Chapter 5 156 What are the main requirements of an application that is meant to support patients with BPD in a clinical treatment setting in becoming more aware of their level of emotional arousal? Our search of the literature brought back there is yet very little existing scientific output on this topic, that is, the use of biosensor-informed e-coaching in the treatment of BPD and/or emotional awareness. To our knowledge, to date only one user centered mHealth project using wearable biosensor technology has reported in detail on specifically targeting and involving psychiatric patients as a user group: the MONARCA project [67]. This large scale, multilevel project focused on the monitoring, treatment and prediction of bipolar disorder episodes by means of several measurement instruments, such as a wrist-worn activity monitor and a mobile EDA sensor. Based on their experiences regarding this project, researchers Mayora et al. [68] state that “it is important to consider that the utilization of technical monitoring systems in the field of mental health causes several challenges on the patients’ sphere”. Among their ‘lessons learned’ (as they named their paper) Mayora et al. stress that well known user experience guidelines apply for these patients such as giving enough time to get familiar with the new technology, and that the user should be able to use the system correctly without help of the professional. Since any technical difficulty may create additional stress - which is aversive in general, but especially when working with vulnerable mental health patients - a contact person should be available at all times in case technical problems occur. Almost all other studies actually carried out were performed with persons with no known mental health disorder. None intendedly included BPD patients. Examples of these studies include those with an e-coach aiming to improve emotional awareness in non–patient groups by providing feedback on subjective experiences provided by the user [69]; some studies include experimental designs in which a biosensor informed ‘e-coach’ of some form is tested with patients with physical problems or disabilities, such as a system aiming to support patients with chronic back and neck pain with their posture [70], one aiming to support patients in monitoring and regulating their diabetes [71], and an e-coach that timely detects seizures in epilepsy [72-74]. Some of the intended or planned studies published describe a biosensor informed e-coach to aid patients with drug-addiction in preventing relapse by detecting and signaling craving [75], emotion detection and communication in patients with autism [76]. Unfortunately, there are no reports known to us on actual testing of these e-coaches with these user groups. Several small field-studies tested feedback of individual arousal or ‘stress’ based on HR-based [77-80] or EDA-based [81, 82] measures in non-patient users. In one of these studies [78] it was found that when participants are given feedback about their heart rate, their estimates of their stress level become more in tune with their heart rate. The researchers assume that
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