The Spheres of Wellbeing are a set of three artefacts that were specifically designed for, and with, a group of women, who were sharing a six-bed flat in a medium secure unit (MSU) of a specialist National Health Service (NHS) hospital for people with a Learning Disability (LD). In addition to a mild-to-moderate LD, the majority of the women had a diagnosis of Borderline Personality Disorder (BPD), a mental disorder characterized by severe emotion regulation deficits. Due to the severity of their mental health problems, extremely challenging behaviours and motivational difficulties to engage in therapeutic treatment, these women present a very vulnerable group.
Responding to their complex mental health and wellbeing needs and secure care environment, we developed the concept of the Spheres in collaboration with mental healthcare professionals (MHPs) at the hospital. As a collection, the Spheres bring together qualities of physical objects and digital technology to invite engagements in therapeutic and mental wellbeing enhancing activities that feel personal and unique to the individual and help to reduce stigma and lower motivational barriers to engagement. More specifically, the Spheres were designed to support the women in the learning and practice of vital skills of the specialist treatment Dialectical Behavioural Therapy (DBT); these include the promotion of mindful awareness, the formation of a strong sense of self, and the tolerance of emotional distress. The three Spheres are the Mindfulness Sphere, Identity Sphere, and Calming Sphere.
The Mindfulness Sphere, is a ball-shaped artefact that assesses and reflects a person’s heart rate through colourful lights. As such, the ball may invite a new, experiential way of bringing awareness to one’s body and – as a form of biofeedback – offers the opportunity to regulate an aspect of one’s self.
The Calming Sphere, is a non-digital bead bracelet inspired by the concept of worry beads. It physically offers something to hold onto and provides a symbol of safety and calm when feeling slightly nervous or anxious.
The Identity Sphere takes the shape of a female leather purse that safely encases technology. The artefact is configured to recognize certain predefined pictures (visual tags) through its inbuilt digital camera, which acts as a ‘scanner’ for these visual tags. Once presented with a tag, it triggers the display of short personalized videos on the screen of the Sphere. The contents of the embedded videos are co-created with each woman and intended to reflect personally meaningful contents and interests of the person; thereby assisting in the construction of a positive self-image.
To actively and sensitively involve the women into a co-design of their artefacts, the design specifications of the Spheres were used as the starting point in a creative process whereby each woman contributed to a personalized design of her Spheres. Working with different art and craft materials over a period of five weeks, the women created visually attractive pieces and personalised content for their artefacts.
Findings of a 15 week evaluation period that involved a qualitative analysis of conversations and observations of both the women and the ward staff revealed four main uses.
Firstly, the women frequently initiated acts of show-and-tell with members of the ward staff, hospital peers or their families during visits to explain the creation, significance and technical workings of the Spheres; providing opportunities for them to feel proud and receive recognition for their achievements and for positive social interactions.
Secondly, they used the Spheres for self-reassurance by approaching them to be reminded of happy memories or good feelings; of their individuality; and of important people in their life; which felt empowering to some women, who described feeling more confident and motivated to try and progress in their life.
Thirdly, they used the Spheres to keep well and maintain a sense of wellbeing when they felt lonely; were bored; sought stimulation or relaxation; or wanted to escape situations that would unsettle them. Here, uses of the Mindfulness Sphere especially were reported to have helped to relax and find calm, yet their use for practices of mindfulness was low and remained largely under-explored.
Fourthly, the women were regularly prompted and directed by the ward staff to use their Spheres as tools for coping –particularly when they were showing signs of distress – to distract them from their troubles. While the women mostly declined uses of the Spheres in those difficult moments, there were a multitude of reports of how engagements with the Spheres had helped to break cycles of disruptive thoughts.
Thieme, A., McCarthy, J., Johnson, P., Phillips, S., Wallace, J., Lindley, S., Ladha, K., Jackson, D., Nowacka, D., Rafiev, A., Ladha, C., Nappey, T., Wright, P., Meyer, T.D., & Olivier, P. (2016). Challenges in Designing new Technology for Health and Wellbeing in a Complex Mental Healthcare Context. Proc. CHI 2016, 2136-2149. LINK PDF
Thieme, A. (2015). Designing Technology to Promote Mental Health and Wellbeing. Doctoral Thesis, Newcastle University, UK. PDF
Thieme, A., Johnson, P., Wallace, J., Olivier, P., & Meyer, T.D. (2014). Designing Technology for Extremely Vulnerable Adults: The Important Role of Staff in Design and Ethics. In D. Furniss et al. (eds.), Fieldwork for Healthcare: Case Studies Investigating Human Factors in Computing Systems. Synthesis Lectures on Assistive, Rehabilitative, and Health-Preserving Technologies, 2(1), 65-74. LINK
Thieme, A., Phillips, S., & Johnson, P. (2014). Technology to promote DBT skills practice: findings from evaluating the Spheres of Wellbeing. Abstr. 13th International Conference on the Care and Treatment of Offenders with a Learning Disability, April 10-11, Newcastle, UK.
Thieme, A., Wallace, J., Johnson, P., McCarthy, J., Lindley, S., Wright, P., Olivier, P., & Meyer, T.D. (2013). Design to promote mindfulness practice and sense of self for vulnerable women in secure hospital services. Proc. CHI 2013, 2647-2656. LINK PDF
Thieme, A., & Johnson, P. (2013). Technology to engage women with a dual diagnosis of learning disability and personality disorder in mindfulness practice and to promote their sense of self. Abstr. 12th International Conference on the Care and Treatment of Offenders with a Learning Disability, April 4-5, Newcastle, UK.
Thieme, A., Johnson, P., Wallace, J., Olivier, P., & Meyer, T.D. (2013). Designing Technology for Women in Forensic Services: The Important Role of Staff in Study Design and Ethics. CHI 2013 Workshop HCI Fieldwork in Healthcare – Creating a Guidebook, 27 April – 2 May 2013, Paris, F. LINK
Thieme, A., Wallace, J., Johnson, P., Lindley, S., McCarthy, J., Olivier, P., & Meyer, T.D. (2012). Can we introduce mindfulness practice through digital design? In Proc. of the 26th BCS HCI 2012 Workshop People, Computers & Psychotherapy, 12-14 September, Birmingham, UK. PDF
Thieme, A., Wallace, J, Johnson, P., Olivier, P., & Meyer, T.D. (2012). Spheres of Wellbeing - Interactive Technology to Support Mindfulness Practice and to Strengthen the Sense of Self of Women with Learning Disability and Emotionally Unstable Personality Disorder in Forensic Services. Poster at the 11th International Conference on the Care and Treatment of Offenders with a Learning Disability, April 12-13, Newcastle, UK. PDF
University of Nottingham, UK (Talk – Centre for Social Futures in the Nottingham Institute of Mental Health, invited by Stefan Rennick Egglestone, Spheres of Wellbeing, 12.10.2016.
Microsoft Research Cambridge, UK (Lecture/ Seminar, invited by Siân Lindley), Designing Technology for Mental Health and Wellbeing, 26.02.2015.
University College London, UK (EBPU Seminar – Anna Freud Centre, invited by Julian Childs), Spheres of Wellbeing – Technology to Poromote DBT Skills Practice and Mental Wellbeing, 16.4.2014.
Calderstones NHS Foundation Trust, UK (2nd Research Showcase, invited by Paula Johnson), Spheres of Wellbeing – Research Findings: Technology to Support Mindfulness Practice and to Strengthen a Positive Self-Image (for the Women on the MSU), 1.10.2014.
University of Washington, US (DBT SPM, invited by Marsha Linehan), Spheres of Wellbeing – Technology to Support DBT Skills Practice, 6.10.2013.
Calderstones NHS Foundation Trust, UK (1st Research Showcase, invited by Paula Johnson), Spheres of Wellbeing – Research Findings: Technology to Support Mindfulness Practice and to Strengthen a Positive Self-Image (for the Women on the MSU), 7.11.2012.
This research was a collaborative project between Newcastle University's Culture Lab and The Calderstones NHS Foundation Trust (now Mersey Care NHS Foundation Trust). The research was supervised by Patrick Olivier, Thomas D. Meyer, Peter Wright, Jayne Wallace and Siân Lindley; and greatly supported in the design and development of the artefacts by Daniel Jackson, Mathew Kippling, Cassim Ladha, Karim Ladha, Tom Nappey, Diana Nowacka, Ashur Rafiev, James Thomas and Derek Anderson.
I am especially grateful to the six women who volunteered to take part in this project and the staff at the hospital for their invaluable and fantastic support of the research, in particular: Paula Johnson, Stephanie Phillips, Alexandra Lampraki and Michaela Thomson. Additional thanks go to Ko Le Chen, David Green and Dermot McNaney for capturing photos and helping in the creation of video documentations of the project.
This work was supported by Microsoft Research through its PhD Scholarship Programme and the RCUK Digital Economy Hub on Social Inclusion through the Digital Economy (SiDE).