5 Design study I: How to create an ambulatory app for patients with BPP 165 Hellen Kramer Age 27 Level of education Bachelor “I very easily tend to ignore my feelings” Experience with technology Hellen is very up to date when it comes to technology. At home she’s got an Xbox One and a laptop and during therapy days she always carries her smartphone with her. She uses these devices to play games, to stay in touch with friends and family and to stay up to date about the news. Mental health care background Hellen has been diagnosed with a borderline personality disorder. To deal with her personality problems Hellen has had several treatments in the past, such as an Emotion Regulation Training (ERT), coaching and different forms of cognitive-behavioral or other forms of therapy. She has also been to a psychiatrist for a short while. Environment Currently Hellen is in clinical treatment at a center for people with personality disorders. At the clinic she resides with approximately twenty-four people and has to follow a busy and structured program. During an average day at the center almost everything – whether it is doing chores, attending a meeting or having therapy – is mandatory and starts and ends at specific times. Goals and motives Hellen has difficulty with regulating her emotions, trusting others, bringing structure to her life and to be herself while connecting with others. Part of Hellen her regulation problems are what therapists call an ‘intense emotional episode’. During such an episode Hellen is caught off guard by a – seemingly -rapid build-up of emotional arousal. The effect such an episode has on Hellen differs each time: sometimes the number of thoughts can overwhelm her and she can become very active and chaotic in her behavior. At other times her mind can go blank, which tempts her to become passive and to avoid social encounters. In the worst-case Hellen is afraid that she cannot bear the emotional arousal and that the episode will never end. At this time, it is impossible for her to constructively express or act on her emotions. She might be urged to emotionally or physically hurt herself or others to cope with the intensity of her emotions, for instance by getting very angry at herself or people (emotionally) close to her, by using drugs or excessive amounts of alcohol or as a last resort by physically hurting herself. While Hellen experiences her time at the clinic as turbulent and sometimes hard, she also thinks it has a positive influence on her life. The therapies and structure that are set out for her within the clinic support her in learning to regulate her emotions and to create the structure she needs in order to cope with her personality problems. Figure 4. Persona of the patients. Eva Smith Age 42 Level of education Postdoctoral degree “The challenge is to learn patients how to recognize the build-up of their emotional arousal ” Experience with technology For her work Eva uses a computer and a smartphone to communicate with colleagues and patients and to handle other job-related matters. Eva considers herself being reasonably up to date about technology. Besides using a computer and smartphone at work she uses a laptop and a tablet in her life outside work. On these devices she uses the internet to read the news, mail with friends and family, shop for clothes or book vacations. Environment Eva works as a psychotherapist in a Dutch clinic for people with personality problems, called Scelta. Since her work contains a lot of different activities and objectives, each day is different and there never is a dull moment. Goals and Motives During an average workday Eva is mostly concerned with diagnosing patients, treating patients and intakes of patients. She treats patients with all sorts of personality problems, for instance people who have an Avoidant Personality Disorder (APD), a Borderline Personality Disorder (BPD), or a Narcissistic Personality Disorder (NPD). Of course, she also sees patients with any other personality disorder; many patients actually have a combination of elements of different personality disorders. Eva does a lot of group therapy but she treats patients individually as well. She systematically evaluates the effect of each treatment with her colleagues and provides feedback to her patients based on these evaluations. She also has several meetings each day with her colleagues about the progress of several patients. Besides group therapy Eva also gives an Emotion Regulation Training (ERT). With this form of therapy Eva teaches the patients how to become aware of and regulate the intensity of their emotions, which is often a problem for people with personality disorders. She also teaches patients how to elaborate their emotional vocabulary and how to act more constructively when they are experiencing intense emotions. Figure 5. Persona of the therapists.
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