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Steph Habif, EdD Calming Technology Lab Stanford University Stanford, CA 94305 firstname.lastname@example.org Neema Moraveji Calming Technology Lab Stanford University Stanford, CA 94305 email@example.com Marily Oppezzo Calming Technology Lab Stanford University Stanford, CA 94305 firstname.lastname@example.org
Physical injury is a powerful source of stress and a public health concern for physically active people. Individuals who are injured face a multitude of psychosocial risk factors and therefore require specific emotional and social support. Interactive calming technologies can increase coping among injured individuals by delivering just-in-time messages to mitigate injury specific stress. This paper aims to explore a mobile technology designed to deliver calm to injured individuals by outlining modalities for inducing calm, a theoretical model of calming technology, and a calming technology prototype.
Injury; coping; interactive design; calming technology
ACM Classification Keywords
H.1.2. User/Machine Systems: Human Factors
Sport and recreational-related injuries are a significant public health concern for physically active persons [. Physical injury is a source of stress, which exacerbates the negative consequences of injury . Injury-related stress comes in many forms including
Copyright is held by the author/owner(s). CHI’12, May 5–10, 2012, Austin, Texas, USA. ACM 978-1-4503-1016-1/12/05.
pain, depression, anxiety, anger, insomnia, and social isolation. These stressors prevent successful healing. Known methods of treating physical injury focus almost exclusively on the physical condition, often ignoring the psychosocial component. However, decades of research provide evidence that psychosocial stress is a primary determinant of injury rehabilitation . Mindbody science has illustrated that injury conditions are exasperated by stress and that the parasympathetic system induces healing processes . As such, a person who can more successfully manage stress during injury rehabilitation will more successfully recover. What needs to be understood, and has been studied, is how a person copes while injured . Coping includes internal factors such as general coping behaviors (i.e., self-care), psychological coping skills (i.e., management of thoughts, energy, attention) and stress management strategies, as well as external factors such as social support. In general, coping resources reflect strengths and vulnerabilities in managing the demands of stress. Huge opportunities exist to use interactive mobile technologies to increase coping among people dealing with injury. For the purpose of this paper, we are most interested in exploring how to use technology to fortify psychological coping skills among recently injured individuals. Specifically, we aim to provide social support by influencing thoughts, attention, and emotional energy by increasing levels of calm during injury recovery. We operationalize ‘calm’ as restful alertness, or a state where one is present and able to function in a sustainable manner. Therefore, we refer to these types of technologies as calming technologies (CTs): systems
that induce cognitive, physiological, or affective states of calm.
Modalities for Inducing Calm
CTs may sacrifice on task efficacy or efficiency for the sake of ensuring the desired state change. Therefore, traditional HCI methods of evaluating interfaces using efficiency, effectiveness, and even usability as outcomes are less applicable; instead, the outcome of the user’s calm state must be used in evaluation. This section outlines the three areas of one’s life in which calming technologies could impact: cognition, physiology, and affect. Cognition Stress can have a number of negative effects on cognition [11, 12]. Even mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities ; more prolonged stress exposure has been shown to cause architectural changes to the prefrontal cortex (PFC), impacting working memory, behavior regulation, and attention regulation . CTs can promote calm by sustaining one’s attention or eliminating distractions, increasing self-regulation, increasing the salience of foreground tasks, augmenting working memory, reframing thoughts, and increasing focus on solutions (rather that roadblocks) when solving problems. The benefits of CTs delivering physiological calmers, for example, can be cognitive in nature. Physiology The physiological effects of chronic stress have been and continue to be extensively studied. There are negative cardiovascular and neurological  effects of chronic stress. Allostatic load is “the physiological
consequence of chronic exposure to fluctuating or heightened neural or neuroendocrine response that results from repeated or chronic stress” . It can accrue as a result of four processes: 1) frequent activation of the stress response, 2) failure to habituate to repeated stressors of the same kind, 3) failure to shut off the stress response appropriately, and 4) inadequate reaction to the stress response. CTs counteract these physiological behaviors, actions, or states in myriad ways such as promoting calm respiratory patterns, reducing muscle tension, eyemovement desensitization and reprocessing (EMDR) and triggering progressive relaxation. Affect. One’s affective state can have profound effects on the other two areas, cognition and physiology. Prolonged stress is a major risk factor for depression  and exposure to traumatic stress can cause post-traumatic stress disorder (PTSD) . Stress can also exacerbate schizophrenia  and bipolar disorder . CTs can mitigate these issues by inspiring and motivating users to maintain a positive short- and long-term outlook, savor current and past experiences, and reframe negative situations.
person is feeling stressed, (e.g., injury) one can begin to isolate the particular sub-components of the domain that actually are stressful.
Figure 1. A theoretical model of calming technology with three primary components: causes/effect of stress, calming mechanisms, and user-centered design.
Through research, instruction, and inspection of known systems, we identified three primary components of any calming technology. We propose the theoretical model shown in Figure 1. Cause/Effect of Stress Design of CTs should be guided by an understanding of the nature of stress, how it emerges, and its effects on the body, cognitively, physiologically, and emotionally. By identifying the stressor’s characteristics (e.g., inadequate coping skills) in the domain where the
For example, many injured people feel stress when they experience pain. Rather than targeting pain in general, the designer can identify exactly what is stressful about being injured– e.g., physical pain, social isolation from not being physically able, etc. Calming Mechanism To be effective, CT design should consider the mechanisms through which a stimulus can have a calming effect (and the literature on different calming therapies). CTs can elicit different sensory experiences or aim to directly mitigate the specific characteristics of stressors. These main methods of designing calming mechanisms into a technology include: a) reducing or eliminating the presence of effects of a stressor or b) introducing or magnifying calmers, or c) both. CTs that introduce novel calmers, for example, can attempt to
expose people to experiences that consciously or subconsciously increase calm in their daily lives. User-Centered Design (UCD) An understanding of UCD and interaction design is fundamental for evaluating and designing methods of embedding calming mechanisms. To the extent that a designer empathizes how the user is experiencing his or her context, s/he will be more effective in targeting implied stressors. Furthermore, stress has been shown to effect people differently at different ages ; thus a CT targeting a teen stressor in his or her teens may be ineffective for senior citizens.
cognitive and emotional suffering that accompanies physical pain, thereby increasing their coping.
Figure 2. Illustrative prototype of SMS ‘Morphine Drip.’
We have developed a prototype (See Figure 2) that provides meditation-based coping messages & social support to people dealing with injury pain. In this prototype - called SMS Morphine Drip - the target users are injured adults who are experiencing stress as a result of physical pain. Personalized and generic SMSbased calmers such as soothing messages, images, inspiring stories, and pain assessment prompts are delivered via text message. Messages are specified according to what the user is experiencing in that moment (e.g. angry thoughts, muscle tension, etc.). The system operates in either a user-initiated ‘pull’ manner, where the user texts an ‘SOS’ when in pain, or system-initiated ‘push’, where a ‘pain check’ is sent out during the user’s typical peak pain times of the day. In the pull scenario, the user’s physical pain triggers stress, to which these SMS-based message triggers calm. In the push scenario, the SMS-based message triggers calm to empower the user to practice calm during a pain cycle (e.g. high stress experience). This gives users a sense of control over their own pain management, and seeks to decrease the subjective
Stress has a proven impact on injury recovery and rehabilitation. Our theoretical model of calming technology guides the development and analysis of CTs that increase levels of coping in users through cognitive and affective means. By tapping into psychological thoughts, attention, and energy among recently injured individuals, CTs can provide emotional support during an injury rehabilitation experience.
We thank all the members of our Stanford Calming Technology lab who provided helpful comments on this project.
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