Theme: Interactivity

The key message from this theme is the importance of user control over TBI usage, as well as how much and the type of information they can input. Giving users more control over treatment delivery appears to be empowering, more engaging, and potentially more effective.

4.4.3.1 Subtheme: User control

The amount of control felt over how participants used the TBI was noteworthy, as the degree to which participants could choose when they engaged with the TBI arose as significant in nearly every interview:

“You don’t want heavy information. It lets you come back at your own time, and videos and just pause.” – P104

Using the TBI at a convenient time allowed for engagement when it was most helpful, or when users were in a suitable state of mental health. Sometimes, it was possible to complete only a small task within the TBI. Participants could avoid feeling overwhelmed by a large amount of content, and being put off from doing anything at all. Conversely, the flexibility in timing offered by some TBIs could lead to therapeutic work not being done, as life’s other demands could more easily

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“I don’t think I would want to do something like that again, because I think what I found is that I wasn’t very disciplined, I didn’t always give myself the right time to

do it.” – P108

Control was not limited to choosing the time at which they used the TBI. For example, some users could select tasks that matched their mood at that particular time, or they could skip optional tasks that did not meet their needs:

“Depending on what your mood is or how you’re feeling that day, you can choose activities to help with that, or just find one that you feel like doing that appeals to

you.” – P101

This shows the importance of giving TBI users choice and control. When people can tailor the TBI to meet their individual needs, it may make it more likely that someone engages with the technology. Other ways in which users suggested engagement could be improved would be to offer different levels of task difficulty depending on the user’s level of expertise, and allow them to have control over selecting the appropriate level.

“It would be good if they had something for beginners. Like beginners, intermediate, and advanced. It’s very hard to get into mindfulness at first. To switch your brain for

something so it would be good if they had like a beginner’s one as well” – P110

4.4.3.2 Subtheme: Personalisation

Participants also discussed tailoring the TBI towards their individual circumstances. For instance, participants could use tools within the TBI to set manageable goals and plans for their own needs. These features supported

engagement with the TBI by helping the user to apply what they learned into their own situations. For example:

“The good thing about it as well is it gives you a chance to sort of make plans. So you’ve got the four step plans (…) It’s about having a goal, but it’s about sort of

having sort of realistic achievable goals.” - P103

TBIs differed in their capacity to cater to varied issues, and their ability to provide appropriate tasks depending on the participants’ goal. Discussions around this issue seemed relevant to one of the core factors of working alliance theory; the

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notion of “task agreement”, or the extent to which the client and therapist agree on therapeutic tasks that should be undertaken. For instance, several participants felt that the TBIs they used did not really address their key concerns, and made some interesting suggestions for added features they would like, including: personal reminders (including medication), mood tracking, and self-reflection:

“I think that maybe it was letting people down in a way, actually. (…) It doesn’t have the medication, sleep, side effects, self-management of medication.” – P112

Some TBIs facilitated a more personalised approach by allowing users to input their information and modifying the content in response. The treatment experience was made to feel more interactive, as opposed to “flat” or unresponsive, which may have mimicked some of the qualities of human-led therapy. Some of the methods for this included the use of questionnaires to tailor content, the ability to input data for graphs/charts, or being able to produce “feel-good” creative outputs.

“You can make your own animation. So each of the components is like part of a recipe. So you have your background which is you pick – do you want autumn or spring or something, so you pick something like that. And you’re picking things that

would make a really nice day for you.” - P101

However, the potential downsides of inputting their own personal

information to a TBI was recognized. This could have some unintended negative consequences, as participants may be required to input distressing information. This could either risk putting people off engaging with the TBI in the first place; or, recapping negative experiences could worsen their mood further:

“Sometimes if you look back on it, and you’ve been through a low period, it can make you a little bit upset, to be honest. You know when you look at it and you think

“Oh my God, was I that bad?”. (…) I tend to not look back on it if I can help it.” – P110