Digital support to improve paranoid thoughts

How can we increase the effectiveness of therapy for people with paranoid thoughts?

Traditional inclusive design methods work very well when conducting research with people who have poorer mobility or physical impairments. But when it comes to working with people who think differently, it pushes inclusive design into new areas of focus. This is one of the most enlightening parts of this project – trying to walk in the shoes of someone else is inherent to inclusive design, but trying to think in a way that you don’t think, presents a new kind of challenge when producing a rational design piece. It becomes about designing for people who are in a different psychological state.

In 2014, the Institute of Psychology, Psychiatry and Neuroscience at King’s College London developed the ‘Thinking Well’ intervention, a cognitive behavioural therapy course for people who suffer from paranoid and suspicious thoughts. This consisted of six individual sessions with clinical psychiatrists in which patients were taught different tools and techniques to help them manage their paranoia on a day-to-day basis. The sessions used a digital platform with interactive tasks, including puzzles, images and video to encourage the participants to slow down their thought processes and look for alternative explanations for their upsetting thoughts.

Coping Between Therapy Session
Although the ‘Thinking Well’ intervention was met with positive feedback from the participants, testing of the intervention pointed to certain user traits that affected how beneficial the therapy could be.  Motivation and working memory were important attributes, and this testing pointed to certain elements of the design that could improve these factors. The Institute partnered with the Centre to further develop the digital platform, and  to carry out in-depth research and design  to further the benefits of the therapy, perhaps even beyond the actual sessions with the therapist.

Research Associate Anna Wojdecka spent  a lot of time with service users observing their therapy sessions. She collected incredibly in-depth information on the kinds of things that affect paranoid and suspicious thoughts and how a digital platform might help. The output is called ‘SlowMo’, an enhanced digital platform to assist therapy sessions, and also a smartphone app to help carry those  lessons beyond the sessions and into  the lives of the service users. 

There were various challenges to working with this specific set of service users, as,  what would normally be considered as good app design might not be beneficial to them. The app’s function is to slow the user down, which is at odds with traditional digital  experience design that usually looks at making something more efficient and speedy.

Slowing Down the Thought Process
As service users progress through the therapy, more content is unlocked.  For example, at the beginning, when asked to log upsetting thoughts, a bubble appears and they resize the bubble according to how distressed they feel; then at the second stage, a bubble spins quickly and by tapping on it to slow it down, the user can slow their own thought process. The idea is that the skills learned during the sessions would synchronise with the app, which could  then be taken away and used outside of the prescribed therapy time.  In turn, as people can keep track of their upsetting thoughts by logging them into the app, the therapist can tailor their sessions to specifically suit the person’s everyday life and understand how they are coping outside of the sessions.

At the moment there are many mental health apps, but a very few have an evidence base supporting that they really help people. The SlowMo platform will be extensively trialled, and will hopefully be a tool that clinicians can confidently point their patients towards due to the weight  of evidence behind it. 

See previous year's project

Research Associate:
Anna Wojdecka 

Healthcare Research Leader: 
Jonathan West  

Research Partner: 
King's College Institute of Psychiatry, Psychology & Neuroscience

Maudsley Charity, Wellcome Trust