Self-direction in daily stress management: the solution for mental health issues

In the lecture Yvette Roke and Jamie Hoefakker will discuss the positive and negative effects of daily stress on mental health. They will also highlight which characteristics are likely to cause more stress related issues, and why recovery time is very important. They will give an understanding of autism spectrum disorder (ASD) in relation to daily stress and they will discuss the app, SAM the stress autism mate, developed and investigated (SCED design) in co-creation with their patients with ASD.

Watch the introductory videos about the SAM app

SAM app:
SAM, a mobile mHealth application, has been developed by a project group consisting of mental health researchers of the Netherlands Organization for applied scientific research (TNO), and practitioners of GGz Centraal Emerhese, Flevoland, in close alignment with the target group, 15 patients of GGz Centraal Emerhese Flevoland. The purpose of SAM is to support individuals with autism in stress recognition and self-management of stress in daily life, thereby improving well-being, among other things. The SAM app is easy to use, no special training is needed to use SAM. Considering the specific communication needs for adults with autism, SAM was designed to be easily customised. One can select different sets of colours for the feedback chart (i.e., traffic light colours or different shades of blue) and for the questionnaire multiple-choice options in written text or emoticons are available. SAM consists of several features, each of which is explained separately below.

Questionnaire
SAM sets a questionnaire four times a day with an interval of four hours. The timing of the first questionnaire is, chosen by the user and it takes two minutes to complete. The questionnaire starts with what activities the user has done in the past four hours and how the user felt during these activities. This is followed by two questions about whether the user had positive thoughts and felt energized during the past four hours. The questionnaire ends with ten multiple-choice questions about stress signals experienced in the past four. These questions are based on the results of the interviews with the target group. Every question-and-answer possibility in the SAM app is linked to a certain score, and the sum score corresponds to a certain stress level (i.e., no stress, little stress, stress, lots of stress). Based on cut-off values within the potential sum scores, the algorithm generates a report of the level of perceived stress (i.e., no stress, little stress, stress, lots of stress). SAM then verifies the results by asking if the measured stress level corresponds to the person’s perception. When there is a discrepancy between the stress level measured by SAM and the person’s own perception, this is registered on the overview page. This forms an input for the dialogue about stress signalling between the user and the practitioner or relative. In addition, we use the authentication data for the further development of SAM.

Personal coping advice
After the algorithm has calculated a stress level, the app provides a general as well as a personalized coping advice corresponding to the level of stress. The personalized advice consists of stress management tips that are pre-set by the user: while installing the app, users are asked to select preformulated tips and/or to enter their own personal tips. Examples of general preformulated coping advice are ‘go for a walk’, ‘do a breathing exercise’ or ‘listen to some music’.

Feedback chart
At the end of every day and week an overview of the daily stress levels is generated in a feedback chart. This chart visualizes the stress level of every measurement moment and summarise which activities contributed to feeling good or bad. By looking at the feedback chart, the user may discover stress patterns possibly related to day-to-day activities. In this way, the user can retrospectively consider which activities or events caused or contributed to the experienced stress. Additionally, this chart could be a focus point in therapy if the user wishes to share the results with the therapist.