Context
As the Lead UX designer, I worked for the first few weeks to build rapport and domain knowledge with the clients at Nielsen. Once the work was defined, we brought in two junior designers, who helped build intermediary screens and contribute to the final deliverable, a prototype whose purpose was to build executive support for funding for this new tool in Nielsen’s media planning ecosystem.
My immediate concern was a lack of user interviews with analysts, but we were able to gain access to prior research and design from tri-weekly Client touchpoints. The final deliverable’s secondary purpose was testing with users sourced from the sales teams, if time and budget allowed.
Overall Challenge
The challenge evolved from Personal Zen to ABM1, with the testing results influencing the product’s direction and audience, as well as its look and feel. We defined The Challenge that encompassed both iterations as how to effectively test, iterate, and validate the application with representative users with the goals of:
- Defining the users and their general personas
- Creating a user interface that is attractive to all user groups
- Demonstrating in a non-scientific study that the application helped mitigate depression, anxiety, or any other conditions that it may be employed for
Role
Principal UX Researcher
Client Lead
UX Research
UI Design
Prototype Development
Usability Testing
Presentational Design
Timeframe
1+ year
Tools
“Patients are best served by integrated, effective digital treatments that augment the care they get from their providers”
— Raj Amin, CEO and Co-Founder, Arcade Therapeutics
Product Evolution
The product underwent a number of changes based on discovery and user testing, arriving at it’s current day version that is undergoing clinical trials for FDA approval.
Personal Zen
The first version of the application had soothing graphics and more passive gameplay.
ACTIVITIES
Discovery testing
Definition of audience preferences
Some gameplay usability
ABM1
This second iteration updated visuals to bolder, more abstract graphics. The gameplay was more dynamic and was designed to elicit more active behavioral responses.
ACTIVITIES
User testing
Usability of more advanced gameplay
Wireframed graphics and interface
StarStarter RX
This final version with more neutral gameplay and graphics. Currently in clinical trials, moving onto FDA approvals.
Personal Zen Research
The first round of research was conducted with a panel of users that would be represented in the envisioned clinical trials, using a prototype that approximated the gameplay.
Problem Statement
“Users need to quiet thoughts of anxiety and combat depression with a flexible, easily accessible solution that is quick and fits into everyday life.”
For the Personal Zen application, the problem statement was instantiated in the application gameplay, and I was tasked to evaluate:
- The affinity for a product across a diverse user base, with the commonality of depression, anxiety, and other co-morbidities.
- Hypothesize the possible product directions based on testing results.
- Test onboarding user flow.
- Test gameplay dynamics and emotional responses.
Competitive Review
We did not do a formal review of the competitors, instead generated a collection of applications the testing users engaged with regularly. With the introduction of Attention Bias Modification (ABM) as a treatment option, there were no other applications that used engaged gameplay as a treatment mechanism (or that would claim it as a benefit). I graphed the applications in two axes;
User Defined Benefit: How much users stated the applications helped them with coping with anxiety and depression
User Engagement: Defined as the amount
of energy and inputs users expended in the application
Insights: Personal Zen/ABM was designed to occupy the space that mapped regular easy gameplay to an explicitly defined user benefit. This was also reinforced through physician review of application usage. Other applications required large amounts of inputs (journaling, health tracking) to get results, or had high gameplay (Call of Duty, match three games) but no lasting benefits.
Research and
User Interviews
I worked with the team to develop an applicant pool in Respondent.io, filtering through many candidates to get a sample set of users from different age and gender categories with varying familiarity about their condition to test the product.
User Selection
The user characteristics and parameters were defined by our client liaison:
- Females/males from 18 - 60
- Diagnosed history of depression, anxiety or related conditions In treatment and under the care of a physician for these conditions
- May have played video games; familiarity with mobile and desktop gaming was noted but not necessary
Participants
We tested with 11 participants, in one hour sessions that covered a full prototype walkthrough and a general set of questions about their testing experience, as well as questions about anxiety and co-morbidities such as diabetes, cancer and other conditions, if applicable.
Testing and setup was the hardest part as we had to modify the test plan to engage prior to actual application testing. Setup, remote screen sharing , recording, and a bias towards “using the application correctly” all exacerbated anxiety in the users. Ensuring that we could get valid results by baselining all participants was essential.
Initial Takeaways
We saw interesting correlations in the user groups:
Users with a higher awareness of their condition (anxiety, depression) were more skeptical and required higher levels of scientific backing that proved the efficacy of the application.
Testers with longer histories of anxiety were more likely to have a larger set of coping skills, and evaluated Personal Zen on how it fit into their personal toolbox.
Gender split was very evident. Women were more likely to consider using the application (88% versus 50%)*. Some possible recommendations were to change gameplay/look and feel to be less gender-specific.
6 Females (20-35)
- Some familiarity with anxiety and other conditions
- More non-clinical coping mechanisms than other groups (astrology, tarot)
Based on the universal response of the testers, this is the core user. They have yet to fully build out their anxiety reduction toolbox, have a high degree of digital fluency, and had an overwhelmingly positive reaction to the visuals and gameplay. They value the simplicity of gameplay, believe in the scientific basis of the game, and don’t question it’s research-derived legitimacy.
Opportunities
High-potential for increased social network integration (Gen Z only) to increase community participation, recruitment and retention.
“It feels like there’s a personalized timeframe—feels like someone is looking out for you”
2 Females (35-55)
- Higher degree of understanding of their conditions
- Well established set of coping mechanisms
This is a secondary user because of their already entrenched practice. The barrier to entry: demonstrate the science and how the convenience of immediate gameplay can fill a gap in their busy schedules. Balance against the stigma of mobile gameplay being seen as not valid. Reinforcing the scientific basis for the gameplay and getting “recommendations” from other medical sources to help bolster trust.
Opportunities
Partnering with health care plans to gain trust, emphasizing Dr. Tracy as a real doctor and playing up the scientific basis for the app
“I’d sign up if I knew it was more than games, offered a more holistic approach, tracking, etc.”
2 Males (30-40)
- Some degree of understanding of their conditions
- Some coping mechanisms centered around community (multi-player games)
This is a secondary user who sees the application as useful but not necessarily targeted at them. Visuals and gameplay are serene and calming (which they appreciate), but they’re more likely to play it with increased scientific explanation and data showing what the gameplay can achieve for them. Although these users have an existing pool of coping mechanisms, they’re digitally literate and could see themselves using and recommending the application.
Opportunities
Sharing the application with gaming friends and adding more social media interactions, while also protecting identities and data.
Most important: This group was drawn to more interactive gameplay dynamics.
“Hey, did you know that three minutes of playing, this game drops your cortisol levels by 10%?”
2 Males (40-55)
- Varying degrees of familiarity with anxiety and other conditions
- Most skeptical of Pesonal Zen treatment
- Not as likely to rely on technology
This ended up being a tertiary user due to the strong reactions to the visuals, some gameplay and expectations around what the application does, and how it’s tied to science. This is also a smaller sample size and would require more testing to fully validate these edge-case reactions. With some cosmetic updates it would be relatively easy to get a more engaged audience.
Opportunities
Updating Doctor’s representation to be more realistic, adding credentials. Revising graphics to more gender-neutral themes.
“I don’t really think like most guys would want to see like sparkles and flowers”
Onboarding
Setting a baseline for evaluation was a primary task that users needed to complete (much of the data was dependent on setting a baseline for users). The Assessment was based on a clinical process that some higher-awareness users were able to suss out the purpose—this led them to increased trust in the application, but more questions for their physicians.
Key onboarding Takeaways
Older male with practice in meditation liked the name Personal Zen—positive associations with Zen.
“Artwork feels Buddhist, like the Himalayas” – Shane C.
Younger female liked the circle and Zen name as well. Expected the brand to be carried through into the interface. Liked the “full circle” analogy.
Some users wanted to know more. After testing, they recommended that the game aspect be called out, and suggested more specific language around the scientific methods that made this an effective treatment.
Assessment
At the end of the Assessment users were given a “Personalized Goal” that would recommend the treatment options (and, to some degree, an amount of gameplay). Experienced users who had been through similar onboardings were skeptical. Non-clinically diagnosed users were happy with the outcome and felt that the application would be helpful.
Key Assessment Takeaways
Most experienced users Those with a longer history of diagnosed anxiety felt these questions were too familiar.
“I would have thought, okay, it’s just yet another copycat assessment.” - Shane C.
Wording Stressed and Anxious were different conditions to some users. Pain and physical discomfort were also similarly viewed
“Escalating” colors caused some users discomfort.
Accessibility Users (and myself!) commented on the low contrast and accessibility issues with this interface.
Gameplay
Playing the “game” is the core of the therapeutic aspect of Personal Zen, and in the first iteration it was simulated in animated GIFs in an InVision prototype—less than ideal for testing the mechanics of the gameplay. Despite this, we were able to test users affinity for the graphics, levels, and basic interactions.
Gameplay Takeaways
Users were pleasantly surprised to start the gameplay, and most reacted very positively to the visuals and simulated gameplay. Some feedback:
Gameplay mechanics were somewhat
understood, but some users commented on a
quicker onboarding to learn how to play faster.
On the other hand, users also wanted to learn how the gameplay really affected their anxiety.
“…is it dropping my cortisol levels?”
Some users were confused that “playing” was the result; they were unaware that gameplay was the primary means of stress relief in the application.
Impact
The readout of the research results was met with enthusiasm, and the clients were particularly interested in the gender split of the respondents. To date, the application was developed with more emphasis on the gameplay, less attention or research had been devoted to the look and feel. Conversations centered around interface updates and the development lead took particular interest in the need for achievement that Males (30-45) wanted.
General Takeaways
We saw some interesting correlations in these user groups:
Users with a higher awareness of their condition (anxiety, depression) were more skeptical and required higher levels of scientific backing that proved the efficacy of the application
Testers with longer histories of anxiety were likely to have a larger set of coping skill set, and evaluated Personal Zen on how it fit into their personal toolbox
Gender split was evident: Women were more likely to consider using the application (88% versus 50%)
Next Steps
Although I was not slated to be involved in the interface development I was able to emphasize the updates that could expand the application’s desirability to our male users.
Some of the recommendations:
- Update all visuals with a consistent, colorful, and less “soft and whimsical” art style.
- Add more leveling up, advancements and opportunities to progress through the application.
- Give awards and recognitions throughout.
- Simplify the onboarding and give better wayfinding signifiers throughout.
- Keep Dr. Tracy as a presence, but give users the option to learn about ABM, or give prescribing physicians training to get user buyin.
ABM Testing
The Attention Bias Modification testing used a coded prototype that was stripped down to minimal visuals. The user profile was much the same as before, but the focus was on gameplay and their reaction to the experience, rather than look and feel.
Problem Statement
“Users need an application to help counter anxiety and depression that offers engaging gameplay, a clinical method that users trust and understand, and dynamics that encourage repeat and consistent usage.”
ABM was the update to Personal Zen, and offered an MVP gameplay solution that was minimal on graphics, and focused on the advancement and scoring that attracted all user groups.
Some of the objectives of testing:
- Validate with the same representative types of users whether the updated gameplay was improved
- In a non-clinical setting, gauge emotional response to the gameplay. Did this experience help distract from intrusive thoughts or negative emotions?
- Determine the time, place, setting, and expectations of the user for a prescribed session Evaluate iconography, interface elements, settings, and user control of the application
Context
Teem Ventures/Wise Therapeutics engaged me for another round of research and evaluation of the ABM1 product which had been updated on prior research recommendations.
The application was now stripped down visually, with primary colors, bright icons and defined levels of gameplay. Scoring, power ups and the ability to “achieve” was baked into the gameplay.
I engaged other researchers to help split up the testing and I debriefed with them, gathered notes in our communal Miro board, and synthesized takeaways.
Product Iteration & New Development Roadmap
The business case was made to dispense with a crowded, mass-market approach and focus on the application’s primary strength as a therapeutic prescription product. The business was going to put the product through clinical trials, leading to an FDA-certified product that physicians would prescribe to patients with anxiety related disorders.
Testing Levels and Gameplay
The new application was developed in conjunction with an interactive game studio that was able to code out the interactions, swiping gestures, physical dynamics, and other interactions that weren’t possible to do in design prototypes.
Participants
We tested with nine participants, in 30 minute quick gameplay sessions. Frequently, the onboarding and setting up for the screen share took longer than the gameplay testing.
Demographics weren’t stressed as heavily and the team developed the game to be more basic and less gendered in graphics and visuals. Nonetheless, we tested a range of user ages and genders.
6 Females (30 - 53)
- Self reported anxiety, depression
- Under current medical treatments
- Also practiced anxiety reducing behaviors
3 Males (28 - 70)
- Self reported anxiety, depression
- Under current medical treatments
- Also practiced anxiety reducing behaviors
Top Level Findings
As the testing was more centered around gameplay refinement in order to have a more refined and easily playable product for clinical trials, we focused on the attributes of the app, rather than the concept of it.
Onboarding
- The onboarding process and game tips weren’t always clear
- Respondents wanted more explicit explanation about game benefits
Gameplay
Graphics were polarizing; some felt like they looked young, others found them soothing
Faces provoked a range of reactions; some felt they were too fast, others didn’t like the Unhappy Face
Scoring and Levels weren’t clear; tips were helpful but users preferred to “figure it out”
Many users saw differences between Phase 1&2, some thought P1 was “repetitive,” some felt it was “relaxing”
Phase 2 (Walls) was more engaging for some, while others liked the ability to level up faster
Features/Improvements
- Mood tracker option appealed to most respondents
- Optional push notifications appealed to some (definitely optional, not mandatory)
- Option for customizing experience a plus; some respondents wanted music, others didn’t
- Demo game was suggested to show how to play game
Demographic Affinities
- Doctor recommendation held more sway than FDA approval
- Testers with more anxiety preferred Phase 1
- Younger, non-clinically diagnosed users preferred the engagement of Phase 2
- Older users had more difficulty with “swiping” and gameplay mechanics
- All users wanted to know how it works, why a doctor would prescribe
Interface and Gameplay
Users didn’t really notice or care about the wireframed interface. They were mainly neutral about the color scheme and reserved opinions for the faces and other graphic elements.
Focus on Faces
Faces tended to be a focal point for many users. They had both positive and negative reactions to the depiction, and some users read more into their meaning. They moved too fast for some users to understand where the trail started.
“Hard to differentiate between the facial expressions. I feel like it takes my brain a moment as those faces look so similar.” Alyssa N. - F, 33
Age Appropriate
Some users commented on the basic color palette and how it could have been confused with a child’s game. Potentially we had over corrected for the graphics feedback from Personal Zen.
“My first impression is that this is a child’s game. That’s the feeling that I get from it.” Judith P. - F, 30
Opportunities: Revise and age up the graphics. Backgrounds and calming graphics are preferred.
Levels Need More Differentiation
While 25% of the users noted a lack of stress moving between levels, close to 75% expressed interest in increasing the differentiation between levels. Also users wanted their points to mean something and gain them access to not only Levels, but other content.
“I’m from the Mario generation, give me something that’s going side to side and I can collect treasures and smash things and I’m happy.” Erin M. - F, 44
Ambivalent and
Unsure of Scoring
Some users were neutral or didn’t focus on points or scoring. They tended to be outliers (younger male, female with autism diagnosis). Some users reported that they didn’t know how points are scored (though some expressed they didn’t care about points!)
“You kind of just forget about things and you just focus on the game, you know?” Seide J. - M, 23
Experience and User Wants
Issues were discussed with users that would help increase engagement, as gameplay was a prescribed 4x weekly. Most users reported that reminders, dashboards and reinforcement from medical professionals would make them more accountable. We also asked users about additional concepts and users responded to in-game rewards and the ability to configure their experience.
Notifications
Notifications were generally accepted by users to help them remember to use the app or track how many days were left of their “prescribed” uses each week. The frequency and timing of notifications were of concern for a portion of the users.
“[Notifications] would be fine as long as it’s not too many. I get a lot of notifications already so I don’t want it to just be added to the pile…. Maybe once a day or maybe you can designate a time where you want to receive a notification.” Tresa, - F, 48
Dashboard
Users reported that they would likely be able to use the application 4 times per week - and a doctor’s recommendation would strongly reinforce.
“Player/Therapist Set Goals: Maybe you could set a goal, like if I feel anxious, you know, three times a week.” Seide J., - M, 23
Mood Tracking
80% of testers would like some mood tracking feature to help them take an active role in their improvement in the application. Graphs, charts and even a diary are recommended features from users. Tracking over time and seeing whether the app is helping seems to fill in for the lack of knowledge about the application’s clinical mechanism.
“You could track to see each time you play how you were feeling at that time. Then it would be kind of like a diary, then you would kind of know what your moods are when you play the game.”
Tresa J. - F, 48
Giving Users
Control and Guidance
Testers wanted more control over their gaming environment—whether it was music, chat, tips or demos of gameplay.
“...if it has like a demo beforehand just to give you an example just to see it”
Tresa J. - F, 48
Opportunity: Create a more accessible settings or system preferences panel that allows users to access settings, tips, and other things on demand.
Updates and
Next Steps
The application is slated for clinical trial testing in Q3/Q4 of this year. The user feedback and iterations that I was a part of is helping develop the unique concept that gaming and therapy can be combined to relieve stress and anxiety using clinical techniques and digital media.
Competition
Interestingly - Both playing levels weren’t gamified enough for some users. Competing or showing others scores came up as a possible add.
“Suggested adding a competitive element where player could compete with them self or invite a friend or family member to play it and see who does better” Alyssa N. - F, 33
Interface Updates
Testers wanted more colorful backgrounds, elements, speed changes and other interactive changes to make the application more dynamic.
“Maybe have some, you know, some color changes in the background, some flashing lights.” Seide J. - M, 23
Overall User Reactions
Positives
A majority of users (75%) found the application helpful in relieving stress, although there was some debate between Phase 1 and 2 which was more effective.
“You’re really focusing on something other than what caused you to be in the problematic area.” Jim W. - M, 70
Opportunities
Some users did not like it for the reasons that they didn’t see it as having a purpose.
“Doesn’t know why she was playing and what
the purpose was...”
Judith P. - F, 30
Current Day: StarStarter Rx
My Personal Zen/ABM testing and engagement rolled off in 2023, with solid recommendations and actionable insights that steered the product development towards the current state. Arcade Therapeutics have conducted over 288 patient trials and have pipelined their new product “StarStarter RX” for release pending FDA approval.
Clinical Trial Application
The application is today a more refined and polished version of the MVP I tested. From their website:
“StarStarter Rx is currently being investigated as a treatment for social anxiety disorder, generalized anxiety disorder, and a range of other anxiety conditions through partnering organizations.”
They’ve partnered with the University of Austin Institute for Mental Health Research to support clinical trials for the application, as well as testing at Kean University.
Final Updates & Improvements
The final version of the application has incorporated many validated user enhancements, visual, interactive, content and navigational. Some examples:
In-App Gameplay Direction
Even with a thorough onboarding, users wanted to know how to play, level up, and gain more points. Regardless of StarSeeker being a therapeutic app, users (of both genders) wanted a robust game experience.
Increased
Gameplay Dynamics
The app now has a more complex game engine, and although it still has the ABM methodology embedded in game patterns, its more “arcade-like” and is habitually easier to continue engaging with.
Enhanced Navigation
and Wayfinding
Users needed to see not only what “levels” they were at, but what that meant in terms of progress and helping with their conditions. The new navigational structure used weekly time increments to give users a sense of where they were at in treatment.
Sessions & Rewards
The app has a defined time limit and notifications that define the treatment sessions clearly.
Douglas Bantz
Product Design
Creative Direction
Educational Consultant
