In 2009, Dr. Abby Rosenberg noticed that teenage patients at Seattle Children’s Hospital were having a hard time coping with chronic and terminal illnesses. Such illnesses are difficult for anyone, but they’re especially challenging if you’re a young adult also going through adolescence who may have never faced any kind of adversity in the past. She wondered: Could adults teach these teenagers coping mechanisms, like deep breathing, setting goals, and remembering how to be grateful? And would that improve their mental outlook?
After years of research and conversations, Rosenberg and her colleague Dr. Joyce Yi-Frazier created the Promoting Resilience in Stress Management (PRISM) program–a set of exercises designed to help teenagers and young adults with cancer and type one diabetes cope with their diseases. And through randomized control trials, Rosenberg found that teens who’d used PRISM described themselves as more resilient, had more hope for future, had less clinical depression, and less need for formal psychological intervention like therapy or drugs.
But there was a disconnect. Most of PRISM was centered around a human therapist coming to a patient’s bedside and working through exercises on mindfulness and gratitude using a pencil and paper. But that’s not the most effective way to help teenagers form new habits–especially not the digital-savvy teens of today.
“They overwhelmingly said this is great, except that the way we practice it is through paper and pencil,” Rosenberg recalls patients telling her. “Instead, we want you to speak the language that we speak. We want to be able to work on this whenever we want. We want it to link with other things that matter to us, including our social networks.”
The only answer that made sense was an app. Rosenberg and Dr. Wendy Sue Swanson, a pediatrician and the chief of digital innovation at Seattle Children’s, turned to Seattle-based design firm Artefact to transform the paper PRISM framework into an app for teenage patients. Now, the app, developed by the company General UI, is in its first pilot at the hospital, where Rosenberg is putting it in the hands of teens who are suffering from all kinds of conditions–not just diabetes and cancer.
From Paper To Screen
The transition from paper to screen was no easy task. First, Artefact’s designers distilled PRISM’s four pillars–stress management and mindfulness, goal setting and forward thinking, cognitive reframing, and building gratitude–into six practical exercises that a user can do. These six modules are laid out in a honeycomb-like, lattice structure on the app’s home screen in warm secondary colors.
The first exercise is just to breathe. When you tap on the breathing module, the app explains how breathing deeply can help users cope with stress, then walks you through a simple exercise where you breathe in for four counts, hold for four counts, and then breathe out for four counts. The app literally counts for you: a simple geometric animation plays as the app instructs you to inhale, hold, and exhale, four times through.
Some of the other modules are connected to the user’s profile page, which looks purposefully like an Instagram feed. When you use the “set a goal,” “catch a negative thought,” or “find gratitude” modules, the app prompts the user to write a few words about how they’re feeling, and attach those words to an image, whether it’s one they take in the moment or from earlier on. Then, the image becomes the background for the words, and the entire thing is added to the user’s profile page. It’s a clever, easy way to put all of your goals, thoughts, and moments of gratitude in one place that will be instantly recognizable to teens. As of now, it’s not something you share, almost like a multimedia diary.
Artefact’s designers were very careful to design an app that exudes trustworthiness and safety, given the fragile state of minds of its users. Part of that is the calming color palette of muted orange, turquoise, purple, and pink. There’s a series of whimsical illustrations that add texture to the descriptions of each exercise while giving the act of doing them a positive connotation. The lattice structure of the home page is supposed to indicate that all the modules are interrelated. The exercise names use an active voice, like “Quiet Your Mind,” or “Find Gratitude,” to subtly empower users.
Rosenberg is skeptical that the app will ever be able to entirely replace a therapist who sits with a sick teenager at their bedside because they provide a guided way into the program. It’s one of the things she’s looking to continue researching.
The app isn’t public yet because testing has just begun. But ultimately, the app could help the doctors bring a methodology that’s been confined to the hospital to a wider population. Many of us who aren’t teens and who aren’t dealing with a serious illness could likely also benefit from the framework’s exercises. “Can we actually learn from the sick and help the non-sick?” Swanson says. “Adolescence is hard for every adolescent.” And if PRISM works for all kinds of teens, could it work for adults as well?