Chapter 5 176 as the proposed e-coach since the effectiveness and appropriateness of proposed strategies depend on the circumstances [100]. Although this need struck us as important, it was decided not to translate this need as a requirement - at least not at this stage of development. The primary goal of the proposed e-coach is to support in increasing awareness of emotional arousal. Incorporating feedback on how to regulate emotion would go well beyond the primary research question and therefore also the scope of the e-coach design that fits to this question. Our review of the scientific literature brought forward evidence on difficulties in emotional awareness in BPD [101], especially regarding the awareness of the level of emotional arousal in BPD [30]. Several experts in the field expressed a need for increased focus on emotional awareness to improve the effect of existing therapies for BPD [20, 30, 102]. The design study set off from here. As is evident from the commonality of therapeutic training programs such as the STEPPS, or therapies such as Dialectical Behavioral Therapy [103], specific training of emotion regulation skills is already well-embedded in many treatment programs. Whether there exists a need for the training of such skills by means of an e-coaching app is an important question that deserves its own research. If so, and when ecoaching on improving awareness of emotional arousal proves to be effective (as studies as [78] suggest), it would be both rational and interesting to incorporate such feedback on emotion regulation in the design of the e-coach. The ability to adequately become aware of and regulate one’s own emotions is heavily challenged in several mental disorders [25, 104]. In this project we chose to target patients with BPD and their therapists. We chose to focus on BPD, since emotional awareness and the ability to adequately regulate heightened levels of emotional arousal are especially challenged in this disorder. Additionally, BPD is characterized by high levels of disability and suffering. This study has a set of limitations. First of all, the study sample was small: only six participants were included, of which three were patients, three were therapists. Yet, there is general consensus that user centered design most often requires no more than five participants [105-107]. Next, BPD is a heterogeneous category; its clinical presentation of disorder can differ greatly from one patient to another – which is in part legacy of the diagnostic system used. Out of nine criteria, a person is ‘classified’ as having the disorder if five (or more) criteria are met – in no particular order [108]. It is therefore unlikely this study will have grasped the mental model of ‘the’ BPDpatient. But then again, it did grasp the mental model of actual patients that all were diagnosed with the specific disorder. Notwithstanding their significant importance for the field, many other participatory design studies only involve non-patient groups – not seldom students, or other experts on design, i.e., fellow researchers [69, 77, 78, 82, 109, 110]. As all three patients were receiving treatment at the same mental
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