How do people with depression use technology at a personal level? The answer “they all use it differently” may or may not be surprising, depending on your perspective, but in my experience this is often assumed to be the case. Eschler et al. take on this question by interviewing people about the roles technology plays in their lives and opportunities to use it in a healthy way.
Authors: Jordan Eschler, Eleanor R. Burgess, Madhu Reddy, David C. Mohr
Link: ACM Digital Library
Background
Much is known about how individuals with depression or other mental illnesses use social media in aggregate, and lots of work attempts to predict mental health status. Some relevant papers that I’ve read:
- Multimodal Classification of Moderated Online Pro-Eating Disorder Content
- ‘This Post Will Just Get Taken Down’: Characterizing Removed Pro-Eating Disorder Content on Social Media
- Methods in predictive techniques for mental health status on social media: a critical review
This work takes a different approach: the goal is to understand individuals, and how they make decisions about technology use. From the abstract:
We interviewed 30 individuals living with depression to explore their technology and social media use. We find that these individuals demonstrated emergent practices related to self-regulation, such as learning to monitor and adjust technology use to improve their emotional, cognitive, and behavioral health. Our findings add a human-centered viewpoint to the relationship between living with depression and technology and social media use.
Past work in the mental health / technology space has found that individuals with higher levels of loneliness (defined as a cognitive state, not an objective one) tend to use Facebook more, and other work has found strong associations between depression indicators and social media use. The goal here was to better understand the role of technology and social media in the lives of individuals with depression. The guiding research question:
How do people living with depression use technology in their day to day lives? What are some opportunities for helping people to use technology in a healthy way in the context of depression?
Methods
These were semi-structured interviews; some questions include:
- What are some of your goals for your quality of life and how you want to feel?
- How do you think using technology like your phone helps with quality of life?
- What kinds of information do you keep track of related to your moods or emotions? How do you use technology to track this information?
- What are some times that you think it’s important to avoid technology, like your phone, computer, or television? Why is it important to avoid technology?
Additionally, the interviewers “met with one of the principal investigators—a clinical psychologist—who was able to validate the construct validity [11] of themes emerging in ongoing data collection.” Great! The interviews were coded and synthesized in what seems like a standard process.
Findings
The authors evaluate the results using the concept of “self-regulation”: a “theory-based, empirically supported framework for developing psychotherapeutic interventions that complement and extend current cognitive-behavioral models,” which describes a process of improving habits by focusing on personal goals. They focus on three forms of self-regulation:
- Emotional self-regulation practices: Participants’ work to formulate and/or maintain healthier emotional states related to technology and social media use, such as managing moods.
- Cognitive self-regulation practices: Thoughts that participants expressed about technology and social media use, including metacognition (thinking about thought patterns when using technology), and efforts to address negative thought patterns, such as rumination.
- Behavioral self-regulation practices: Participants’ efforts to design new behavioral habits around technology and social media use, which can lead to a positive feedback loop in maintaining all three elements of self-regulation.
Bundles of technology: a number of participants reported using apps like Calm, Headspace, or other mood management tools; but they only used these as part of a bigger-picture strategy:
However, our participants described using these apps as just one part of a broader strategy for using technology and social media to self-regulate their emotions. Participants were thoughtful and resourceful in building self-regulation routines. They employed “bundles” of technology and social media tools tools (e.g., combinations of apps, online streaming videos, cell phone games, and music) to do so.
I think that an important (and perhaps understated) contribution of this work is that it takes a holistic view of what “technology” that individuals use for self-regulation. Different people will find different combinations of apps useful—this much is obvious to anyone starting a self-regulation routine. This work recognizes that.
Mental reset: participants reported needing a “mental reset” where they watched an episode of a favorite show, watching videos, or listening to music. One notable example was a participant using Alexa to exercise more control over their room, where they would be prone to going into negative mood spirals. These technological tools were often enough to change the course of these spirals.
This was part of a larger process in identifying emotional feedback loops. Participants started to connect technology and social media use to their mood and mental health states. One example was in how participants were able to identify problematic uses of technology, which were mostly associated with lack of intent—there’s a difference between taking time to yourself, [or] watching stupid television for an afternoon and not moving off your couch because you’re depressed and have no motivation,” one wrote.
This often manifested itself as a distraction, too: some were aware of the negative impacts of technology for distraction (e.g., going on Facebook vs. exercising). “Sometimes it’s hard to give up this short-term pleasure for a longer-term pleasure,” another individual wrote.
Manging negative behaviors: the two main strategies for managing negative technology use were limiting access to certain platforms (deleting the apps, moving to another platform, tracking usage) or curating content (seeking out positive content, pinning content that they liked on Pintrest, following inspirational pages).
Behavioral self-regulation included “planning time for self-care, forging new patterns in use, tracking activities important for mental health maintenance, … reflecting on changes in mood or response to certain stimuli, and regulating behaviors in formal mental health care settings.”
One major example was planning and tracking, using calendars, bullet journals, goal-tracking apps, or phones’ native health apps. One participant reported using Instagram to track their mental health states, by looking back on posts on their rinsta and finsta. Not all participants engaged in tracking behaviors—some believed “it would never work,” for example—and of those who did, they were mostly designing them themselves.
Design implications
Understanding how people with depression use technology is an important part of supporting them. “We suggest that individuals living with depression do not necessarily have a preexisting positive relationship with technology, as many app designers suggest.”
This relates to something I wrote a couple days ago, in my write-up of Celebrating Everyday Success by Avrahami et al.:
The major contribution is in how this scientifically informs the design of future tools. It’s important for these tools to be studied and validated, so that designers of other tools can learn from this one.
Moreover, I see lots of “health tech” tools that claim to be able to help you with parts of your life—tracking sleep, controlling anxiety, monitoring your mood, practicing mindfulness losing weight—and most of them haven’t been validated or studied. In some cases, this can be dangerous.
Here is a perfect example of this! People with depression do not all use technology in the same way, and yet with the deluge of apps that claim to help with this or “one size fits all” treatments, one might be led to believe this. Participants in this study often referred to their phones as a trap, so an app predicated on an existing positive relationship with one’s phone would be bound to fail (and might in fact make things worse!).
Therefore, we advocate for a design solution regarding technology-based, targeted mental health applications that would help users assess their own technology use and reflect on their attitudes about technology to promote metacognition around its use. In this way, targeted mental health applications can assist users to start thinking about their devices as powerful, personalized tools for improving mental health and augmenting self-regulatory instincts for technology use. In sum, technology-based, targeted mental health applications must convey a sort of self-awareness that the mode of intervention—technology—can be part of the problem and part of the solution for individuals living with depression.
This is so important! In order for technology to truly help people, we must first recognize that it won’t help everyone. Following that, technological tools should help people to understand their personal relationship with technology, assist them with using technology intentionally, and help them with their existing efforts at self-regulation where appropriate.
Reflections
This is one of the rare papers that makes me think “hey, I could do this!” The question asked is so natural, and deeply personal. The researchers are from Northwestern, where I went, and the PI is part of the Technology and Social Behavior program that I have considered applying to. The subject is interesting, and on the whole I could absolutely see myself doing this kind of work.
The section on how individuals manage their negative behaviors (by limiting access to platforms or by seeking out positive content) was particularly interesting to me. I would be interested in a study comparing people’s ability to do these on various platforms. One person described Pintrest as being particularly helpful because they can pin what they like, for example; I imagine Reddit would be similar because of the ability to decide which subreddits’ content you see. Facebook, Twitter, and Instagram afford the user less control. What does behavior change look like on Facebook vs. Reddit?
Being intentional with technology has been one of my biggest struggles over the past two years or so. Once I started becoming aware of the effect that technology was having on me personally, I sought to curb undesirable behaviors—stopping Facebook use, spending less time on Reddit, focusing more on group chats or personal conversations.
I downloaded some of the “mental health apps” (for lack of a better term), but found them woefully inadequate. This paper helped me to see why: because they assumed that they had the solution. But the “right” solution would have been one that helped me with what I was already trying to do—set limits, seek out positive content, plan more, etc.
This was a bigger problem when I was experiencing more severe depression, but it persists even today. One of the reasons I like Android so much is because it gives me more control over my relationship with my phone, and I appreciate this work for helping me to understand why that matters so much.