iNViVO is a mobile application and web platform designed to serve as a digital companion for prolonged exposure (PE) therapy, one of the fastest growing treatments for PTSD — an anxiety disorder that affects nearly 7.7 million adults every year in the United States. When paired with weekly in-person sessions, iNViVO creates an immersive digital experience that helps clinicians better facilitate treatment, increase their client retention rates, and most importantly, provide those silently suffering with the help they so desperately need.
iNViVO’s main features allow users clinicians and their clients to customize their treatment program, visualize their progress, safely store their recorded exposures, access all tools and resources necessary to completing the treatment program, and securely communicate between weekly sessions.
PTSD & PE therapy explained
We tend to think of traumatic events as things that happen to other people and yet, an estimated 70% of adults in the United States will experience a traumatic event at least once in their lives. Up to 20 percent of these will go on to develop post-traumatic stress disorder (PTSD).
While most of us tend to explicitly associated PTSD with veterans, it’s an anxiety disorder that any person may develop after experiencing or witnessing a life-threatening event. PTSD is characterized by four main symptoms: (1) re-experiencing, (2) avoidance, (3) hyperarousal, and (4) persistent negative thoughts and feelings.
Those experiencing PTSD are also more likely to suffer from a host of other mental health problems such as anxiety, depression, or substance abuse. But many of these problems are actually caused by PTSD symptoms, and can be resolved with PTSD treatment.
PTSD has only been classified as a mental illness since the 1980s, which means that research around its treatment is still evolving today. There are, however, many successful and evidence-based treatments out there; the current “gold standard” of which is a specific type of cognitive behavioral therapy called prolonged exposure therapy (PE) therapy.
PE therapy is a treatment method characterized by encouraging clients to re-experience, re-engage with, and emotionally process their traumatic experience rather than avoid it. Clients will learn about PTSD and the rationale behind PE therapy and then practice strategies for managing their anxiety. Then, they will begin to complete exposures:
In-vivo Exposures: At the beginning of their treatment program, clients make a list of the people, places and activities that they have been avoiding since their traumatic event. During exposures, they then repeatedly “expose” themselves to these situations in safe and controlled ways.
A man is physically attacked while waiting at his bus stop and has not ridden a bus since. As an in-vivo exposure, he will purposefully take the bus to work this week.
Imaginal Exposures: In these exposures, clients retell the story of their traumatic event in as much detail as possible The clinician will make a recording of this exposure and have the client listen to it regularly.
A woman is sexually assaulted at a party and has not discussed the experience with her family or friends. As an imaginal exposure, she will retell the story of her sexual assault to a therapist and then listen to the recording several times throughout the next week.
The rationale behind any kind of exposure therapy is that as a client completes exposures, their distress will decrease. While the idea can seem cruel, it’s based on a principle that most of us can understand — the thought of something is usually scarier than the thing itself.
Even so, the experience is especially unpleasant and emotionally exhausting for clients and can often be met with resistance. PE therapy is very task-oriented and for the program to be successful, clients must overcome this resistance and complete assigned tasks in a timely manner.
As with any form of therapy, clients are encouraged to remember that things have to get worse before they can get better — but many clients drop out before getting the chance to see what better might feel like.
Outside of weekly sessions, clients may be asked to:
- Read about common reactions to trauma
- Read an explanation of PE therapy
- Practice daily breathing retraining
- Record imaginal exposures in session
- Listen to imaginal exposure recordings at home
- Log subjective units of discomfort (SUDS) while listening to recordings
- Create a hierarchy of in-vivo exposures
- Complete weekly PCL-5 self-assessments
If accomplishing all of these weekly tasks while revisiting a previous trauma sounds overwhelming, that’s because it is. While the success of PE therapy is highly documented, the dropout rates are still notoriously high. This statement is not altogether surprising when we think about what PE therapy asks of its clients.
Unfortunately, when it comes to tools, that client may feel pretty much on their own. The tool most commonly used to facilitate PE therapy is a paper workbook called “Reclaiming Your Life from a Traumatic Event.”
Prolonged exposure therapy is in desperate need of an emerging solution that can (1) improve the efficacy of treatment, (2) increase retention rates, and (3) provide those silently suffering with the help they so desperately need.
And that’s where iNViVO comes in.
iNViVO is a technology meant to be paired with prolonged exposure therapy as facilitated by an experienced practitioner. Unlike many other mental health apps on the market, it is not intended to be a substitute for professional treatment. When paired with weekly in-person sessions, however, iNViVO creates an immersive digital experience that can help clinicians better facilitate treatment and provide clients with the support that they need.
iNViVO is made up of two main components: a mobile application for clients and a connected web platform for clinicians. Clients use the mobile app to access all of the necessary tools and resources for treatment, record imaginal exposures and log their subjective units of discomfort(SUDS) during in vivo exposures. The connected web-based application acts as a dashboard for clinicians to manage all of their client’s data and monitor ongoing progress.
Clinicians can subscribe to iNViVO for $49.99/month, clinics can subscribe for $499/year, and clients can download the app one time for $0.99 and then connect to their clinician’s dashboard for free using a provided code. This business model provides a cost-effective solution with a significant competitive advantage over present alternatives. With the implementation of a clinician dashboard, iNViVO provides a treatment solution that can pass the cost (and thus burden) onto the clinician instead of the client.
Its main features would allow clinicians and their clients to:
Customize Treatment: Depending on the severity of symptoms and the number of necessary exposures, a PE therapy program may take anywhere from 8 to 12 sessions to complete. Using their web dashboard, clinicians can adjust the schedule of treatment and the objectives for each weekly session so that each new client has a customized experience.
Visualize Progress: iNViVO can be used to track client data (such as SUDS, number of completed exposures, etc.) over time, both in and out-of-session. Insights from this dataset can be valuable for clinicians to better inform the course of treatment; visualizing this personal progress can be motivating and encouraging for clients.
Stay Organized: Clinicians can use the dashboard to organize their weekly schedule with calendar integration. They can also send appointment and homework reminders to clients via push notifications from the iNViVO mobile app. Clients can opt-in to receive their own set of scheduling reminders or use the feature to send messages of encouragement between sessions.
Access Toolbox: Within the mobile app, clients have access to all of the resources and reading material they might need to complete their PE therapy. The mobile app also includes a toolbox that clients can use to record each therapy session, practice their breathing retraining, log their SUDS during each exposure, and complete weekly self-assessments.
Secure Your Data: iNViVO is HIPAA compliant and dedicated to protecting all client personal information and data. The mobile app also provides clients with a safe space to keep recordings of imaginal exposures—which often include graphic details of a person’s traumatic experience.
Communicate Feedback: Clients and clinicians are encouraged to use the in-app messaging tool to communicate in-between sessions. This features removes a lot of the barriers to client/clinician communication and allows clients to receive the emotional support they may need week-to-week.
The iNViVO web and mobile prototypes were developed using the Adobe Creative Suite (specifically Photoshop & Illustrator) and stitched together using Marvel, a collaborative tool for designing and prototyping.
Throughout the entire process, I stumbled upon some very useful and very free online tools and resources worth sharing:
- UI Names & UI Faces: These tools generate names/faces of hypothetical users.
- FlatIcons: This is like a search engine, but for icons. All of the icons are editable vectors and you can download 1–2 packs for free each day.
- Adobe Color: This is a free Adobe service that allows you to explore and create custom color palettes for your project.
- Fontpair.co, Typ.io, & Fonts.greatsimple.io: All of these are well-designed websites that pair together great fonts.
- The Big List: An evergreen blog post from Invision full of wireframes, UI kits, stock photos, mockups and more. What more could you need?
And of course — don’t underestimate Pinterest as a resource. While I’m not that into crafts or recipes or potential wedding planning, Pinterest is a fount of inspiration as far as design and branding go.
I could probably write an entirely separate post about all of the lessons I’ve learned from this capstone project: how to conduct user research and usability testing, how to use prototyping tools, how to design for the best user experience, how to solve small problems (like where do I put a button?) and big problems (like how will this ever make money?), how to manage a project… and also how not to manage a project.
I can admit (and any of my classmates would be happy to tell you) that when it comes to this capstone project, I’ve been my own worst enemy. Week after week, I seemed to drag my feet across every deadline and scramble to finish every assignment. I have always believed in the idea of iNViVO and in my own ability to execute it— but each week, my fear of creating something “not good enough” usually stopped me from starting anything at all.
The supposed good advice of “failing fast” has become such a trope in startup culture recently that it has always felt to me insincere. But today, it sounds to me a lot more like good advice than it did a year ago. “Failing fast” isn’t about being reckless or haphazard. It just means putting your work (and yourself) out into the world even before you feel “ready.”
It’s the same principle as PE therapy, isn’t it? The only way to move past our fears is to confront them out in the real world. And when we do, we usually realize that the thought of something is scarier than the thing itself.
I can assure you that capstone has been a rollercoaster of emotions for all of us involved, but for me — it’s been a prolonged exposure in more ways than one. And maybe the biggest lesson that I’ve learned is one that I'll have to learn over and over again: in work and in life, perfect is the enemy of done.