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Summary about Plan8 Co-rumination project

The mental health of young people aged 11 to 16 significantly declined between 2017 and 2021. Especially, young adolescent girls in secondary education report having more emotional problems (Vuijk, n.d.). Patricia Vuijk believes that co-rumination is one of the causes of the increase in emotional problems among girls.

Co-rumination is a maladaptive emotion regulation strategy where two friends excessively discuss their problems, which can potentially lead to depression. Co-rumination is most common among girls aged 12 to 14 (Borowski & Zeman, 2016). It can occur in various settings, such as at school, via social media and outside of school.

Interviews with teachers and care coordinators from secondary schools revealed that schools have not yet focused on emotional development or awareness.

Type of project
Healthcare, E-learning, Education

My role 
Lead/ Product designer

Project language
🇳🇱 Dutch 

Duration
September 2023 – January 2024

Team members
6 members in total, 3 social workers, 1 educator, 1 health technology and 1 product designer (myself).

Figure 1: Brainstorming based on literature, as preparation for the interviews.

1. Empathise 

Main Question
How can we teach young adolescent girls aged 12 to 14 a new adaptive way to regulate their emotions?

For the design challenge, we delved deep into the literature of the  psychopathology of the target group who we aim to build an intervention for. Together with my team we each read 1 or 2 literature articles about the cause, development and prevention of co-rumination among youngsters. These insights brought light to better understand the current situation. With these insights we prepared field research questions to ask health professionals, interview teachers and young girls between the age of 10 – 14 years (see figure 1).

Best, Good and the Bad practices

Deskresearch

Figure 2: Current market analysis.

Sub-questions

  1. Why do girls aged 12 to 14 co-ruminate?
  2. What interventions are used to help young girls prevent co-rumination?
  3. What are the needs of the target group and how are they being met?
  4. Which stakeholders are involved and what influence do they have?

Within the collaboration I’ve created a solid plan on behalf of my team, by selecting the specific tasks and frameworks within Design thinking. Reason why the Design Thinking method is more suitable for this project rather than the Double Diamond, is in the wording of the process, such as “Empathise” instead of “Discovery” phase. Working in a interdisciplinary team with social workers and health professionals demands different approach of language jargon. We aimed a more in depth approach for the Empathise phase since it’s the most crucial part to develop a well thought intervention.

The Empathise phase includes:

  1. Desk research
    1. Literature study 
    2. Similar app intervention analysis
  2. Field research
    1. Interviews with stakeholders. (Planned a interview with Daniella Butrus to speak with the Director of Youth Care and Board Member, L.Kop.)
    2. Visiting secondary school (Through my own initiative we got to visit Wolfert College VO Rotterdam, on-site interview with the care coordinator).
  3. UX workshop
    Giving a presentation about “introduction User Experience design” to peers.

Some tasks were done by other teammates which we later on combined our insights, to expand our research and see possible pitfalls and opportunities for the next sprint. For more in depth insights, see Design Rational Paper (in Dutch).

Insights (short version)

Desk research

Article: “Co-Rumination Facilitate Depression Contagion in Adolescent Friendships? Investigating Intrapersonal and Interpersonal Factors.”

 

  • Definition and Impact of Co-Rumination: Co-rumination involves excessive discussion and focus on negative feelings within close relationships, such as friendships. This behavior is linked to the spread of depressive symptoms within a social network, particularly among adolescents.

  • Factors Influencing Co-Rumination: The study examines both interpersonal factors (such as excessive reassurance from friends and the quality of the friendship) and intrapersonal factors (such as personal distress and emotional sensitivity) to understand how co-rumination affects depressive contagion in adolescent friendships.

  • Strategies for Positive Development: To minimise the negative effects of co-rumination, the study suggests identifying warning signs of increased risk, teaching adaptive emotion regulation strategies, providing psycho-education on depressive behaviors and balancing problem discussions with positive activities. These measures aim to support positive social and emotional development in adolescents.

Article: “Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth”.


This article highlights the importance of technology can how it can help for mental health care purposes, but it must be effective and evidence-based (preferably longterm effects).

Article: “An Observational Study of Co-Rumination in Adolescent Friendships”.

 

Co-rumination can lead to depressive contamination under specific circumstances, such as high personal distress and seeking excessive reassurance from friends.

Article: “Emotional Competencies Relate to Co-Rumination: Implications for Emotion Socialization within Adolescent Friendships. Social Development”.

 

A lack of emotional awareness and skills in girls leads to more co-rumination and increased vulnerability to depressive symptoms.

Book: “Groeisport! Jeugd, Alliantie en Sociale Technologie”.

 

Technology must be user-centered and align with user needs. Social professionals must be actively involved in technological developments to support vulnerable groups.

Article: “Depression Prevention” (Rooijen, K., 2018).

 

Preventive interventions for depression range from universal to selective and indicated, with cognitive behavioral therapy often used. Short duration and homework assignments are more effective. Relevance: Implementing concrete goals and interactive teaching methods in preventive programs can improve effectiveness.

Article: “Girls Might Just Be a Bit Too Good at Talking Each Other into a Hole, Says This Orthopedagogue”.

 

Co-rumination and depressive contamination via social media are significant. Solutions include better connection between school, parents, and children, and promoting positive activities.

Article: “Talking Each Other into a Hole Well-Meaningly”.

 

Co-rumination increases the risk of depression. Schools can take preventive measures and use questionnaires to identify co-rumination.

Report: “Study Protocol for a Randomised Controlled Trial to Evaluate the Effectiveness of a Serious Game Targeting Interpersonal Emotion Regulation in Early Adolescents”.

 

Research protocol for a serious game aimed at interpersonal emotion regulation (iER). Final results are not yet available.

Article: “Mindfulness”.

 

Mindfulness has positive effects such as improved attention and emotional regulation, but the duration of training and support are crucial. It can be detrimental for younger children without adequate support.

Article: “Emotion Regulation Training in Children and Adolescents”.

 

Adaptive emotion regulation strategies such as distraction, cognitive reappraisal, and problem-solving are effective. Emotion regulation skills like relaxation, emotional awareness, acceptance, and self-support are essential..

Figure 3: Desk research insights summarised and translated to English.

2. Define 

After gathering insights from interviews with experts, teachers, care coordinators, parents, and our primary stakeholders—the target audience of young girls aged 12-14 years → we created an Empathy Map to highlight key quotes from the interviews with the girls. This helped us gain a clearer view of their perceptual world. We then developed two main personas to represent our target audience’s different behaviors:

  1. Sara who actively and unconsciously co-ruminates.
  2. Fleur, who passively co-ruminates (absorbing it).

Co-rumination amongst duo friendships

The 2 Main Persona’s

/ Actively and unconsciously co-ruminates

/ Passively co-ruminates (who absorbs it)

Figure 3: Desk research insights summarised and translated to English.

Based on the Empathy Map and the two persona profiles, my team and I have visualised the journey of Fleur’s experience, as someone who passively contributes to co-rumination within her friendship duo with Sara. This is based on a actual journal from one of the interviewed girls. While filling in this framework, we made notes on possible changes throughout Fleur’s day that could help to cope with difficult emotion.

Figure 4: Experience map – current behavior based on insights and interviews with the target audience. On the right is the Empathy Map.

3. Ideate 

During the ideate phase my team and I made different stages into developing a suitable approach for our users. In our first concept we brainstormed on different game ideas that includes all students during the E-learning intervention. For our first ideation we made 3 different games in which we divided our collaboration into 3 groups to do this experiment. Daniella & Khadija made a animal based character similar to a tamagotchi which the user can take care of. Maartje and Nikki made a roulette game that the user can spin while the teacher project a case and the students answer questions that they have spun in groups, to answer about the particular case. Tycho and I made a prototype of a roleplay game, in which the student can decide what to answer based on the multiple choice questions. This will showcase the different approaches of situations and overall experience based on the specific scenario. The students get to see how the response could effect the scene and the character development.

After testing all 3 games we decided to continue with the roulette game in combination with the roleplay game. We started by creating a LO-FI prototype and during this process I came up with a theme for the E-learning, based on storytelling approach we can share information about the space with 2 fictional characters. Since classrooms are very diverse, we focussed on creating a theme that interest both girls and boys to follow through the E-learning program. We spoke several students and teachers about the concept. During this process, I’ve created 3 moodboard of possible style direction for the new application. The most voted style is implemented in the final prototype design.

Figure 5: On the left CIMO-Logica Model. On the right, ideation brainstorm for possible games for the E-learning application.

4. Prototype

Our second iteration took place after pitching the concept at the Immersive Tech Week (ITW) in Rotterdam. We presented our new idea of creating a digital journal in a form of an app for youngster to use after classes. This way students can share by voting and writing on how their day went. Besides this app, teachers still present information about the cause of co-rumination and share information to practice on recognising co-rumination, how to prevent and  regulate emotions. After speaking with multiple professionals, we found possible iteration directions for the concept. Something to note was definitely the fact that ethical questions on who will have access to the vulnerable information of the journal of those students? How does gathering those data help youngsters. Will the application offer other solutions and/ or support in case of suicidal tendencies?

This helped us to work through a improved version of the prototype, in which the E-learning, gamifiction and intervention all in one – offers a solution for teachers to follow and give a 10 week program for students that will be taken place during mentoring hour. Mentoring hour is usually once or twice a week here in the Netherlands. Most secondary schools don’t offer a particular program. This prototype solution would be a great fit to include during those hours.

The E-learning 10-week program consist the following content for each session:

  1. Animated video
  2. Dialogue with the class
  3. Interactive game in groups
  4. Journal (homework)

Figure 5: On the left CIMO-Logica Model. On the right, ideation brainstorm for possible games for the E-learning application.