Transcending Blue: Adolescent Interconnection & Empathy in the Age of Screens

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TRANSCENDING BLUE adolescent interconnection & empathy in the age of screens

Catherine S. Weislogel



TRANSCENDING BLUE Adolescent Empathy and Interconnection in the Age of Screens

by Catherine S. Weislogel edited by Leigh Gallagher


CopyrightŠ2020 by Catherine S. Weislogel All Rights Reserved Design by Catherine S. Wieslogel First Printing: May 2020

Transcending Blue is a body of thesis work and thought published in completion of the Masters of Fine Art degree for the Products of Design program at the School of Visual Arts, New York.


I owe thanks and gratitude to many for the completion of this thesis. For my husband, Reubenjamin. You have endured much and supported me with steadfast love and encouragement all the while. For The Lady Gang: Seona, Yuko, Victoria, Stephanie, and Pantea. My sanity would have been lost without you. For the PoD Class of 2020. It’s been a joy to be on this journey with you. For the wonderful PoD faculty and the department who have pushed me to grow into the designer I have become. In particular, Allan Chochinov, Jennifer Rittner, Sinclair Smith, Megan Ford, Krissi Xenakis, Mark Dones, Shanti Mathew, Marko Manriquez, Alissha Wessler, and Kristina Lee. For my parents, who have loved and supported me on my journey to adulthood and beyond.



“Innumerable confusions and profound feelings of despair invariably emerge in periods of great technological and cultural transitions. Our “Age of Anxiety” is, in great part, the result of trying to do today’s job with yesterday’s tools—with yesterday’s concepts” Marshall McLuhan The Medium is the Massage, 1967


a not e f r o m t h e designer This thesis was born from memory. As someone who grew up in the early days of the internet, I straddle the line between digital-native and “the world that came before the internet.” I remember a time when constant connectivity was not a part of our lives. This thesis was born from confusion. I consider myself decently well-versed in many of technology’s uses, but recognize myself as a late adopter. I continue to remain baffled by some of the ways my peers connect on a digital level– Snapchat, Twitter, TikTok. I feel torn between the romanticism of a childhood spent reading books with paper pages, and the bright possibilities of a technological future. This thesis was born from fear. As someone who’s struggled with anxiety since my early teens, my experiences with fear are both intimate and long-standing. I am afraid of many of the changes the digital revolution is producing. I am afraid for the people who are vulnerable in a virtual society. I am afraid that, by living so much in the virtual world, we are simultaneously devaluing the real world. This thesis was born from a desire to escape. Having spent a lot of time hiding from all that I fear, I understand all too well the pull of virtual realities. Only a button away from slipping into a place that doesn’t hurt as much. This thesis was born from anger. I am angry at the manipulations of tech companies, social media platforms, and applications in service of capitalism. That delivering profits to shareholders and board members in the name of innovation is worth sacrificing the mental and emotional health of many. This thesis was born from empathy. Social media’s insistence that I compare myself and conform is bad enough as an adult; I can only imagine how hard it


must be for people in their formative years. Awkward in mind and body, unsure of self and others as they try to navigate the hormonal waters of middle and high school. How easy it is to become addicted to something when you lack self-knowledge and self-love. This thesis was born from determination. Determination to snatch back control. To root for the underdog. To try to help adolescents from making the same mistakes or feeling the same pain I did at their age. To support them on their mental health journeys. To understand what the hell is going on. This thesis was born from hope. That technology and design can be leveraged to help young people realize their human potential. That they can connect with others in ways that bolster community and mental/emotional wellbeing. A hope for a balanced integration of digital and physical worlds, where young adults can be their authentic selves with others.

This thesis will be born by design.


table of contents intro 1 / kids these days................................................. 3 / process...........................................................13 / initial findings.................................................. 27

physical instantiations

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/ pip..................................................................31 / Arti................................................................ 43

digital instantiations

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/ mishappy hour................................................ 57 / SoMonki......................................................... 73


other projects

89

/ in situ..............................................................91 / olive............................................................... 93 / #SmR16.......................................................... 95

outro 99 / conclusion..................................................... 101

addenda 109 / public policy memo........................................ 110 / bibliography................................................... 124 / glossary of terms............................................130



INTRO


“Nothing—whether it’s being with your friends, having sex, licking an ice-cream cone, zipping along in a convertible on a warm summer evening, hearing your favorite music—will ever feel as good as it did when you were a teenager.” Laurence Steinberg


kids these days

We live in a confusing time to say the least. (Especially at the time of writing this thesis. Hello, Coronavirus.) Flashing screens, lights, color, sound, and blurs of photoshopped perfection constantly compete for our mental bandwidth in this nonstop attention economy. These days, our lives revolve around the smartphone: we rely on them for everything from organizing our busy lives to keeping us hyper connected to appeasing moments of boredom in small moments. Humans were not built to withstand the torrent of stimulus, distractions, and addictive interactions though. And the mismatch between the glacial pace of human evolution and the frenetic pace of technological/cultural evolution has never been more striking.

While all humans are susceptible to the effects of the omnipresence of technology in our daily lives, children and adolescents, in the critical stages of brain development, are the most vulnerable (Alter). In particular this thesis will explore the effects of technology on development during adolescence: those years of hormonal growth, discovery, identity exploration, and just plain awkwardness (I mean, who wasn’t awkward for at least 75% of their teenage years?). Adolescence represents a critical period of development, not just in the way our bodies are morphing into the future forms and minds of our adult lives, but also in how we communicate and build relationships with other members of our species.

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Adolescent Social & Emotional Development According to the World Health Organization, adolescence spans the years of 10 to 19 years of age, but even medically speaking there is confusion and inconsistency around the exact ages that define adolescence. There are also the terms “youth,” which the UN uses to refer to people 15 to 24 years old, and the term “young people,” for 10 to 24-year-olds used by other organizations (“Adolescents: a period”). For the purposes of this thesis, I will use the term “adolescence” to refer to both the stage of human development between childhood and adulthood and the age range of people 10 to 24 years old. According to traditional markers, people are entering puberty earlier and adulthood later. For reasons both cultural and economic, many young people are dependent on their parents well into their 20s (as reflected in average ages of marriage and financial security occurring later as well). Meanwhile, the age of menarche (first menstrual period) is happening earlier for girls. All of this has led to an unprecedented increase in the length of adolescence, which “now lasts about 15 years, twice as long as it did in the 1950s” (Gamble). According to childhood development expert Stuart Shanker, the plasticity of the brain during this period is what helps teenagers gain independence from their parents, shifting their focus to

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peer-centered activities. Adolescents are biologically programmed to test limits: when risks are taken, especially in the presence of peers, the pleasure-seeking reward centers of their brain light up like Christmas trees on MRIs (Kolbert). A leading expert on adolescence at Temple University, Laurence Steinberg, contends that “adults spend their lives with wads of cotton in their metaphorical noses. Adolescents, by contrast, are designed to sniff out treats at a hundred paces” (Kolbert). While all this curiosity and expansive learning capacity helps adolescents develop the skills they need to succeed as adults, it also makes them incredibly vulnerable (which I will discuss more in the next section). Because the frontal lobes of their brains, which helps keep impulses in check, are not fully developed, they are less likely to heed the potential consequences of their actions in pursuit of a neurologically rewarding experience. The impulse control developed through trial and error during this time disproportionately affects healthy relationship building and successful work outcomes in the long-term (Gamble). In our current age, however, when these young humans are supposed to be learning self-control and stress management, they are now inundated with distractions fueled by the attention economy, which makes it


much harder to learn these difficult new skills before they’re really put to the test. As Steinberg puts it, “Many recent innovations [...] exacerbate the mismatch between teen-agers’ brains and their environment. Adolescents today face temptations that teens of earlier eras[...] couldn’t have dreamed of. In a sense, they live in a world in which all the water bottles are spiked” (Kolbert). Temptations wrapped in aesthetically appealing, engaging packages, like social media and video games.

and author of Friendship: The Evolution, Biology, and Extraordinary Power of Life’s Fundamental Bond, “the intensity of feelings generated by friendship—or loneliness—in childhood and adolescence is by design. The complexity of the human brain development takes time. Much of that time is spent honing a new, more advanced set of social skills.” Adolescent brains are incredibly sensitive to peer influence, which Steinberg characterizes as “peer presence” rather than the more common “peer pressure” (Denworth).

PvP Mode (Parents v. Peers)

Although humans face social pressure throughout their lives, it’s particularly acute during this period. Friends can simultaneously help buffer the stress that comes with this pressure and also make it worse (Denizet-Lewis; Denworth). According to Steinberg, peer presence can lead to danger if it feels good. But on the flip side, “teenagers learn faster when they’re with peers than they do by themselves. And they engage in more exploratory behavior” (Denworth). As social creatures, humans have evolved to develop in a way that’s conducive to building relationship and communication skills. Historically that’s taken place mostly in-person. But now that virtual interaction plays such an important role in how we communicate and manage our social network, how are humans adapting?

One of the hallmarks of growing up— one that can bring both joy and pain—is the process of separating from one’s parent(s) and family to form an individual sense of identity. Up until that point, your parents are your primary community as they, ideally, provide the stability and framework for you to develop. The turning point arrives in adolescence; a point many parents dread, when hugs and affection become uncool. When parental public displays of anything are mortifyingly embarrassing. In adolescence, humans begin to shift their primary social bonds from parents to peers. At this stage, peer-to-peer interaction and socialization drives social and emotional development. According to Lydia Denworth, science journalist

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Intro

Social Media & the Smartphone Addictively Yours, Screen Time Let’s be real. Screen time can get excessive for everyone. (Unless you’re consciously uncoupling from your digital devices while on vacation.) Average daily screen time for adults is at least 10-12 hrs (Nielsen Total Audience Report). While many of us must unavoidably use screens for work and school, we also spend a lot of time consuming screen-based media— texting, playing video games, scrolling Instagram, and bingeing the latest Netflix craze, to name a few activities. According to statistics from the CDC and Common Sense Media, “Screen time (mostly mobile)

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grows exponentially as kids do. Children aged eight to ten spend an average of six hours a day in front of a screen, while those eleven to fourteen spend about nine hours in front of a screen every day” (Phillips 6). And it’s all by design. In his book Irresistible: The Rise of Addictive Technology and The Business of Keeping Us Hooked, Adam Alter writes that, “These entrepreneurs recognize that the tools they promote—engineered to be irresistible—will ensnare users indiscriminately. There isn’t a bright line between addicts and the rest of us. We’re all one product or experience away from


developing our own addictions” (4). He goes on to detail how young adults are the most at risk for developing addictions. As adolescents move into adulthood, they must take on a bevy of responsibilities that they haven’t yet figured out how to handle, so “they learn to medicate by taking up substances or behaviors that dull the insistent sting of those persistent hardships” (Alter 74). In fact, “very few people develop addictions later in life if they haven’t been addicted in adolescence,” making the potential consequences of their “medication” of choice during this time very real (Alter 74). Furthermore, Brené Brown, a renowned psychologist and researcher on shame and vulnerability, describes addiction as “chronically and compulsively numbing and taking the edge off of feelings” (70). In short, addiction is a behavior anyone can learn as a way to soothe psychological distress, be it an experience of fear, anger, or boredom. And it hardly takes a researcher to observe that, today, obvious options for “numbing” and escape are increasingly digital: like video games, social media, and YouTube. Teenage pregnancy and substance abuse (drugs, cigarettes, and alcohol— minus marijuana) have been in steady decline since the 1990s (Graf et al, 2019;

Ahrnsbrak, 2017). This is of course a positive change. But the inverse trend—increasing rates of adolescent anxiety, depression, and behavioral addiction—beg the question: is addiction really disappearing, or are the objects of addiction only being replaced by less obvious alternatives? The conversation around screen time and usage remains complicated and multi-layered. Many experts, like psychologists Catherine Steiner-Adair and Jean Twenge, believe that the proliferation of smartphones, in particular, are responsible for many of the behavioral and mental health issues we’re seeing in today’s youth. However, other researchers and academics argue against this view, claiming that the current conversation is driven mostly by fear and over exaggeration. More recent studies are finding that there isn’t a strong causal link between digital technology usage and adolescent well-being. The differing opinions on the consequences and effects of screen time on adolescents are, in part, due to inconsistencies in study results. Analyzing the research done on screen time and usage, Kim Tingley, the writer of the “Studies Show” column in The New York Times Magazine, asks, “How can the same sets of numbers spawn such divergent conclusions?” (20). Ultimately,

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Intro

she concludes that, “the answer to the question of whether screen time is bad for kids is ‘It depends.’ And that means figuring out ‘On what?’” (20). While experts can’t seem to reach consensus about the effects of copious screen time, they can agree that it can exacerbate underlying behavioral and mental health issues for those who have them (Popper). Dr. Candice Odgers, a professor and psychologist at Duke University, points to the “emergence of a new kind of digital divide, in which differences in online experiences are amplifying risks among [the] alreadyvulnerable” (Julian). Where the use of digital technology can further disadvantage those who are already struggling with their mental, emotional, and social well-being. This opens up broader questions about how to craft solutions that can suitably address screen time, with “researchers worry[ing] that the focus on keeping children away from screens is making it hard to have more productive conversations about topics like how to make phones more useful for low-income people, who tend to use them more, or how to protect the privacy of teenagers who share their lives online” (Popper B6). But when so much of adolescents’ social lives takes place virtually, to remove the digital aspect could only serve to isolate them further.

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In instances where adolescents rely on a social network of peers for support to offset an unstable or unsafe home situation, wouldn’t the benefits of the screen outweigh the risks? What this all points to is a strange dynamic in our current culture and society, where digital connectivity can positively benefit adolescents, but it can also engender loneliness.

It’s better to be alone . . . Right? In discussing the modern “It Girl,” an archetypal female influencer, New York fashion and culture writer Natasha Stagg notes, “‘You can become really famous without leaving your house, [...] I’ve definitely met very young people who create an image of themselves being always at home when they’re really not. It looks better for their personal brand to seem like they have less friends and they’d rather be alone’ ” (Tiffany). In a world where we’re often physically distant but always digitally available, it’s becoming cool to be digitally connected while physically remote. The desire to appear physically alone has become especially prevalent on Instagram—the undisputed social media platform queen of visual curation and glossy, polished influencers—where being alone can be a critical part of building a successful brand. In this digital realm, the self presented alone becomes a singular


object. The commodification of self in this way provides a realm of fantasy for onlookers to “imagine themselves as the corrective to your loneliness, in reciprocity for the way they’ll use your image to try to combat theirs” (Tiffany). Objectification is a gateway to dehumanization. By transforming either ourselves or others into objects, we venture into dangerous territory. Doubly so for adolescents, who are, for the very first time, developing critical social and emotional skills necessary for building relationships throughout their lives. At odds with what the adolescent brain is designed to do – take risks and learn from them – technology, and smartphones in particular, can act as inhibitors for “getting out there,” as Sherry Turkle, author and psychologist, writes in her book Alone Together. Digital communication technology, objectification, risk, and loneliness are all a part of this puzzle. Turkle explains,

take a chance. (154) Dehumanization thus isolates adolescents even further if they become less willing to engage outside of the virtual realm, for fear of taking those risks or appearing uncool. So while they appear connected on the surface, they’re safely alone underneath. Humanization is a critical component of learning to take the perspective of someone else, which, in turn, is a key skill necessary for building empathy. Humanization, like empathy, must be practiced if we want to successfully relate to others.

Networked, we are together, but so lessened are our expectations of each other that we can feel utterly alone. And there is the risk that we come to see others as objects to be accessed—and only for the parts we find useful, comforting, or amusing. Once we remove ourselves from the flow of physical, messy, untidy life—and both robotics and networked life do that— we become less willing to get out there and

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Intro

The Empathy Loop

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Sure, understanding other people sounds cool and all, but why is empathy so important? It is one of the foundational skills necessary for building intimate relationships. In adolescence, as our primary social bonds shift from parents to peers, it is critical that we learn to understand the viewpoints and feelings of others. Empathy can be categorized in two ways: affective and cognitive. Affective empathy describes the ability to share in what another person is feeling, or concern for feelings observed in that other person. For example, if your friend feels sad because a loved one has passed away, you may share in their grief. Cognitive empathy refers to the logical comprehension of another person’s emotions, often through perspective-taking. Both affective and cognitive empathy are necessary halves to an empathic whole when it comes to our relationships with others.

relationships with parents and peers” (Boele et al. 1049). Empathy develops as a skill through the voluntary formation of social bonds with peers, which can be more intimate, egalitarian, and reciprocal than the relationship with parents. Meaning, unlike your relationship with your parents, friendship is voluntary. Your friends have no obligation to continue a relationship with you if you’re an asshole. The lack of parental power dynamics allow for more intimacy as you go through experiences together. In addition to intimacy, the reciprocal nature of close peer relationships facilitates perspectivetaking through co-rumination, where peers think about one another’s problems, often together. On the flip side, relationships are also built and reinforced through empathy. Empathy builds stronger relationships, and relationships teach empathy through practice.

A kind of feedback loop develops between empathy and relationshipbuilding in adolescence. Returning to the role of parents versus peers in adolescent development, a meta analysis of the connection between adolescent empathy and the quality of their relationships with their parents and peers found “that adolescents who both show more concern for and a better understanding of others’ emotions experience higher quality

Unfortunately, the ability to empathize is also a skill we seem to be losing. A meta study of 72 studies done over the past 40 years found that empathy has been declining among college students since the 1970s. There is no definitive cause for this, but experts suspect that the internet and digital technology may have something to do with it. According to Alter, “online interactions aren’t just different from real-world interactions; they’re

Transcending Blue


The decline of empathic concern (a form of affective empathy) and perspectivetaking (a form of cognitive empathy) correlates with the proliferation of the internet. We see another sharp drop after the release of the iPhone. S ourc e : ht t ps : //stud y. c om / articles/Generation_Me_Study_ Finds_College_Students_Lack_ Empathy.html

measurably worse. Humans learn empathy and understanding by watching how their actions affect other people. Empathy can’t flourish without immediate feedback, and it’s a very slow-developing skill” (40). This doesn’t mean that virtual empathy isn’t possible; it’s just harder to convey and less common to experience. Virtual empathy and real-world empathy both generate positive social support, but realworld empathy lends itself to much stronger relationships (Carrier et al.). Preliminary studies suggest that it’s the type of online activity, rather than the amount of time spent online, that determines the effect on one’s ability to empathize. Research shows that face-to-face communication, whether real-world or virtual, seems

to contribute positively to real-world empathy. This echoes previous findings, that speech is more important than textual or facial cues in conveying the presence of a human mind. We are more likely to identify with and understand someone’s humanity, indeed empathize with them, if we hear their voice (Schroeder et al.; Ugolik Phillips). While empathy may seem to be slipping from our fingers, hope remains, if we stay open to the possibility that, given the right conditions, empathy might be shared virtually. The question for designers becomes, how we can utilize technology to function in service of human social and emotional development?

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process

While this thesis has not been a strictly linear endeavor, research has proved the foundation and starting point of every design project herein. Even as my creative process became messy and unpredictable (new inspirations sparking over here, uncharted paths opening up over there), research worked to anchor my concepts and focus my execution. I began with secondary research—reading books, articles, and psychology research papers— in order to formulate a basic understanding of psychology, digital technology usage, mental health, and adolescent development. From there my process split into two more specific practices: making and primary research.

Making—from early idea brainstorms to computer generated renderings and, eventually, the creation of threedimensional objects—allowed me to turn my responses to my research into tangible forms. These physical embodiments of my thoughts as objects also worked as valuable reference for my thought and design development as I conducted my primary research. My primary research involved interviewing subject matter experts, who helped me synthesize my reading with my design ideas, and understand how my creative responses might resonate with (or complicate, or contradict) expert opinions. The stories and knowledge shared by the people I interviewed—from teachers and counselors, to designers

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Intro

Subject Matter Experts

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Professor of Counselor Education at a University

Family, Children, & Group Therapist

Title IX Counselor, Therapist, Violence Prevention Advocate

Interaction Designer Google

Meaghan Muller Counselor & Performance Coach

Loryn Cummins Counselor

Steve Roberts Couples Therapist

Wesley Wooten Elementary School Counselor

Cowen Harter Education Consultant Former Principal & Teacher

Avi Silber Academy Coordinator & Teacher

Jeremy Jackson Program Manager Facebook

Cece Balboni Counselor

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Marjorie Gosling Counselor

Project Manager Amazon

Human Development & Psychology Master’s Student

High School Senior

Student Teacher

Elementary School Psychologist

Undergraduate Student

Project Manager Starbucks

Margi Scoufis Speech Language Pathologist

Middle School Counselor

Rianna Black Child & Adolescent Counselor

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at large tech companies—enriched my comprehension of my area of study. This further strengthened my understanding of how design might intervene in adolescents’ technology usage, particularly as I moved into the third stage of research and design—participatory design. Collaboration and participation are critical components of designing in an inclusive, equitable manner, in which the designer also becomes the facilitator. Without facilitating stakeholder participation throughout the different stages—from research to ideation to prototyping and beyond—, the design process simply becomes designing for a population instead of designing with. (Without the collaborative element, design edges closer to mirroring problematic power dynamics like that of colonialism— using their insights and what they’ve shared to benefit the product/project instead of the community. Taking without giving back.) Engaging stakeholders in describing the current state of their world, and then asking them to envision the future, generated rich dialogue and insights into how to best articulate, then address, contemporary problems around emotional and social growth during adolescence. In hindsight I regret that there was not, I believe, enough collaboration in my design process for this thesis. I think my thesis work would have been much richer through 16

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working more in depth with adolescents and mental health care providers during the reasearch, ideation, and testing phases of the design process. For example, speaking to more adolescents with mental health concerns during user interviews. Or conducting separate co-creation sessions with adolescent counselors. In particular, user testing could have been much more robust. Ideally, many of the products proposed, such as Arti or SoMonki, (as you will see later) would be tested in clinical settings, such as a therapists office, where two of the core users intersect. This is a consideration I will strive for in my future work. The primary lenses through which I designed ran along a phygital spectrum from physical to digital. The secondary lenses were everyday interactions and mental health care. Since so much of the problem space for my thesis touches upon mental health, I thought it was important to design for support across a range of interactions and environments. Following my primary research phase, I began a cycle of research, prototyping, feedback, and (in some cases), user testing for five different projects spanning the phigital and therapeutic spectrum. As you will see later in the book, these projects served as explorations of the thesis, and as manifestations of the insights I gathered from stakeholder interviews and reading.


Concept Modelling After gathering information through primary and secondary research, I began to analyze and break down key components of the complex interplay between digital tech usage, human connection, and human development. (As can be seen to the left in different stages of progress.) What emerged was an overlapping of six primary, interconnected areas: mental & emotional

health, social/human interaction, development, methods of learning, and tech/media. Tech and media, last but not least on that list, influences all of the other areas. Attention, tools, empathy, and communication serve as nodes of interplay between the primary areas.

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Graduate Students Social Work, Counseling, or Public Heatlh

Intro

Core Users Primary

Psychologists Adolescent, School, or Private Practice Psychiatrists

Counselors Adolescent, School, or Private Practice Early Adolescents 10-14 yrs old Mental Health Care Providers

Adolescents Middle Adolescents 14-18 yrs old

wh os tru ggl e

wit h

Mental & Behavioral Health Issues Late Adolescents 18-26 yrs old

Tech Addiction

Anxiety Depression Social Anxiety 18

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Secondary

Teachers

Friends / Peers

Education System

Policy Makers

Parents / Family

icon credit: Victoruler on Noun Project

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Intro

Competitor / Ally Landscape Products

Yondr, Photo Credit: Yondr

Physical interventions, like Yondr (above), lock up phones to prevent distractions, and are being applied in large scale settings, such as schools and concerts. Artists, like Special Projects Studios, explore ways to limit phone access in a more whimsical, self-driven manner (left). Envelope by Special Projects, Photo Credit: Special Projects

Many of the toys and digital platforms targeting social and emotional growth in children and adolescents are specifically designed for youth with Autism. For example, Floreo (right) utilizes VR to help teach perspective-taking skills. More broadly, mobile apps, like SuperBetter (below) are seeking to use gamification to help bolster mental health in high school and college students.

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Floreo by Floreo Tech, Photo Credit: Floreo Tech


Organizations digital

individual

communal

physical

Many non-profit organizations, such as Roots of Empathy or The Relationship Foundation, are dedicated to helping bring back the empathy skills younger generations seem to be losing. These organizations that are addressing empathy and communal social development often do so through the avenue of schools and the education system, where they can reach a bigger audience. Other groups, like the Center for Humane Technology or Common Sense Media, are more concerned with educating the public on the effects of digital tech and media in people’s lives, and providing alternative guidelines for tech companies and individuals to follow to lead healthier lives.

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Intro

Co-Creation Workshop: Akin To In my continuation of user research, I wanted to better understand how adolescents are affected by the use of digital technology, particularly smartphones. Through participatory design I sought to grasp what mechanisms and behaviors adolescents use to form social

years time and imagine how they would communicate in those spaces. What I learned is that young people are connecting by using smartphones as a medium for the transmission and transferral of experiences. In one example, a participant imagined that they’d be able to digitally share the

Participants engaged in Near Futuring activity

relationships. To do this, I facilitated a cocreation workshop, in which adolescents first came up with spaces of interaction, like the subway or a coffee shop, and identified how they communicate and connect in those spaces. After that, they were asked to reimagine what future spaces of interaction would be like in 5

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physical thrill of being on a rollercoaster in the future. But the workshop also showed smartphones are also a tool for riskaversion. As one participant put it, “Talking to people face to face is kind of scary,” and screens provide a comfortable barrier of time and distance. While still valuable, the findings of this co-creation workshop were


Participants created name tags and reviewed

(Above) Participants used stickers to indicate

Informed Consent forms

how they communicate in different spaces (Below) Participants pinned imagined future communication

somewhat limited by the small number of participants with fairly similar backgrounds. In the future, I might prioritize different tactics with regards to recruitment in order to find a more diverse participant group, thereby expanding the dialogue. As for the design and co-creative process, I learned more about what types of instructions and structures do and don’t work, as well as how people respond to different activities. What came as a surprise was the

depth of conversation and quality of userinsights that came at the conclusion of the activities. In the future, I might prioritize ways to generate stronger participation and methods for encouraging the group to challenge or question the design process.

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Intro

Seeding In order to understand how they envision the future, it was first necessary to establish the present and ground the imagination there. Participants were first asked, “What are the spaces in which you connect, communicate, and build relationships? What are some examples?� Then, using the provided stickers or by drawing their own, they populated the spaces they came up with. The group then walked through and discussed their creations on the board.

Near Futuring Future Scenario: The year is 2025. As new tools for communication are introduced, the forms taken by human interaction begin to shift. After establishing spaces of communication in the future, participants took the next 20 minutes to create, draw, collage, sticker, act out, and collaborate on their visions of the future on blank sheets of paper. These were then stuck to the board and discussed as a group.

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initial findings

Adolescence is an important stepping stone from childhood to adulthood in which we develop many of the social, emotional, and coping skills needed later in life. But during this crucial time frame for developing life skills, today’s youth is simultaneously and constantly exposed to distractions and applications intentionally designed to be highly addictive. While the U.S. has seen increasing rates of anxiety and depression in today’s youth, the causal link between increasing rates of mental illness and screen usage is unclear. Experts generally agree, however, that large amounts of screen time exacerbate underlying issues and predispositions. It became clear to me that by designing a world where the virtual becomes allconsuming, we are sacrificing the futures of our youth by stunting their social and emotional development.

social fabric to a new phygital norm that merges both digital and physical worlds, there are new opportunities for design to intervene and uplift vulnerable populations. In 2020, designers across many fields are entrenched in this issue. Having designed many of the problematic applications, devices, and platforms we use, it is dually our responsibility to help correct the course of these innovations. Designers are nothing if not change agents. Faced with a world increasingly reliant on digital technologies, we can support young people through both their journeys into adulthood and toward a tech-focused future. As citizens of this world, I believe designers have an opportunity to incorporate social and emotional responsibility into our processes and products to help build a better, more balanced future for the young.

Screen time and digital media consumption are concerning, but abstinence is not a viable solution. As we witness a paradigm shift in the human

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PHYSICAL INSTANTIATIONS



Core Users

pip Grandpa’s Cookie Jar Let me tell you a story about my grandpa (may his soul rest in peace). Grandpa had a legendary sweet tooth. His favorite treat: cookies. Now a cookie every now and then won’t hurt, but that man, he loved cookies. Could not stop eating them, even when the doctor told him his sweet tooth had led to diabetes. And yet Grandpa’s love of sugary goodness in crispy biscuit form could not be denied. Everytime we went to visit, Grandpa was inevitably sneaking a cookie or three from the ceramic jar tucked away in a corner of the kitchen. Happily munching without a care in the world. If you called him out on it, he would deny it, like some sort of biscuit burglar. Unfortunately for him, evidence of the crime scene usually remained as crumbs lingering at the corners of his mouth or scattered across his shirt. Come to think of it, Grandma probably should’ve stopped filling that jar with cookies in the first place. Picture the smartphone as the world’s most seductive cookie jar. All smooth glass and minimalist, sleek curves. This cookie jar isn’t filled with just ordinary cookies though. It’s filled with a rainbow of flavors to suit your every mood. Cookies with just the right ingredients,

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Source: https://www.facebook.com/CookieMonster/

designed to satisfy those sweet cravings and keep you coming back for more. You want crunchy dark chocolate ganache on a shortbread biscuit? You got it. You want warm, gooey chocolate chip that melts in your mouth? You got it. You want Pillsbury easy bake sugar cookies? You got that too. God forbid, you want those oatmeal raisin cookies, but you can have those too, I guess. Now, imagine yourself as a teenager with an enormous sweet tooth. You’re still working on self-control (no judgment, you’re just at that phase of life where executive functioning is in development and impulse control? Wtf is that?). And you’re carrying this beautiful cookie jar full of tempting delights with you everywhere. 24/7. It’s by your bed at night. In your pocket during the day. And the best part? Everyone else has a cookie jar too. Nobody thinks it’s weird if you eat cookies all the time. Your friends and parents, pretty much everyone you know, are constantly eating cookies too. So you just keep opening that cookie jar and reaching for more sugary snacks. Even if you feel bloated and nauseated from all the cookies you’ve consumed, it’s there, so why not? Just admit it. You’re kind of addicted to the cookies. And by kind of, I mean absolutely. The question is, what could possibly get you to stop reaching for the cookie jar?

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A Pip a Day Keeps the Cookie Jar Away Luckily for you, Pip is here to help. Wrapped in a deceptively cute package, Pip is a cell phone charger that helps you take enforced breaks from your screen. When a user puts their phone in Pip’s charging dock, the device activates a one-hour timer which locks the phone screen If the user tries to retrieve their phone before the hour is up, Pip delivers a little shock. The more you reach, the more shocking Pip becomes. Just think of Pip as an electric fence for your cookie jar. Now that you’re taking an enforced break from eating cookies, what could you possibly do with all this free time you suddenly have?

Process Pip is a speculative object. Or rather, speculative-ish, since it could be real, and doesn’t quite cross so far into an imagined future that it becomes a true provocateur. But the physical shock element is still too far outside the average person’s comfort zone to make Pip a viable product of the now. In this way, the idea of Pip was more of a thought process to help me explore new solutions and propel my thesis forward. Unlike the way my other thesis projects explored my thesis topic (to be seen later), where the smartphone serves as a facilitator of integrated physical and digital experiences, Pip investigates how to intervene in the physical and mental aspects of teen relationships with their devices. Looking at the smartphone as a barrier to adolescents engaging with the real-world due to their physical attachment to the object, I wanted to figure out a way to playfully remove the phone from the equation. The options currently on the market are generally some sort of lock up contraption or bag, more like a locker of sorts. Initially,

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Pip took the appearance of a blowfish. But in order to make phone breaks appealing to adolescents, I felt it was key to create a more visually compelling form that also offered playful interaction. Pip took on a more cute, cartoon-like appearance that appeals to young users, while the modern minimalism of the lines makes it more appealing to older users as well. The cuteness is also meant to deceptively lull users into a false sense of security, at odds with the unpleasantness of the shocking mechanism. But the point of Pip is to shock users. Introducing a negative, physical feedback loop has the potential to change the brain’s understanding of the phone as an object of security. By intervening in the physical attachment to the device, Pip intends to help teenagers begin to see the smartphone for what it is—a potentially dangerous object.

(Above) At first, I took a bit of a dramatic approach, where your smartphone can become a thespian in it’s own play through dress up. But then I started to wonder, wouldn’t it be better if there was something that could steal your phone instead?

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(Right) The initial prototype of Pip was that of a blowfish. In that early stage, the spikiness of the form directly mimicked the tactile shocking mechanism

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The form of Pip gradually became more abstract to make it more appealing to mainstream consumer tastes.

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(Above) Pip as a daily journaling practice.

Through the process of making and creating marketing for Pip, I began to understand that Pip is less about the product and more about instigating opportunities for users to engage outside of their screens. By developing the product through a different lense, the purpose of Pip evolved beyond artifact into the realm of practice and interaction. Instead of just a provocation for changing the perception of the smartphone, Pip as a concept became more about allowing users moments for reflection and/or connection throughout the day. An opportunity, if you will, to help teenagers set up space and time to take a break. Whether it be during the morning coffee routine (yes, teenagers drink coffee these days), talking to a stranger on the plane, or pausing for written reflection, Pip could be a chance to put the phone down, expand beyond the digital world, and connect to oneself and others in different ways.

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(Above & Right) Pip as part of the daily coffee ritual.

(Left) Pip as public instigation.

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Core Users

Arti

Traditional talk therapy can be awkward and trying for adolescents and the counselors working with them. Where talking can create barriers instead of promoting liberation. Building trust and connection while providing alternative methods of communication and thought/ feelings/emotional conveyance are key components of forming what is called a therapeutic alliance between adolescent and counselor. The therapeutic alliance creates a relationship geared towards belief in a mutual goal that of the client’s wellbeing and achievement of their own goals. A successful therapeutic alliance is one of the primary predictors of positive outcomes in counseling (Bennett et. al). As adults, we generally have autonomy in the matter of how, when, and with whom we may seek mental health treatment, but in the case of a young person who is still dependent on their parents, it may not be a choice. Resentment, unwillingness, or simply a lack of understanding can create obstacles to helping a young person reach their treatment goals. In order to build the

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therapeutic alliance, however, the counselor must be able to engage the client in their own journey, as “engagement is one of the most significant tools that counselors can employ when working with teens who are reluctant about participating in counseling” (Bennett et. al 2). According to one of the experts I interviewed, Rianna Black, a licensed adolescent therapist, it helps to meet adolescents where they are, since building authentic relationships and trust is “a huge piece of the work, like 90%.” Black described sessions in which adolescent clients sat in silence the entire time, the clock awkwardly ticking for an hour. “When a kid is sitting in front of you and refusing to talk to you, it’s an expression of power, because they feel powerless. They’re definitely demonstrating something. [...] There’s a rebellion against authority, and as a therapist sometimes you can embody that role.” Fortunately, talking is not the only way to get there. Rianna and many other therapists interviewed over the course of this thesis discussed nonverbal ways to help their clients feel more comfortable and empowered during the therapy process. One of the most powerful ways is through creativity. As Rianna put it during our interview one rainy afternoon, “it’s a rare adolescent who can sit and just open up and talk.” This is where play and creativity come in. “Creativity can serve as a medium of expression that is often recognized as therapeutic rather than threatening

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or stigmatizing, because it provides a safe distance between client and counselor in comparison to traditional talk therapy� (Bennett et. al 2). At a time when adolescents are working out identity and personality, creativity can serve as a powerful medium for articulating who they are and how they feel, despite struggling to get the words out. This is where Arti comes in. Arti is a set of four figurines designed to be canvases for creative, noverbal expression for adolescents, while simultaneously acting as tools for a therapist to help engage their young clients. Material objects hold power in this human world. Rather than a sheet of paper to be drawn on (as in traditional art therapy) or a game to be played out (as in play therapy), Arti borrows and combines elements of both practices. The materiality of Arti as an object provides the structure of a physical form for the adolescent to handle and move. On the other hand, its blank facades offer an opportunity to customize and surfaces to manipulate at will. The client chooses whichever figurine they respond to the most. They then mark on or modify the surface of the figurines using easily accessible art or craft supplies, such as markers, paints, stickers, glue, etc., that the therapist has on hand in the office. In this way, Arti is both object and activity. First, it invites the user to engage in a creative process of their choosing. Then, it becomes an object to reference and hold throughout the therapy session. Ideally, Arti becomes a tool with which the adolescent client can communicate with their therapist and express how they feel.

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(Left & Right) Arti’s two geometric forms

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(Left & Right) Arti’s two organic forms

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Process Objects can hold special significance during a time of change - particularly as adolescents walk the journey from childhood to adulthood. For this reason, it’s important that Arti exist as a threedimensional object and not merely a 2D representation. Combined with the potential of creativity in a therapeutic setting, the physicality of 3D objects can offer a new way for young people to express themselves and explore identity (Frederick et. al). The reading I have found suggests that interpretation of shapes is often subjectively in the eyes of the beholder. Initially, I had considered mapping shapes onto emotions to give structure and order to the qualities of each form. But different cultures and people interpret aesthetics differently, so it is difficult to say definitively what a shape may represent to whom and why it does so. Ian Woodward’s book Understanding Material Culture suggests that the prior identification of the object matters less than the fact that it’s an opportunity for the user to assign it meaning. As he puts it, it is the

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expressive capacity of objects that affords individuals the opportunity to articulate aspects of self through material engagements, in an attempt to communicate something about – and indeed to – themselves. [...] objects also carry personal, cultural and emotional meanings, related to subjective identity – they can facilitate interpersonal interaction, and help a person to act upon him or herself. For example, wearing certain clothing may make a person feel empowered by changing their self-perception. [...] The fact that one has exclusive control and ownership of an object is the crucial aspect mediating the boundaries between self (who controls the object) and the other (who doesn’t). In this way, possession of the object affords cultivation of identity, sometimes irrespective of an object’s aesthetic or functional qualities. (Woodward 135) Thus the range of shapes is merely to provide a range in the qualities of shape and movement, so that an adolescent may be free to choose (in a world where they often have few choices) what best suits them at that moment for the purpose of expressing themselves. The collection of Arti figures is categorized under different form qualities, from geometric (squares, circular, triangular) to abstract and organic (fluid curves, representations of forms in nature). Further research suggests that “ the act of anthropomorphizing can alleviate loneliness and promote social connection, ” a notion I wanted to keep in mind in determining Arti’s shapes (Luu 2016). The primary challenge in designing therapeutic forms that are also inviting to adolescents has been providing enough structure and dynamism to suggest anthropomorphization (in order to assist an adolescent’s ease of identification), while keeping them minimal enough to preserve the smooth surfaces on which to create.

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Limitations / Future Research Unfortunately, due to the circumstances of the COVID-19 pandemic occurring during the final months of my thesis, I was unable to conduct user testing on this product beyond user validation of the idea with subject matter experts. A lack of access to both people and fabrication tools/facilities made further testing impossible. In the future, I would like to conduct more robust user testing to refine the product and address the following questions: A. Are the objects comfortable to hold in the hand? B. Can the objects easily be marked on? C. What shapes do adolescents respond to the most and why? D. Is there a correlation between the reported mood or state of the client and which figure they picked? E. Did the adolescents find the figurines and the activity helpful in expressing themselves? F. Was the therapist able to better understand or communicate with clients and build better rapport with them? Before it might be marketed for or used in a clinical setting, this project requires comprehensive testing to determine its efficacy for both adolescent patients and the mental health professionals who work with them.

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DIGITAL INSTANTIATIONS


“What would you think if I sang out of tune? Would you stand up and walk out on me? Lend me your ears and I’ll sing you a song And I’ll try not to sing out of key Oh, I get by with a little help from my friends Mh, I get high with a little help from my friends Mh, gonna try with a little help from my friends” With a Little Help from My Friends The Beatles


Core Users

mishappy hour Fear (& Connection) You complement me with a smile on your face. I thank you with a shy smile of my own. But there’s a ping in the back of my mind that tells me you’re lying.. I’m positive I’ve fucked this up somewhere. What have I said in the last five minutes? What social faux pas have I committed? I’m sure I’ve disappointed you, you’re just too nice to say anything. Over and over, I turn over our interaction. Did I say the right things? What about the way I laughed awkwardly (and too loudly) at that passing comment you made about Janet’s pet tortoise (because really? Janet? A tortoise?)? Shit, I’m never gonna have friends if I keep saying dumb stuff all the time... You know what? It’s probably just safer if I stay home. I mean, I like to spend time by myself. I only play solo RPGs anyways. Reading is fun too. You don’t need another person to do that. Besides, I’m not really alone because we’re always connected, right? Friends on social media, we text all the time. That means we’re real friends. Even though we don’t really hang out or talk much irl. Texting is better really. Gives me plenty of time to think about my response first. And no one can see my face, my expressions. Texting is good. Texting is safe.

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We’ve all had moments, on occasion, where it seems like we just can’t say the right thing. For people with social anxiety, everyday interactions with others can feel like navigating a minefield. For teenagers with social anxiety, it’s even worse. Social Anxiety Disorder (SAD) is one of the most common anxiety disorders. As defined by the DSM-5 a.k.a. the modern bible of Western psychiatry (the diagnostic manual published by the American Psychiatric Association), social anxiety disorder is characterized by “marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech)” (Substance Abuse). Especially noted in the entry on SAD - is that the amount of fear and anxiety (and avoidance) provoked by social encounters is A) disproportionate to the actual threat presented and B) causes “clinically significant distress and impairment in” critical areas of life (Substance Abuse). Individuals with SAD are afraid of committing some sort of “social mishap,” the consequences of which is perceived to be severe. Social Anxiety Disorder could be triggered by something as simple as feeling offended by a passing comment not necessarily intended to hurt, or it could come from something more obvious, like tripping in front of everyone or being laughed at. While this is embarrassing for most of us, for the socially anxious, such situations could be catastrophic. For those suffering from SAD, the fear of rejection or disapproval is amplified. Common fears of

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SAD center around “being rejected, looking stupid or unintelligent, expressing disagreement or disapproval, and being the center of attention” (Fang et. al, 2). In turn, the socially anxious might adopt avoidance behaviors (like addiction, a learned behavior that helps someone deal with their psychological distress) - to help in their defense against social mishaps and their own thoughts and negative self-perception. Avoidant behaviors can take many forms – from playing video games as a means of escape to staying away from certain places because they trigger anxiety. Smart phones, our constant mobile companions designed to be addictive, are an especially dangerous enabler of avoidance behaviors since we carry them with us everywhere. All one needs to do is reach into a purse or pocket to be transported to a different, virtual world. But while escapism is a natural coping mechanism and can even be good for helping the brain reset in short dosages, constant engagement in numbing the mind to its environment to circumvent the processing of negative thoughts and feelings can become detrimental to growth (Brown). Psychologists warn that avoidance behaviors can form barriers to success, interfering with academic, social, and occupational functioning. Furthermore, SAD is even more dangerous and painful for teenagers. Habitually refraining from social interactions can result in social isolation and loneliness, exacerbated by a dependence on digital technology for communication and the ease of escapism it allows for. (Although, at the time of writing this, when many of us are stuck at home due to quarantine and social distancing, escapism is arguably helping American maintain their sanity in the face of a global pandemic.) Between the critical developmental ages of 10 and 24, when the primary relationships in a young person’s life shift from parents

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to peers, peer-to-peer interaction is critical to learning and indeed practicing the social skills needed for long-term success. This is not to say that digital interactions are not a valid form of peer-to-peer interaction; virtual social skills, like internet and texting etiquette, are important too. Digital interaction cannot totally supplant in-person communication though. To let it would be to sacrifice a core part of what makes us human – and to . lose one of the primary tools we have in forming friendships – time spent together, in physical proximity. The danger is especially real for teenagers with social anxiety disorder. Already afraid of getting out there and being with people, they will never have the chance to practice those social and emotional skills they are so afraid they don’t have.

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How It Works Mishappy Hour is an iMessage app-based service that adds silly/ ridiculous word scrambles into text and video chats to help adolescents with social anxiety overcome their fears of social mishaps. By exposing users to feared outcomes in a fun, inclusive way, teens feel empowered to change avoidant behaviors and engage with their peers in order to build social skills and confidence. Users activate Mishappy Hour by downloading or turning on the extension for their text and video apps, then inviting their friends to join them for a Mishappy Hour. For one hour, all non-serious text communications are randomly subject to scrambling by the insertion of ridiculous words. When used with video, the same randomization applies, but in this case, Mishappy Hour will verbally interject embarrassing words, phrases, or sounds. The application can be used intentionally, too, as a filter to send funny messages to friends. By forefronting the probability of communication mistakes, Mishappy Hour creates a safe space for adolescents to collectively experience mishaps, reducing the risk of interaction both virtually and in person. The primary goal of Mishappy Hour is to impact the ability of adolescents to develop empathy and communication skills by helping them balance time spent communicating digitally and in-person. A secondary impact indicator will be changes in adolescent perception of the social costs (i.e. rejection, disapproval) associated with social mishaps. The vision is to help adolescents struggling with social anxiety overcome their fears to engage in more meaningful and fulfilling in-real-life relationships for better long term health and wellness.

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Placeholder Symbol

make absurdity Create atime symbolfor for your custom

iMessage App UI. Then swap this placeholder symbol with custom Marie has invited youyour to mishap iMessage App UI symbol.

with her from 6pm -7pm today!

Placeholder Symbol gird thy loins for thefor next 30 custom min Create a symbol your these words App boutUI. to get risky iMessage Then swap this

Users choose from one of three modes. 1.

Placeholder Symbol with Create some a fresh symbol nonsense for your custom iMessage App UI. Then swap this

A regular mishappy hour occurs at a scheduled time.

2. Blast mode can be activated at any time for 30 min or 1 hr. 3. Hit em up will scramble a single message.

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Placeholder Symbol gird thy loins for thefor next 30 custom min Create a symbol your these words App boutUI. to get risky iMessage Then swap this

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Mishappy Hour iMessage UI (user interfaces) half screen (L) and full screen (R)

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Process Mishappy Hour began with identifying the following problem: socially-anxious adolescents who rely on smartphones/digital technology for communication have a harder time learning empathy and other in-person communication skills. In order to design for this particular problem, there were three primary things I needed to understand. First: What are the primary goals of a teenager with SAD when engaging avoidance behaviors? Second: What are their primary channels of interaction? And third: How is SAD being clinically treated? The goals of a socially anxious young person are like supercharged versions of some basic desires that most humans have – avoid rejection and embarrassment, don’t disappoint others, limit conflict. But if we dig deeper, we can see the root of these aims lies in negative self perceptions regarding social skills and emotional control, as well as a fear that the cost of these shortcomings will be more than the individual can handle (Fang et. al, 2). Taking this into account, I saw an opportunity to shift the focus away from strictly “avoidance” and reframe the intentions of the socially-anxious as: 1. Decreasing negative self-perception 2. Increasing emotional control 3. Increasing social skills 4. Decreasing the perceived cost of violating social norms In order to understand how best to help teens achieve these ends, I first needed to identify the range of communication channels those with SAD already use to interact, and with whom. Based on my interviews with adolescents, several different platforms are commonly used to talk to different categories of people. I’ll refer to those groups as “communication brackets” according to the following clusters – home/

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parents/family, school/extracurricular/outside authority, peers, and other/public. The channels through which teens communicate range on a spectrum from digital to physical. On the digital side, there’s social media, like Instagram, TikTok, and SnapChat (Facebook is apparently for old people now); texting apps, like the iPhone native iMessage, WhatsApp and Discord; video games; and chat rooms. On the more traditional, in-person side, there’s speech and body language, among other subtle human forms of communication. Because the particular user group I’m designing for (here I acknowledge it’s not with, a subtlety I expand on in the Limitations section of this project) spends a majority of their time communicating digitally, I decided to use a digital medium to address this problem. Of the conventional treatment methodologies for social anxiety disorder, the most common method is CBT (cognitive behavioral therapy). A fairly common type of psychotherapy, CBT helps the client, with the help of a mental health counselor, to identify and break down negative and distorted thoughts and behaviors before then trying to build more positive ones. But changing behaviors, especially those ingrained as protection against the monsters that embody our greatest fears, can be challenging to say the least. In clients with SAD, however, a more extreme form of treatment, called exposure therapy, has yielded some of the most promising results (Denizet-Lewis; Fang et. al.). Rather than asking clients to identify their fears and stopping there, exposure therapy encourages actually facing those anxieties and fears head-on. Are you afraid of talking to strangers in the park? Great. Now go sit next to that hot person on the park bench and strike up a conversation. Afraid of public speaking? Awesome. Now go sing as loudly as you can off-key on the subway. The logic behind exposure therapy dictates that by confronting the very outcomes clients are so terrified of they’ll see these catastrophes for what they really are—

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small obstacles they are quite capable of overcoming. Exposure helps retrain the brain so that negative perceptions of social interactions and self can be reframed more positively (Denizet-Lewis; Fang et. al.). Having articulated my three primary design considerations – 1. Exposure therapy is the most successful form of treatment, 2. The main goals adolescents with social anxiety disorder have, and 3. Digital communication is their preferred method of interaction – it was time to figure out what could be done to make an interaction of digital, social exposure a frictionless experience. Could it even be fun? One of the insights I gathered during user interviews was that digitally transferred humor in the forms of gifs, memes, videos, etc. has become a form of communication itself for adolescents, and a way of building bonds. Much of what draws them to platforms like Tik Tok and SnapChat is the opportunity to view something unexpectedly random or funny. Drawing on this insight, I felt that humor would be an important part of making the product more and accessible and desirable (one of our functions as designers is manipulating desire, is it not?). From these elements was born Mishappy Hour.

Limitations Mishappy Hour remains limited to a visual and Invision-based prototype due to a lack of user testing and limited app development knowledge on my part. As someone who personally struggles with social anxiety, I feel that I have a decent understanding of the condition to imagine myself as a user. However, I’m no longer an adolescent. To really flesh out Mishappy Hour, I would need to conduct more user research with adolescents who have social anxiety. In the future, to make this a more viable product, much more extensive user testing would be needed for the app’s concept, user interface, and branding.

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Core Users

SoMonki U.S. Adolescent Mental Health Care A University of Michigan study found that in 2016, approximately half of the teens and kids in the U.S. with at least one treatable mental health condition did not receive the care they needed from a mental health professional (Mostafavi). That’s about 3.8 million children and teenagers. While there are many factors feeding into this treatment disparity, notable barriers are a lack of access to adequate care, an overall shortage in youth mental health care providers (from counselors and social workers to psychiatrists), and cultural/societal stigma. Even teenagers themselves are concerned about the amount of anxiety and depression amongst their peers, ranking it as the number one problem they see – above drug use, bullying, and teen pregnancy (Graf et. al). Although a rise in awareness signals positive progress in combating stigma, the increasing rates of anxiety and depression in today’s teens are worrying. Teachers and school counselors are worried too. Suicide currently stands as the second leading cause of death amongst young people ages 10-24 (Curtin et. al). Of the subject matter experts who work with children and adolescents that I interviewed, manybrought up something called suicide contagion, where exposure to suicide or suicidal behavior increases the risk of suicide for those already at risk.

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(Interestingly, all of the interviewees who mentioned contagion also cited the popular Netflix show 13 Reasons Why, in which a teenaged character commits suicide on screen, as, well, one of the reasons why there’s been a spike in youth suicides recently. Whether this is true or not, I cannot say.) One expert, a public school counselor mentioned a neighboring school to theirs where an adolescent had committed suicide, only for a string of subsequent suicides to follow. While not all teenagers with anxiety and depression experience suicidal ideation, the potential for such consequences is devastatingly real. According to the National Survey on Drug Use and Health, approximately 3 million teenagers (13.2 percent of all young people in the U.S. ages 12 to 17) received some form of mental health service in an educational setting in 2014 (Lipari et. al ). This indicates that many teenagers rely upon the education system for mental health care, most likely due to the ease of accessing it at school. But there’s still a shortage of providers, particularly for this age range. According to many of the subject matter experts I spoke with, adolescents are a difficult population to work with, so a lot of potential providers choose to work with adults instead. Additionally, counselors and other mental health care professionals in educational settings referred to their many responsibilities--wearing too many hats at school, or being assigned an unrealistic caseload that leaves them stretched too thin. One elementary school psychologist I interviewed oversees three schools in a Virginia school district. She expressed, “I feel like in school, no one ever feels like they can give enough [...] Oftentimes, I think like our school now, [I] kind of want us to be more focused on that mental health piece. And so, really considering how stretched we are across multiple schools, and that’s true for I would say most districts in the country but certainly our area, it’s just not totally feasible.” Later in the interview she went on to say that she “hopes [school psychologists

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and counselors] become more prevalent with decreased case sizes� in order to be able to provide a certain level of care. Mental health care providers and teachers working in educational settings are, essentially, the frontlines of mental health care for the youth of this nation. By interacting with teenagers on a daily basis, they are perhaps best able to monitor behaviors and moods over time. How might we utilize design to help these mental health professionals provide better care? And instead of exacerbating mental health conditions for students, how might we rethink digital tools to address the accessibility of mental health care?

icon credit: Victoruler on Noun Project

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Design + Care + Edu = SoMonki SoMonki, at its core, investigates how technology could be leveraged in a positive way to benefit mental health care. How can we make the smartphone a tool for human social and emotional development? In other words, can we utilize the tricks of big tech for good? SoMonki (short for Social Monki) is a dual-facing mobile app for middle school psychologists, counselors, and social workers and the students they work with. There are two primary users, counselors and students, and one secondary user, mentors. On the student side, the app serves as a way to help adolescents practice social and emotional skills. Through mentorship and exercises, adolescent students can practice communicating, thereby increasing their capacity for empathy and improving relationships. On the mental health care provider side, the app functions more like a client/caseload management platform. Providers can manage student care and easily communicate with mentors, which allows them to quickly process where a student is in a practice curriculum and see how many students and schools are using it. SoMonki works like this: When a student meets with their school counselor, they download the app and are guided through the onboarding process with the counselor’s help. After setting up their account, a gamification element keeps students engaged by awarding them points (which can be used to customize their avatar in game or be traded in to their mentor for an in-person reward). Once the app is set up, the student is assigned a mentor who they can reach out to for support. The counselor then recommends to the student practice exercises specifically tailored to their individual needs in the following categories: communication (conversation, listening skills, nonverbal communication), self-awareness (positive thinking, self-confidence, and practicing a growth mindset), and perspective (empathy, social cues, perspective-taking). Since these exercises are intended to be

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practiced on the student’s own time, outside of the counselor’s office, the mentor is there to help the student overcome any problems they might encounter. After successfully completing an exercise, they gain more points, which can then be exchanged for in-person rewards during their counseling sessions. By bringing together both the in-person and digital, this mental health care experience takes both the technological and human aspects of modern life into consideration.

icon credit: Victoruler on Noun Project

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Student Onboarding Screens

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Student-Facing Platform UI

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Student Exercises

1

Student starts an exercise on their own, but is struggling with it.

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They reach out to their mentor for help.

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They successfully complete it after talking to their mentor and gain more points.

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Counselor Platform UI


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Process Drawing from an earlier project in my thesis exploration, Olive, the process began with an idea for an app that helps teens practice social skills within the educational context. After building out the wireframes for the student-facing app, I wanted to approach the app more holistically and built out the interface for counselors. Wireframes and clickable Invision prototypes were created for both interfaces. Onhand user testing only occurred with the counselor interface, although critique was offered for both. The user testing process focused more heavily on the content of the application than the design, but was quite productive overall for refining the counselor side of the app, shifting the mentor role, and reenvisioning how the student-facing side of the app could function. The primary suggestions in response to the counselor-facing component were to add management or browsing capacities for student exercises, increase the customizability of the interface to prioritize actions, and add student concentration areas and/or diagnoses to student profiles. In particular, a middle school counselor mentioned how the digital tools she currently uses don’t sync with one another, and the resources they have available aren’t aggregated. (Her school currently uses a Google Drive to store worksheets and share exercises with teachers and other counselors.) For the student interface, immediate

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Counselor-facing UI wireframe sketches from the prototyping process


feedback on how they are doing on exercises and/or their progress progress (potentially with hints or clues if they are struggling with an exercise), use of gamification and a point system to incentivize use (what if points could be traded in to upgrade an avatar? Or for help on an exercise?). As for the mentoring component of the app, concern was expressed over confidentiality issues and potential barriers to working with minors, as well as what qualifications the mentor must meet, how they would be supervised, and what programs they would be associated with. Initially the mentors were meant to function more as peer mentors — older adolescents, such as college students studying psychology, who were still within the same stage of life, but more experienced. Almost like a trained peer volunteer at a mental health hotline, the idea was that mentors could help students emotionally problem-solve without seeming intimidating or overly professional. However, following user testing, concerned feedback elicited valid points about potential complications, which caused me to rethink the role. Upon the excellent advice of a middle school counselor, the mentor morphed into more of a sub-counselor role. My intention was to shift some of the care burden from the primary school counselor to the mentor, while helping the mentor practice for their future career. Graduate students in social work, counseling, psychology, or public health programs could potentially be eligible mentors, professionally overseen, in much the same way that these students accrue the hours of clinical experience necessary to become licensed counselors themselves. While this change would mean the mentor would be better equipped to help students, it also means the mentor would no longer be a peer. And a possible unintended consequence of changing the mentor role could be a frequent turnover in mentors once they move to the next stage of their careers. This could make it more difficult for mentors and students to form trust, and possibly inhibit students when it comes to reaching out for help; an already vulnerable act. Catherine S. Weislogel

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Limitations Several components of this app would need refining, and many features would, ideally, be added if the project were developed further. Looking at it from a broader perspective, SoMonki falls short of addressing bigger systemic issues – such as the root causes of adolescent anxiety and depression. Another consideration is the language fluency of users, for whom English might not be their first language. . School counselors mentioned an influx of Spanish speakers, in particular, who need assistance adjusting not only to a new country and school system, but also a new language.. Already there’s an overall lack of youth mental health care providers, but it seems to be particularly acute for ESL students. If I were to take this app further, I’d design dual language capabilities for both ESL students and multilingual counselors. I could imagine expanding the platform in order to train both mentors and counselors by offering educational tutorials on counseling. For example, mentors might be able to access sensitivity training, and/ or de-escalation techniques in case of emergency situations, such as suicidality. For counselors, a guide for what exercises are appropriate for which situations or behavioral issues. The biggest potential concern here is confidentiality and health policy, given the vulnerability of the target student population. More research would need to be done to determine the viability of this idea. The gamification aspect of the app is where many of my questions around current design ethics come in. Gamification offers both potential and drawbacks. During user testing, the middle school counselor who provided input said, “Just make it like Fortnite, and they’ll use it.” Fortnite is a free-to-play, multiplayer online video game that has recently exploded in popularity amongst kids and adolescents. It was mentioned by several of the Subject Matter Experts interviewed

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during my thesis as an example of addictive technology. Fortnite’s development team has (very successfully, I might add) designed addictive gameplay elements and a smooth user experience via intuitive UI. Utilizing design, they’ve been able to increase the amount of time players spend playing the game and encourage microtransactions (small purchases that let them customize the appearance of their characters, gain access to new powers, etc.) to “enhance” the gaming experience. Manipulation is of course part and parcel of design, and successful design necessitates taking into account psychology and human behavior. But would it be right to use the same design strategies, specifically gamification, that make Fortnite compelling in my own app designed to encourage mentally healthy behavior? Perhaps transparency of intent and methodology is the best way to be ethical in this instance. SoMonki is clearly not a gaming app. In addition, the business model, once developed, would not be dependent on how much time students spent in the app itself for monetary profit. It may not change anything, but at least users will be aware of what’s happening. This lends itself to bigger questions about how to practice design in a non-exploitative manner that uplifts rather oppresses. Is equity possible if we continue to use the same methods and tools that have been used in the interest of monetary gain over human benefit?

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OTHER PROJECTS


Other

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Core Users

in situ

In Situ is a non-profit organization that empowers middle and high school students struggling with social isolation and social anxiety through student-led social clubs and initiatives that facilitate peerto-peer connection and relationship building. While In Situ suggests operating guidelines, students are asked to imagine the parameters and policies of their own school’s In Situ, ensuring a safe and inclusive environment for their members while also allowing the students ownership of their own club. Different analog games, activities, and materials are available for printing and modification on In Situ’s website, which the students are encouraged to change to fit their club’s interests and needs. Once a month, In Situ, in conjunction with a corporate partner, sponsors a challenge, in which all clubs nationwide participate in a collaborative activity and discussion.

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Other

(Above) Part of Olive’s onnoarding process and app screens.

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Core Users

olive

Olive is an app that helps encourage empathy during personal conflict situations through AI guided perspective-taking exercises and dialogues. In response to fears around talking to people face-to-face in tense situations, Olive harnesses experiential learning in service of building those skills needed to handle them. For example, let’s say that Mina and Mary are romantic partners arguing. On Olive, they set up the dialogue situation (such as romantic partner, friends, family, or workplace) and the type of conversation they want to have on the app. The phone is then set aside to prevent distraction. (Once cued up, all app interactions are controlled by voice until the end of the session). Olive coaches Mina and Mary through a discussion exercise using prompts and commands, like: Describe the situation from your point of view. Mina obliges. Then Mary is asked to summarize what she heard Mina say, then explain her point of view. And Mina is asked to repeat Mary’s experience back. The sequence is repeated until both parties feel like they have been heard and understood. Instead of being a means for avoidance and distraction during uncomfortable conversations, the smartphone becomes a tool for transformation. Olive represents an opportunity for technology to operate, like training wheels, in service of human development.

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Core Users

#SmR16

Studies show that narrative and voice are two of the most powerful tools humans use for humanization and creating empathic connection. SmR16, an online social media challenge, aims to leverage these tools to invoke intergenerational empathy. The steps are simple: 1) enact a memory from your 16th summer in 1 min or less, 2) share your story on social media, 3) tag your post with #smr16_challenge, and 4) tag 3 friends to continue the chain. People can be invited to participate in one of two ways. The first is through AirDrop invitation in a public space, such as a park or the train. The second is by being challenged by friends or family on one of three social media platforms: Instagram, Facebook, and TikTok. After sharing a story of their 16th summer on social media and tagging others, they can then look at SmR16’s social media accounts and the challenge hashtag. Shared memories and experiences then aggregate as a collective memory box for different generations. For example, let’s say Alana is on the subway on her way to work. Alana receives an invite via AirDrop, and, curious, she opens the invitation. She decides to look up the challenge online and starts to recall memories of her own 16th summer. Watching the various videos of people who’ve already participated in the challenge, she Catherine S. Weislogel

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feels moved by the funny, poignant stories she’s witnessed. She decides that she would like to participate. She picks a memory of her first heartbreak during that 16th summer and starts to brainstorm how she wants to enact it. Alana films herself acting out her memory, then posts it to social media. It is cathartic, but also funny. She tags her friends and her grandma. She starts to watch her friends and family post their own stories online, many of which surprise her, move her, and make her laugh, then participates in the thread of comments. Alana finds connection through being both an audience to others’ memories and sharing and receiving feedback on her own memory.

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OUTRO


“I define connection as the energy that exists between people when they feel seen, heard, and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.” Brené Brown


conclusion

There comes a time in the research process when you realize how little you know. In a strange way, my thesis has turned out not at all like I expected it to. I had originally thought my thesis was going to be all about grounding people in the physical world; I firmly believed (or thought I did) in the separation of the physical and the digital. I picked my thesis topic in part because I didn’t want to make digital products, and yet, in the end, many of my designs are digital anyway, perhaps because I’ve come to realize the human potential of technology isn’t limited to the loudest examples thrust into our view by Silicon Valley. Ultimately I think this shows much I’ve evolved as a designer through the thesis process. My thesis began in a place of fear and anger, but the more I researched, and the more people I spoke to, I began to understand that digital technology’s role in the lives of today’s youth is nuanced and layered. This isn’t some sort of good vs. evil situation, where physical battles digital for supremacy. Because today’s youth are digital natives, their understanding of technology is fundamentally different from the generations that came before them. They are also, however, uniquely situated to understand the complicated merging of virtual life and real life in current society. Catherine S. Weislogel

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Through this body of thesis work, I’ve come to realize my job as a designer is to meet people where they are. My initial assumptions were challenged even as some of my fears were confirmed. Adolescents (indeed, most people these days) spend so much of their lives online that it would be selfish and high-handed of me to presume that the best solution is to remove them completely from the digital realm. Rather, it is more appropriate to ask how I, as a designer, can help support them on their journeys into adulthood across multiple avenues, be it virtual or real-world, for a brighter future?

Limitations / Future Research The design approach for my thesis body of work has been primarily grounded in Western psychology and anecdotal research conducted with different stakeholders in the U.S. As a result, my thesis is incredibly U.S.-centric, framed by Western psychology and design practices. Science and data are not infallible. If we step back and think about the way new power systems form from pre-existing ones, it is likely that colonial dynamics have influenced how we understand human behavior and development in the Western world. Unfortunately, old biases and assumptions have likely trickled into how we research, address, diagnose, and treat mental health. I have not done enough research to wholly understand how these historical qualifiers might have shaped my subject matter in 2020, but feel it is important to acknowledge the likelihood that they are a part of the spaces and systems I’ve been working within.

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There are several areas not yet addressed in my thesis, but which are important parts of the ongoing conversation around adolescent digital technology use and social/emotional development. With further development, my thesis work would expand to include the following aspects: 1. The role of family and parents/guardians. How does parental technology use influence or inform the way adolescents interact with technology? 2. Bullying and cyberbullying. What role does bullying play? How utilizing empathy in virtual situations alleviate cyberbullying? 3. Resiliency. How can technology be leveraged to bolster adolescent resiliency to the hard parts of life instead of being more of a tool for escape? 4. Intergenerational dynamics. How are the ways different generations interact across the phygital spectrum benefiting or hampering adolescents’ social and emotional development? 5. Identity formation. How is the phygital paradigm affecting adolescent identity and authenticity? 6. Community formation. How do communities cross the boundary between virtual and real? Is there even a boundary between the two anymore? 7. Historicity. What is the impact of imbalanced technology usage on historically marginalized communities? What does equity look like in this problem space?

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The end of my thesis process has left me with much bigger questions, too, specifically concerning the role capitalism plays or doesn’t play in different design methodologies. Most instantiations of my thesis approached the problem space through human-centered design. But it might instead take a system-design approach, of reimagining policies and social structures, in order to create real, long-lasting ways for technology to aid in human social and emotional development. Future research might explore systems analysis to determine how to best leverage positive change. Given what I’ve learned over the course of my thesis research and my tenure as a graduate student of design, from a macro perspective, capitalism as a system is the biggest issue challenging design initiatives that might benefit users across the socio-economic spectrum. Efficiency, productivity, and profit drive our current economic system, which have in turn fueled fast-paced technological innovation. But above that is the prioritization of shareholder and board member profits above social welfare. Legally, public companies are required to deliver monetary value to people who invest in their businesses. As a society, though, we need to fundamentally shift the ways commercial institutions and tech companies make money. How might we economically incentivize the industry to innovate for the social and emotional welfare of the public, instead of merely for profits? Can we change public policy so that businesses are also obligated to consider the health and wellbeing of the consumers they sell their products to? Until there is more legal and social pressure placed on businesses, we will fail to see the changes needed to support a thriving, healthier youth.

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Reflections At the time of writing this conclusion, I am still quarantined in my home, socially distancing myself while the U.S. waits for coronavirus infection rates to slow. Waiting for it to be safe enough to resume a “normal life.� When I embarked on this thesis journey, I never imagined that at the end of it, we would be living in a world where screens are the only way many of us can talk to one another or connect. For those of us fortunate enough to have stable housing and access to technology during this time, our worlds have become screen-sized. We work on screens, talk on screens, go to school on screens, escape on screens, connect on screens. Starting this thesis, I felt angry and confused about the fast-paced technological changes happening in society. Afraid that we were losing our humanity to technology. In a strange reversal, I now feel incredibly grateful. Because of the advances in virtual communication that have taken place over the last 30 years, I have been able to continue many aspects of my life that would otherwise have been impossible during a pandemic induced quarantine. The final months of my graduate school education continued relatively smoothly via Zoom and Google Hangouts. The iMessage group chat with The Lady Gang has sustained and uplifted me through the stressors of thesis and social distancing. FaceTime and Zoom let me celebrate my birthday with friends and helped me wish my mother a Happy Mother’s Day face-to-face. And, probably most importantly, I can still go to weekly therapy. For people who have lost their jobs, who are stuck at home in unsafe situations, or have to find ways to occupy small children suddenly not in school, the escapism that virtual realities can provide is a blessing. Video games have seen record sales (thanks mostly to Animal Crossing), and the Nintendo Switch, a popular gaming console, is sold out everywhere (thanks, again, to Animal Crossing). Thanks to

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ecommerce, some of the economy is still going. High-risk individuals can acquire food and necessities without leaving the safety of their homes. (Although it would be remiss of me to not acknowledge those who are risking the health of themselves and their families to deliver this food and keep our essential stores running, as well as the healthcare workers who are tirelessly treating patients.)

No one knows what the outcome of this global pandemic will be, neither in a public health, nor economic, nor political, nor sociocultural sense. Perhaps we will see some sort of pastoral longing for the physical tactility of the past. When actual human beings were standing in front of us, lit by rays of the sun instead of being projected to our eyes by the blue glare of LEDs. When we could communicate feelings, thoughts, and emotion through touch and spoken word uninterrupted by the glitches of an “unstable internet connection.” Or perhaps, having relied so heavily on technology to weather the hardships of quarantine, this dependency will stick around even after it’s quite necessary. Even while the current practices of maintaining social distancing are perhaps unsustainable in the long run, the ingenuity and creativity of humanity to connect during this time of challenge has given me hope for what’s to come. 106

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ADDENDA


Addenda

public policy memo To: Shanti Mathew From: Catherine S Weislogel Date: 04 Dec 2019 RE: Youth Mental Health Care Access in Georgia Problem Summary While at least 1 in 7 children and adolescents have one or more treatable mental disorders in the U.S., less than half are receiving adequate treatment. There are barriers to access—particularly for youth of color, LGBTQ youth, youth in poverty and/or rural areas—and lack of sufficient care. According to Voices for Georgia’s Children, in the state of Georgia only 40% of children who need behavioral health services actually receive them. Mental health affects all aspects of a person’s life, this is especially acute during such a critical development period for young people. School performance and socialization at this stage play important roles in determining the further success of an individual later in life—higher education opportunities, career, and formation of bonds and community. Lack of care can contribute to compounded trauma and issues over time, affecting lifelong health for individuals, families, and communities, thereby increasing the cost and usage of health care. The debt-burden on society becomes immense over time as a large percentage of the youth population remains underserved and can lead to higher rates of poverty. Background & Context There are several factors contributing to this imbalance in youth mental health care. The first is that there simply are not enough mental health care providers–such as counselors, psychiatrists, and psychologists–specializing in child or adolescent care to meet the

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need. Cultural elements also come in to play. While it has been declining over the years, there is still stigma around mental health. Youth and parents/guardians may be reluctant to acknowledge problems and seek outside help. There are also increased barriers for youths of lower socioeconomic status, of color, or LGBTQ orientation, which is in line with a lack of access to general healthcare care for these historically marginalized groups. Lack of funding and representation have also historically played a part in this. However, with the rising rates of mental illness and addiction in the US, more attention is being placed on addressing these issues. Like the rest of the country, Georgia is currently facing healthcare shortages across the state, where only 8 out of 159 counties are not medically underserved (by area or population) per the State Office of Rural Health. According to Mental Health America, Georgia ranks in the bottom five out of all states for poor access to mental health care and ratio of mental health care workers to citizens. Suicide was the 3rd leading cause of death for adolescents aged 12-17 in the state in 2018. Georgia has been particularly challenged with adequate access to healthcare in rural areas, where approximately 20% of the population lives below the federal poverty line, and underserved communities of color. Approximately 48% of Georgia’s counties do not have a licensed psychologist and 33% do not have a licensed social worker. Most of these counties are rural areas south of the major cities in the state. Of the children who do receive behavioral health services, three-fourths receive that care in school.

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Policy On the federal level, the biggest efforts to address this on the policy side have been the introduction of Mental Health Parity laws that have been passed with varying degrees of success since the 1990s. Health insurance companies are notorious for providing unequal access or benefits when it comes to mental health services in comparison to medical/surgical care. These laws seek to address this by mandating that insurance companies provide the same level of coverage for mental health services. However, these have not had the level of impact intended and insurance companies are still finding ways to skimp on mental health coverage. Other policy initiatives seek to address the mental health crisis through supporting families, communities, mental health professionals, and the education system. Early intervention, and increased awareness and education around mental health disorders and treatment options are also being pushed. On the state level Georgia’s policymakers are seeking to address issues of mental health care access in several different ways. Although not specific to only mental health care, when it comes to rural areas, Georgia is trying to address the shortage of health care by incentivizing foreign physicians to work in these ares. Georgia offers a J-Visa waiver to foreign physicians who commit to practicing in an underserved area for at least 3 years. Implemented in 2015, the Georgia Apex program, under the Georgia Department of Behavioral Health and Developmental Disabilities, is the state’s biggest attempt to provide adequate youth mental health care in the state. Apex provides school-based mental health services by partnering public schools, communities and health care providers. Seventy-six percent of the schools they serve are in rural areas in an effort to reduce the healthcare gap. There are also several Telehealth pilot programs being pushed forward in schools.

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However, in November 2019, two new health care proposals were pushed forward by the Georgia Department of Community Health and Governor Brian Kemp in an attempt to waive the requirements of the Affordable Care Act. While the stated goals of the new policy are to expand Medicaid coverage and health care access for the poorest Georgian residents, further analysis done by the Georgia Policy and Budget Institute reveals that they may have the opposite effect. If the proposals became policy, the reinsurance program would leave more people ineligible for Medicaid, drive up private insurance costs, and leave the system at the mercy of private insurance. Most importantly, the proposals undermine mental health parity laws and are trying to avoid covering essential health benefits—like prescriptions, emergency services, maternity and pediatric services, mental health services, and preventative care—for individuals with pre-existing conditions. This would render a vulnerable part of the population even more so by choosing to support insurance companies over its own constituency. Recommendations The primary recommendations for addressing youth mental health care in G.A. are focused on increasing access to health insurance for all residents that covers essential health needs, increasing availability of care and providers, and promoting individual and community health through early intervention. A. Enforced standards of care and increased regulation of insurance companies could help make sure mental health parity laws, assuming they stay in place, are maintained. However, the question then becomes, who is responsible for overseeing this and keeping a multi-billion dollar industry in line?

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B. Alternative forms of health care using GovTech, such as Telehealth, could help address the mobility and range issues of rural, underserved areas. Psychologists would be able to see a broader range of patients. At this stage, however, things like therapy and counseling may be much better served through physically present providers so they can better assess the situation and build rapport with patients. C. Similar to compulsory education for all children, counseling or mental health services could become a required part of the school system or curriculum. Placing youth mental health services in schools provides easier access to kids who would otherwise have a hard time getting to those services since they are already transported to school locations. This would allow for much earlier intervention in a child’s life to help. Early intervention can significantly improve patient care outcomes, reduce costs in the long term, and set children up for success academically and socially in school and later in life. State mandated mental health care could conversely be a means of reinforcing problematic power dynamics between the government and more vulnerable populations. Additionally, diagnosing behavioral issues points to longstanding tensions between those who are considered “well” and those who are “unwell.” This could lead to children being ostracized or bullied in the school system if they are labelled as such. Other concerns are matters of consent and choice in receiving treatment, and giving people options in their own care. My primary recommendation for improving access to availability of care is increasing the number of mental health care workers— psychologists, social workers, psychiatrists, and counselors—in rural

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areas through incentivizing programs like that of the J-Visa waiver and robust public or private state university and college mental health care education programs. Something similar to army or ROTC structure, where education is paid for on exchange for years of service could perhaps provide an influx of available workers. While this does not address the greater issue of poverty at first, it could be highly beneficial in the long-term by alleviating the circumstances and outcomes of children who grow up in rural poverty. The downside to programs like these is that while it would help the overall shortage, high turnover and/or attrition rates once people have served their time, so to speak, could drastically reduce the efficacy of the program. Additionally, many of the entering workers would be inexperienced, which could lead to a situation where rural areas receive less adequate care and new recruits burnout due to difficulty and size of case loads. Limitations and Barriers The state of Georgia’s behavioral mental health care for youth is part of broader conversations around urbanization, the value placed on mental health care and social welfare in this country, and the poverty trap. As people continue to migrate to urban areas, wealth and resources of all kinds are redirected there, leaving those in rural areas with a shortage. The current political climate in this country has also devalued mental health care and social welfare, which is exemplified in awful border camps for the children of illegal immigrants. In addition to this, there’s a growing wealth gap in this country, which, due to the nature of compounding interest (through capital and assets) and issues (through historical trauma and family). There are limitations in the knowledge and data accumulated thus far to support the recommendations made. At this point, I do not know if people would be interested in working in mental health care and what would incentivize them to work in rural areas.

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Conclusion & Next Steps In order to fully understand this space, research and participatory design are needed. First, I would engage with rural families and children to understand their needs through participatory design research. Then I would conduct research with mental health care and family services professionals who work in rural areas and schools. Going more broadly, I would then bring the related governmental agencies, such as the State Office of Rural Health, the Dept. of Edu, and community health and development, into the conversation. Working with a concerned nonprofit organization like the Voices for Georgia’s Children would help provide contacts, resources, and information needed. After connecting with the different groups of stakeholder, the challenge would then be to facilitate inter agency communication, cooperation, and creativity to craft viable solutions where all stakeholders are represented.

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Citations / Sources University of Michigan, Health Lab https://labblog.uofmhealth.org/rounds/half-of-us-children-mental-health-disorders-are-not-treated U.S. Department of Health & Human Services https://www.hhs.gov/ash/oah/adolescent-development/mental-health/access-adolescent-mental-healthcare/index.html https://www.hhs.gov/ash/oah/adolescent-development/mental-health/how-adults-can-supportadolescent-mental-health/resources/index.html U.S. Department of Health & Human Services, Substance Abuse and Mental Health Services Administration https://blog.samhsa.gov/2018/10/10/lets-help-our-youth-change-the-way-they-look-at-mental-health https://www.samhsa.gov/brss-tacs/recovery-support-tools/youth-young-adults The National Institute for Health Care Management (NIHCM) Foundation https://www.nihcm.org/pdf/CMHReport.pdf Mental Health America https://www.mhanational.org/issues/state-mental-health-america U.S. Centers for Medicare & Medicaid Services https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html National Alliance on Mental Illness https://www.nami.org/Learn-More/Mental-Health-Public-Policy/Mental-Health-Reform/A-Closer-Look-atMental-Health-Reform-Legislation https://www.nami.org/getattachment/Learn-More/Mental-Health-Public-Policy/Public-Policy-PlatformDecember-2016-(1).pdf Mental Illness Policy Org. https://mentalillnesspolicy.org/federalmentalhealthlegislation.html Stanford Social Innovation Review https://ssir.org/articles/entry/the_crisis_of_youth_mental_health National Center for Biotechnology Information, U.S. National Library of Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585724/ Science Direct https://www.sciencedirect.com/science/article/pii/S2405872617300138 Los Angeles County Department of Mental Health https://dmh.lacounty.gov/about/mhsa/innovation/

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Prevention Institute https://www.preventioninstitute.org/projects/accountable-communities-health-ach Rural Health Information Hub https://www.ruralhealthinfo.org/states/georgia https://www.ruralhealthinfo.org/project-examples/788 Georgia Department of Community Health https://dch.georgia.gov/georgias-j-1-visa-waiver-program https://dch.georgia.gov/sites/dch.georgia.gov/files/related_files/document/SORH%20MUAP%20Map.pdf Center for Family Research, Owens Institute of Behavioral Research, University of Georgia https://cfr.uga.edu/saaf-programs/saaf-t/ 41 NBC, WMGT https://41nbc.com/2019/04/24/governor-kemp-adds-millions-mental-health-services-schools/ Georgia Budget and Policy Institute https://gbpi.org/2019/georgia-health-care-proposals-fall-short-undermine-comprehensive-health-plans/ https://gbpi.org/2019/five-year-waiting-period-barrier-immigrant-health/ https://gbpi.org/2019/medicaid-waiver-principles-for-georgias-health-crisis/ Enable My Child https://enablemychild.com Atlanta Journal Constitution https://www.ajc.com/news/state--regional-govt--politics/proposed-budget-cuts-could-have-big-impacthealth-care-georgia/9L93C4z1RkEDwUE1s2e7FO/# U.S. Census Bureau https://www.census.gov/quickfacts/GA Georgians for a Healthy Future https://healthyfuturega.org /2018/06/18/healthy-minds-healthy-bodies-getting-know-georgia-apexprogram/ Georgia Public Health Association https://www.gapha.org/wp-content/uploads/2016/06/1-5.401-The-two-Georgias.pdf Georgia HOPE https://gahope.org/recovery-services/sbmh/

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Citations / Sources—cont’d Voices for Georgia’s Children https://georgiavoices.org /wp-content/uploads/25.-Georgias-Crisis-in-BehavioralHealth-12.4.18.pdf https://georgiavoices.org/wp-content/uploads/26.-Snapshot-of-Behavioral-Health-4.1.19.pdf https://georgiavoices.org/wp-content/uploads/21.-SBHC-Whats-Happening-in-Georgia.pdf https://georgiavoices.org/wp-content/uploads/27.-Youth-Suicide-in-Georgia.pdf U.S. News & World Report https://www.usnews.com/news/healthiest-communities/articles/2019-05-20/young-peopleincreasingly-represented-in-growing-mental-health-insurance-claims Spaces4Learning https://spaces4learning.com/Articles/2018/08/08/Tele-Therapy.aspx

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bibliography Literature Review “Adolescence: a Period Needing Special Attention.” World Health Organization, World Health Organization, apps. who.int/adolescent/second-decade/ section2/page1/ recognizingadolescence.html. Ahrnsbrak, Rebecca, Jonaki Bose, Sarra L. Hedden, Rachel N. Lipari, Eunice ParkLee & Peter Tice. Substance Abuse and Mental Health Services Administration, 2017. “Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health” (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/ Alter, Adam. Irresistible: The Rise of Addictive Technology and The Business of Keeping Us Hooked. Penguin Press, 2018. Boele, Savannah, et al. “Linking Parent– Child and Peer Relationship Quality to

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Empathy in Adolescence: A Multilevel Meta-Analysis.” Journal of Youth and Adolescence, vol. 48, no. 6, June 2019, pp. 1033–55. DOI.org (Crossref), doi:10.1007/s10964-019-00993-5. Brown, Brené C. The Gifts of Imperfection: Let Go of Who You Think You’re Supposed To Be and Embrance Who You Are. Hazelden Publishing, 2010. Carrier, L. Mark, et al. “Virtual Empathy: Positive and Negative Impacts of Going Online upon Empathy in Young Adults.” Computers in Human Behavior, vol. 52, Nov. 2015, pp. 39–48. doi:10.1016/j. chb.2015.05.026. Chödrön Pema. The Places That Scare You: A Guide to Fearlessness in Difficult Times. 1st ed., Shambhala, 2002. Denworth, Lydia. “Friendship Is Crucial to the Adolescent Brain.” The Atlantic. 28 Jan 2020 https://www.theatlantic. c o m / f a m i l y /a r c h i v e / 2 0 2 0 / 0 1 / fri e n d ship - c r u cia l - a dol e s c e nt brain/605638/. Accessed 05 Feb 2020.


Gamble, Jessa. “The Cognitive Benefits of Being a Man-Child.” The Atlantic, 3 Nov. 2016. https://www.theatlantic. c o m / h e a l t h /a r c h i v e / 2 0 1 6 / 1 1 / metaplasticity/506390/. Accessed 15 Jul 2019. Graf, Nikki and Horowitz, Julia Menasce. “Most U.S. Teens See Anxiety and Depression as a Major Problem Among Their Peers” Pew Research Center. February 2019. Julian, Kate. “Childhood in an Anxious Age.” The Atlantic, 17 Apr. 2020, https:// www.the atlantic.com /mag azine/ archive/2020/05/childhood-in-ananxious-age/609079/. Accessed 19 Apr 2020. Kolbert, Elizabeth. “Why Teen-Agers Are the Worst.” The New Yorker, 25 Aug 2015. https://www.newyorker.com/ magazine/2015/08/31/the-terribleteens. Accessed 01 Feb. 2020. Office of Adolescent Health. “Access to Adolescent Mental Health Care.” Office of Population Affairs, U.S. Department

of Health and Human Services, 15 Jan. 2019, www.hhs.gov/ash/oah/ adolescent-development/mentalhealth/access-adolescent-mentalhealth-care/index.html. Popper, Nathaniel. “The Menace of Screen Time Could Be More of a Mirage: A growing number of academics are challenging the common wisdom that social media and smartphones are linked to anxiety and depression among adolescents”. The New York Times. Jan 18 2020, Print. Romano, Aja. “‘Ok boomer’ isn’t just about our past. It’s about our apocalyptic future.” Vox, Nov 19, 2019. https:// www.vox.com/2019/11/19/20963757/ what-is-ok-boomer-meme-aboutmeaning-gen-z-millennials. Accessed 06 Dec 2019. Rushkoff, Douglas. Present Shock: When Everything Happens Now. Current, 2014 McLuhan, Marshall, and Quentin Fiore. The Medium Is the Massage. Edited by Jerome Agel, Penguin, 2008.

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Schroeder, Juliana, et al. “The Humanizing Voice: Speech Reveals, and Text Conceals, a More Thoughtful Mind in the Midst of Disagreement.” Psychological Science, vol. 28, no. 12, Dec. 2017, pp. 1745–62. escholarship. org, doi:10.1177/0956797617713798. Susskind, Jamie. Future Politics: Living Together in a World Transformed by Tech. Oxford University Press, 2018. The Nielsen Total Audience Report: Q3 2018. www.nielsen.com, https:// www.nielsen.com/us/en/insights/ report/2019/q3-2018-total-audiencereport. Accessed 30 Apr. 2020. Tiffany, Kaitlyn. “Why the New Instagram It Girl Spends All Her Time Alone: Loneliness is Instagram’s hottest trend” Oct 16, 2019. The Atlantic Tingley, Kim. “Is screen time bad for kids? It depends on many factors, including what you mean by ‘screen time.’” Studies Show, Screen time, The New York Times Magazine, Dec 22, 2019 Turkle, Sherry. Alone Together: Why We Expect More From Technology and Less From Each Other. Basic Books, 2017. Ugolik Phillips, Kaitlin. The Future of Feeling: Building Empathy in a Tech-Obsessed World. Little A, New York, 2020.

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Arti Ardito, Rita B., and Daniela Rabellino. “Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research.” Frontiers in Psychology, vol. 2, Oct. 2011. PubMed Central, doi:10.3389/ fpsyg.2011.00270. Bennett, Elisabeth D., et al. “Five Out of the Box Techniques for Encouraging Teenagers to Engage in Counseling.” American Counseling Association, VISTAS Online, 2017. Frederick, Christina, et al. The Impact of Technology on Adolescent Identity Development. The International Journal of Liberal Arts and Social Science. Vol. 2, No. 7. September, 2014.

Luu, Chi. “Personification Is Your Friend: The Language of Inanimate Objects.” JSTOR Daily, 23 Mar. 2016. daily.jstor.org, https://daily. jstor.org /p ersonification-isyour-friend-the-amazing-life-ofletters/. Roig, Enrique, et al. “The Use of Transitional Objects in Emotionally-Disturbed Adolescent Inpatients.” International Journal of Adolescence and Youth, vol. 1, no. 1, Jan. 1987, pp. 45–58. DOI.org (Crossref), doi:10.1080/02673843.1 987.9747625. Woodward, Ian. Understanding Material Culture. SAGE Publications Ltd, 2007. DOI.org (Crossref), doi:10.4135/9781446278987.

Lee, Jung Min, et al. “Anthropomorphic Design: Emotional Perception for Deformable Object.” Frontiers in Psychology, vol. 9, Oct. 2018. PubMed Central, doi:10.3389/ fpsyg.2018.01829. Lowenstein, Liana. Favorite Therapeutic Activities for Children, Adolescents, and Families: Practitioners Share Their Most Effective Interventions. Toronto: Champion Press, 2011.

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Mishappy Hour Denizet-Lewis, Benoit. “Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?” The New York Times, 11 Oct. 2017. NYTimes.com, https://www.nytimes.com/2017/10/11/ magazine/why-are-more-americanteenagers-than-ever-suffering-fromsevere-anxiety.html. Denworth, Lydia. “Friendship Is Crucial to the Adolescent Brain.” The Atlantic. 28 Jan 2020 https://www.theatlantic. c o m / f a m i l y /a r c h i v e / 2 0 2 0 / 0 1 / fri e n d ship - c r u cia l - a dol e s c e nt brain/605638/. Accessed 05 Feb 2020. Fang, Angela, et al. “Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient.” Cognitive and Behavioral Practice, vol. 20, no. 2, May 2013, pp. 213– 20. PubMed Central, doi:10.1016/j. cbpra.2012.05.003. Kolbert, Elizabeth. “Why Teen-Agers Are the Worst.” The New Yorker, 25 Aug 2015. https://www.newyorker.com/ magazine/2015/08/31/the-terribleteens. Accessed 01 Feb. 2020. Matthews, Timothy, et al. “Social Isolation, Loneliness and Depression in Young Adulthood: A Behavioural Genetic Analysis.” Social Psychiatry and Psychiatric Epidemiology, vol. 51, no. 3, Mar. 2016, pp. 339–48, doi:10.1007/ s00127-016-1178-7.

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Substance Abuse and Mental Health Services Administration. “Table 16, DSM-IV to DSM-5 Social Phobia/Social Anxiety Disorder Comparison - DSM5 Changes - NCBI Bookshelf.” DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]., U.S. National Library of Medicine, www. ncbi.nlm.nih.gov/books/NBK519712/ table/ch3.t12/.


SoMonki Denizet-Lewis, Benoit. “Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?” The New York Times, 11 Oct. 2017. NYTimes.com, https://www.nytimes.com/2017/10/11/ magazine/why-are-more-americanteenagers-than-ever-suffering-fromsevere-anxiety.html. Graf, Nikki and Horowitz, Julia Menasce. “Most U.S. Teens See Anxiety and Depression as a Major Problem Among Their Peers” Pew Research Center. February 2019. Office of Adolescent Health. “Access to Adolescent Mental Health Care.” Office of Population Affairs, U.S. Department of Health and Human Services, 15 Jan. 2019, www.hhs.gov/ash/oah/ adolescent-development/mentalhealth/access-adolescent-mentalhealth-care/index.html. Ahrnsbrak, Rebecca, Jonaki Bose, Sarra L. Hedden, Rachel N. Lipari, Eunice ParkLee & Peter Tice. Substance Abuse and Mental Health Services Administration. (2017). “Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health” (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved

from https://www.samhsa.gov/data/ Curtin, Sally C., and Melonie Heron. “Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017.” U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. National Center for Health Statistics Brief, no. 352, Oct. 2019, p. 8. https:// www.cdc.gov/nchs/data/databriefs/ db352-h.pdf Mostafavi, Beata. “Half of U.S. Children with Mental Health Disorders Are Not Treated.” University of Michigan Health Lab, 18 Feb. 2019, https://labblog. uofmhealth.org /rounds/half-of-uschildren-mental-health-disordersare-not-treated. Lipari, R.N., Hedden, S., Blau, G. and Rubenstein, L. Adolescent mental health service use and reasons for using services in specialty, educational, and general medical settings. The CBHSQ Report: May 5, 2016. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD. https://www.samhsa.gov/data/ sites/default/files/rep or t_1973/ ShortReport-1973.html

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glossary of terms Adolescence /Adolescents Adolescence is the stage of human development between childhood and adulthood. Informally, it refers to the timespan between the onset of puberty and the onset of adulthood when they are no longer dependent on their parents. Adolescents are young people between the ages of 10 to 24 years old, who are in this stage of development.

Anxiety A type of mental health disorder characterized by intense and excessive anxiety, worrying and fear that interferes with an individual’s ability to function in daily life. Symptoms can range from physiological to behavioral. Anxiety Disorders are a category of mental health disorders in the DSM-5, examples include Generalized Anxiety Disorder, Social Anxiety Disorder, and Panic Disorder (a.k.a. panic attacks). Anxiety is often seen comorbidly with Depression.

CBT (Cognitive Behavioral Therapy) A form of talk therapy that focuses on changing unhelpful behaviors and negative ways of thinking. It can be used in the treatment of a variety of mental health disorders, including anxiety and depression, as well as behavioral and emotional issues.

Client Instead of calling them patients, counselors and therapists usually refer to the people they’re working with as clients.

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Counselor A mental health practitioner licensed to provide mental, behavioral, and emotional health services such as psychotherapy. A graduate degree—usually in social work, counseling, or psychology— is generally required throughout the U.S. to become one. Before getting licensed, counselors have a certain number of counseling hours or an internship they must complete before they can become fully licensed and practice without a supervisor. Counselor is often used interchangeably with a Therapist, but counselor is the more professional term.

Depression Classified as a mood disorder in the DSM-5, Major Depressive Disorder is characterized by a continual depressed mood and lack of enjoyment or interest in activities to the degree that it interferes with daily life and functioning. Depression often occurs comorbidly with Anxiety, such that they are often referred to together.

Digital Native A person who has had access to the internet and digital technology since they were born or since childhood. Someone who has never know what the world was like before the proliferation of the internet and smartphones. Someone who has always been connected.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) The bible of American psychiatric medicine. The DSM-5 is a diagnostic guide published by the American Psychiatric Association that categorizes different mental health disorders. It helps clinical mental health practitioners determine how to diagnose and define different disorders. Catherine S. Weislogel

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Empathy The ability to understand and share in another person’s feelings. Empathy can be categorized in two ways: affective and cognitive. Affective empathy describes the ability to share in what another person is feeling or concern for feelings observed in that other person. For example, if your friend felt sad because a loved one has passed away, you may share in their grief. Cognitive empathy defines the logical comprehension of another person’s emotions, often through perspective taking.

Mental Health Care Providers Clinical practitioners who focus on mental health, including but not limited to counselors/therapists, psychiatrists, psychologists, and social workers.

Phigital The integration of the virtual and the real. The merging of the physical and digital worlds culturally, socially, and technologically.

Screen Time Usually refers to the overall amount of time spent using digital devices with screens (computers, phones, tablets) whether for work or play; can also refer to the amount of electronic media consumed via screens.

Social Anxiety Disorder A type of anxiety disorder characterized by intense fear or anxiety around specific social situations.

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