5 Design study I: How to create an ambulatory app for patients with BPP 151 1. Introduction Recent years have seen a tremendous increase in the number of health-related applications and services, including a vast number of mobile applications claiming to help improving one’s mood, emotional balance, or other aspects of mental health. However, apart from a limited number of decent exceptions, the majority of these applications seems to be developed with little regard to the specific characteristics and actual needs of its target users. Many of these applications also fail to incorporate current scientific or medical knowledge on their prospected users in their design. This practice potentially comprises risks for mental health patients who decide to use these not-validated, potentially ineffective apps. In the field of mental health care there is considerable interest in the potential added benefits of using combinations of therapies [1]. However, in doing so practitioners usually keep a close watch on potential harmful therapeutic interactions. Such interactions can include the combined intake of two or more therapeutic drugs [2], but also the combination of different psychological interventions or treatments. As with some combinations of drugs, the combined use of different psychotherapeutical techniques can result in lesser or even adverse effects [3, 4]. For example, the advice of your GP to simply avoid your mother-in-law to lower stress, could negatively interact with a treatment in which your psychotherapist tries to improve your social skills and assertiveness. Recent studies bring forward that there are already many unsupported, ‘low-value’ or even harmful interventions in traditional medicine [5, 6]. Many of these ‘do-notdo services’ lack any scientific evidence or are scientifically proven to be ineffective and/or harmful for patients [5, 7]. A lack of proper inquiry into the user needs and requirements will also likely negatively affect the adherence to an e- or mHealth intervention [8]. One particular group of mental health patients who are ‘at risk’ of using potentially ineffective or other ‘do-not-use’ applications are those with a borderline personality disorder. Borderline personality disorder (commonly abbreviated as BPD) is a severe mental health disorder that influences practically all domains of life including work, finances, leisure, and relationships. The disorder is characterized by a pervasive pattern of instable relations, a distorted self-image and profound disturbances in the processing and regulation of emotions. Impulsive and self-harming behaviors such as self-injuring and autointoxication are frequent, and many BPD-patients experience severe problems in social and interpersonal functioning [9-12]. The characteristics of the disorder often make it hard for patients to fully engage in any treatment they may be offered. Those who are able to do so often find it hard to stick with the treatment and more than occasionally leave before the end of a program [13]. Analyses of outcomes measured 2–3 years after treatment suggest that treatments-as-usual are marginally effective at best [12].
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