiology

The physiological effects of chronic stress have been

and continue to be extensively studied. There are

negative cardiovascular and neurological [15] effects of

chronic stress. Allostatic loadis the physiological


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consequence of chronic exposure to fluctuating or

heightened neural or neuroendocrine response thatresults from repeated or chronic stress [16]. It can

accrue as a result of four processes: 1) frequent

activation of the stress response, 2) failure to habituate

to repeated stressors of the same kind, 3) failure to

shut off the stress response appropriately, and 4)

inadequate reaction to the stress response. CTs

counteract these physiological behaviors, actions, or

states in myriad ways such as promoting calm

respiratory patterns, reducing muscle tension, eye-

movement desensitization and reprocessing (EMDR)

and triggering progressive relaxation.

Affect.

Ones affective state can have profound effects on the

other two areas, cognition and physiology. Prolonged

stress is a major risk factor for depression [14] and

exposure to traumatic stress can cause post-traumaticstress disorder (PTSD) [19]. Stress can also exacerbate

schizophrenia [8] and bipolar disorder [10]. CTs can

mitigate these issues by inspiring and motivating users

to maintain a positive short- and long-term outlook,

savor current and past experiences, and reframenegative situations.

Theoretical ModelThrough research, instruction, and inspection of known

systems, we identified three primary components of

any calming technology. We propose the theoretical

model shown in Figure 1.

Cause/Effect of Stress

Design of CTs should be guided by an understanding of

the nature of stress, how it emerges, and its effects on

the body, cognitively, physiologically, and emotionally.

By identifying the stressors characteristics (e.g.,

inadequate coping skills) in the domain where the

person is feeling stressed, (e.g., injury) one can begin

to isolate the particular sub-components of the domainthat actually are stressful.

Figure 1. A theoretical model of calming technology with three

primary components: causes/effect of stress, calming

mechanisms, and user-centered design.

For example, many injured people feel stress when

they experience pain. Rather than targeting pain in

general, the designer can identify exactly what is

stressful about being injured e.g., physical pain, social

isolation from not being physically able, etc.

Calming Mechanism

To be effective, CT design should consider the

mechanisms through which a stimulus can have a

calming effect (and the literature on different calming

therapies). CTs can elicit different sensory experiences

or aim to directly mitigate the specific characteristics of

stressors. These main methods of designing calming

mechanisms into a technology include: a) reducing or

eliminating the presence of effects of a stressor or b)

introducing or magnifying calmers, or c) both. CTs that

introduce novel calmers, for example, can attempt to


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expose people to experiences that consciously or

subconsciously increase calm in their daily lives.

User-Centered Design (UCD)

An understanding of UCD and interaction design is

fundamental for evaluating and designing methods of

embedding calming mechanisms. To the extent that a

designer empathizes how the user is experiencing his

or her context, s/he will be more effective in targeting

implied stressors. Furthermore, stress has been shown

to effect people differently at different ages [12]; thus

a CT targeting a teen stressor in his or her teens may

be ineffective for senior citizens.

Illustrative PrototypeWe have developed a prototype (See Figure 2) that

provides meditation-based coping messages & social

support to people dealing with injury pain. In this

prototype - called SMS Morphine Drip - the target users

are injured adults who are experiencing stress as a

result of physical pain. Personalized and genericSMS-

based calmers such as soothing messages, images,

inspiring stories, and pain assessment prompts are

delivered via text message. Messages are specified

according to what the user is experiencing in that

moment (e.g. angry thoughts, muscle tension, etc.).

The system operates in either a user-initiated pull

manner, where the user texts an SOS when in pain, or

system-initiated push, where a pain check is sent out

during the users typical peak pain times of the day. In

the pull scenario, the users physical pain triggers

stress, to which these SMS-based message triggers

calm. In the push scenario, the SMS-based message

triggers calm to empower the user to practice calm

during a pain cycle (e.g. high stress experience). This

gives users a sense of control over their own pain

management, and seeks to decrease the subjective

cognitive and emotional suffering that accompanies

physical pain, thereby increasing their coping.

Figure 2. Illustrative prototype of SMS Morphine Drip.

Conclusion

Stress has a proven impact on injury recovery and

rehabilitation. Our theoretical model of calming

technology guides the development and analysis of CTs

that increase levels of coping in users through cognitive

and affective means. By tapping into psychological

thoughts, attention, and energy among recently injured

individuals, CTs can provide emotional support during

an injury rehabilitation experience.

Acknowledgements

We thank all the members of our Stanford Calming

Technology lab who provided helpful comments on this

project.


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20120123 design calming tech for recently injured individuals chi 2012 habif et al2

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