Postphenomenological Insights from an In-the-Wild Collective Sensing System Deployment for PTSD Therapy

Treatments like Cognitive Behavioral Therapy (CBT) have high clinical efficacy for a variety of mental health disorders. Their effectiveness, however, is often limited by low patient engagement with clinical homework. Novel technologies are accordingly being integrated into clinical mental health workflows, but this is a delicate endeavor and studies of in-the-wild clinical deployments remain rare in the CSCW and HCI communities. Lab-based and theoretical design studies are valuable first steps toward integration, but they struggle to disambiguate the real-world impacts of novel technologies on ecologically sensitive clinical environments as the relationships between human actors and technologies are co-constituted. We developed a collective sensing system meant to help contextualize patient homework exercises within a two-week CBT intensive outpatient program (IOP) for PTSD. We then conducted an in-the-wild field deployment study involving 20 patients and 10 clinicians over 15 months. The system received strong performance ratings for usefulness, usability, and preliminary efficacy, and, in interviews, patients and clinicians reported that it facilitated collaborative clinical homework review and accountability throughout the therapy process. We also found four themes related to its unexpected real-world impacts on CBT practice surrounding emotional processing, patient agency, accountability, and contextual trust. Given the observed complexity of relationships developed between patients, clinicians, and the collective sensing system, we ultimately draw from the philosophical tradition of postphenomenology and conduct a “variational cross-examination” of our findings to discuss implications for future deployments. Our work highlights the importance of clinical deployments and the subsequent value of postphenomenological analysis to the CSCW and HCI communities.