The History of JoyPop

Adolescence is an extended developmental timeframe of risk and resilience – from brain growth to education completion to labour market participation. The World Health Organization defines “youth” as in the 15 to 24 year-old age group, acknowledging this as a time between reliance on caregivers and governmental shapers. Resilience is an adaptation process supporting the management of extreme stress, such as adverse childhood experiences (ACEs), as well as chronic, daily stress, such as with pandemics and disasters [1-5]. One model of posttraumatic stress highlights that: (1) traumas may reduce the positive value of activities (i.e., they need to be more intense to be experienced positively) and (2) positive experiences may co-occur chronic backdrop of tension (preferentially attentive to negatives to scan for threat or perceived danger)[6]. This calls for a need to: (1) create an easy-to-access resilience intervention that bundles multi-modal features to help regulate emotions; and (2) to orient these features towards experiencing one’s positive affect and engage in evidence-based positive activities.

In 2017, the process of developing a mobile application (app) was begun with reviewing our research findings, conducting pre-app and post-app consultations, and initiating a feasibility/pilot research study with late adolescents in their first entry of an urban university. This is further described below.

CIHRTeamSV Research Findings Review

JoyPop was developed from a cumulative research and parallel consultation approach.  A Canadian federally-funded team has, over the past five years, published epidemiological and clinical research projects investigating sex/gender differences in the linkages among ACEs, child sexual abuse, trauma, resilience and health. Collectively, these research results highlighted important constructs to carry forward into intervention: (1) trauma-informed care approach [7,8]; (2) the context of trauma-based negative emotionality (i.e., depression, anxiety, PTSD symptomatology, suicidality)[9]; (c) unmet mental health needs of male youth.  Emotion-mediated pathways emerged as key mediators for targeting in intervention[10]. Work pointed to the resilience value of developing internal assets (i.e., positive identity [11], well-being[12,13], self-compassion[14,15] and mattering[16,17] to support increased contact with positive self-mood, self-reflection and self-regulation.  Finally, technology was identified as a “good fit” with youth, across domains of assessment (e.g., icons/visuals)[18] to intervention mode (e.g., virtual reality mindfulness)[19-21]. To date, no resilience-focused mobile apps existed, despite the parallel development of resilience alongside mental health issues and daily living challenges of sub-groups of youth experiencing transitions, poly-victimization, and limited effective social supports. This developmental approach to such an app development was undertaken.

In parallel, a consultation process proceeded which informed a week-long design and discovery exercise with Clearbridge Mobile, a top-tier app development company. The pre-app consultations included male and female undergraduates and system-involved youth (child welfare and victim services), as well as adult service providers to youth victims. Over the course of a year, the app features were developed to target daily emotion regulation, via research-based approaches (e.g., deep breathing, journaling with self-compassion and resilience prompts), incorporating gaming to be more attractive to male youth. Post-app consultations included a different group male and female adolescent and young adult trauma survivors, as well as clinician-scientists working in the trauma, mental health and resilience fields. Following the completion of the first app version, two feasibility and pilot research studies were launched with more resilient sub-populations, who also experienced high stress, namely adolescents making the transition to first-year university (the current study) and young adults making the transition to social work studies (on-going).

Pre-App Consultation

Support for this phase of development was via a Canadian Institutes of Health Research, Institute of Gender and Health Team Grant (C. Wekerle).  In working together with a computer science McMaster professor and his students, university undergraduates in the computer science and health science programs participated in pre-app consultation (8 females, 3 males). This work identified mood ratings as a primary feature of interest. These youth further consulted their networks which indicated that: (1) the ability to distinguish among gradations of mood (low to sad to depressed) was too difficult, and (2) a “catch all” for negative or low mood that is difficult to label be available. Consequently, JoyPop has four possible moods, focusing on happy, and if that is low, then sad, angry and “meh” is available. Further, youth from a large urban centre’s police victim services who completed a leadership training program were consulted (8 females, 1 male) on apps that they enjoy and features they would like to see. Youth identified journaling as a valuable activity and having a calendar to support a diary-like function. Youth concurred with the value of mood and especially endorsed a positive mood and activity focus. Arts engagement was identified as a positive coping strategy for youth. Privacy and safety were emphasized as important considerations.

Social workers, helpline counsellors and other healthcare clinicians, as well as an inter-disciplinary child maltreatment specialty clinic team (14 females, 3 males) provided input into youth resilience needs and app feature consideration fit with youth with trauma backgrounds and experiencing mental health challenges. Privacy and safety were key considerations, with support for including 24/7 help or crisis lines.

Post-App Consultation

Support for this phase was funded through a corporate donation (C. Wekerle) and working with youth from diverse communities. Indigenous and former foster care youth (7 females, 4 males) provided review of the app in demonstration and discussion.  Uniformly, positive feedback for all features of the app and the user experience was provided.

The app has been presented to various agencies, including in the areas of child welfare, bullying prevention, education, Indigenous mental health and wellness, public health policy, environment and health and, internationally, to clinician-scientist groups.  At the CIHR Idea Fair, technology as an education for health was presented; the resilience app.

On-going JoyPop Development

From a Canadian Institutes of Health Research, Institute of Indigenous People’s Health, we are conducting research in partnership with Six Nations of the Grand River to adapt JoyPop to an Indigenous culturally-relevant version. This will include a water-based “ease-to-sleep” feature.

We are currently engaging to translate JoyPop to French.

A US JoyPop study is led by Dr. Ashwini Tiwari, a form CIHRTeamSV member.

Our future goals will be to develop an Android version, as JoyPop is currently only iOS.

Interested in conducting a JoyPop research study?

Contact please Dr. Christine Wekerle at wekerc@mcmaster.ca.

References

[1] Drawson, A. S., Houlding, C., Braunberger, P., Sawula, E., Wekerle, C., & Mushquash, C. J. (2016). Violence and Resilience: A Scoping Review of Treatment of Mental Health Problems for Indigenous Youth. International Journal of Child and Adolescent Resilience, 4(1), 48-63. Retrieved from: https://www.ijcar-rirea.ca/index.php/ijcar-rirea/article/view/197

[2] Supkoff, L. M., Puig, J., & Sroufe, L. A. (2012). Situating resilience in developmental context. In The social ecology of resilience (pp. 127-142). Springer, New York, NY.

[3] Snowshoe, A., Crooks, C. V., Tremblay, P. F., Craig, W. M., & Hinson, R. E. (2015). Development of a Cultural Connectedness Scale for First Nations youth. Psychological Assessment, 27(1), 249. Retrieved from: https://psycnet.apa.org/buy/2014-37944-001

[4] Wekerle, C., Waechter, R. L., Leung, E., & Leonard, M. (2007). Adolescence: A window of opportunity for positive change in mental health. First Peoples Child & Family Review, 3(2), 8-16. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.824.9793&rep=rep1&type=pdf#:~:text=Adolescence%20is%20a%20window%20of,past%20pat%2D%20terns%20of%20behaving

[5] Wekerle, C., Vakili, N., Stewart, S. H., & Black, T. (2018). The utility of Twitter as a tool for increasing reach of research on sexual violence. Child Abuse & Neglect, 85, 220-228. Doi: 10.1016/j.chiabu.2018.04.019

[6] Frewen, P. A., Dozois, D. J., & Lanius, R. A. (2012). Assessment of anhedonia in psychological trauma: psychometric and neuroimaging perspectives. European Journal of Psychotraumatology, 3(1), 8587. Doi: 10.3402/ejpt.v3i0.8587

[7] McTavish, J. R., Sverdlichenko, I., MacMillan, H. L., & Wekerle, C. (2019). Child sexual abuse, disclosure and PTSD: A systematic and critical review. Child Abuse & Neglect, 92, 196-208. Doi: 10.1016/j.chiabu.2019.04.006

[8] Bargeman, M., Smith, S., & Wekerle, C. (2020). Trauma-informed care as a rights-based “standard of care”: A critical review. Child Abuse & Neglect. Manuscript under review.

[9] Daigneault, I., Esposito, T., Bourgeois, C., Hébert, M., Delaye, A., & Frappier, J. Y. (2017). Health service use of sexually abused adolescents aging out of care: A Matched-cohort study. International Journal of Child and Adolescent Resilience, 5(1), 53-66. Retrieved from: https://www.mcgill.ca/crcf/files/crcf/daigneault-esposito-bourgeois-hebert-delaye-frappier-2018_ijcar_transition.pdf

[10] Park, T., Thompson, K., Wekerle, C., Al‐Hamdani, M., Smith, S., Hudson, A., … & Stewart, S. H. (2019). Posttraumatic stress symptoms and coping motives mediate the association between childhood maltreatment and alcohol problems. Journal of Traumatic Stress, 32(6), 918-926. Doi: 10.1002/jts.22467

[11] Bell, T., Romano, E., & Flynn, R. J. (2015). Profiles and predictors of behavioral resilience among children in child welfare. Child Abuse & Neglect, 48, 92-103. Doi: 10.1016/j.chiabu.2015.04.018

[12] Sanders, J., Munford, R., Thimasarn-Anwar, T., Liebenberg, L., & Ungar, M. (2015). The role of positive youth development practices in building resilience and enhancing wellbeing for at-risk youth. Child Abuse & Neglect, 42(1), 40-53. Doi: 10.1016/jchiabu.2015.02.006

[13] Dubé, S., Lavoie, F., Blais, M., & Hébert, M. (2017). Psychological well-being as a predictor of casual sex relationships and experiences among adolescents: A short-term prospective study. Archives of sexual behavior, 46(6), 1807-1818. Doi: 10.1007/s10508-016-0914-0

[14] Strickland, N. J., Wekerle, C., Kehayes, I. L., Thompson, K., Dobson, K., & Stewart, S. H. (2019). Self-Compassion as a Compensatory Resilience Factor for the Negative Emotional Outcomes of Alcohol-Involved Sexual Assault among Undergraduates. International Journal of Child and Adolescent Resilience, 6(1), 52-69. Retrieved from: https://www.ijcar-rirea.ca/index.php/ijcar-rirea/article/view/105

[15] Tanaka, M., Wekerle, C., Schmuck, M. L., Paglia-Boak, A., & MAP Research Team. (2011). The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents. Child Abuse & Neglect, 35(10), 887-898. Doi: 10.1016/j.chiabu.2011.07.003

[16] Flett, G. L., Flett, A. L., & Wekerle, C. (2015). A conceptual analysis of interpersonal resilience as a key resilience domain: Understanding the ability to overcome child sexual abuse and other adverse interpersonal contexts. International Journal of Child and Adolescent Resilience, 3(1), 4-33. Retreived from: https://www.ijcar-rirea.ca/index.php/ijcar-rirea/article/view/173

[17] Flett, G. L., Su, C., Ma, L., & Guo, L. (2016). Mattering as a unique resilience factor in Chinese children: A comparative analysis of predictors of depression. International Journal of Child and Adolescent Resilience, 4(1), 91-102. Retrieved from: https://www.ijcar-rirea.ca/index.php/ijcar-rirea/article/view/205

[18] Blander, E., & Saewyc, E. M. (2015). Adolecent reactions to icon-driven response modes in a tablet based health screening tool. Computers, informatics, Nursing, 33(5), 181. Doi: 10.1097/CIN.0000000000000145

[19] Mistry, D., Zhu, J., Tremblay, P., Wekerle, C., Lanius, R., Jetly, R., & Frewen, P. (2020). Meditating in virtual reality: Proof-of-concept intervention for posttraumatic stress. Psychological Trauma: Theory, Research, Practice, and Policy. Accepted manuscript. In press.

[20] Frewen, P., Mistry, D., Zhu, J., Kielt, T., Wekerle, C., Lanius, R. A., & Jetly, R. (2020). Proof of concept of an eclectic, integrative therapeutic approach to mental health and well-being through virtual reality. Frontiers in Psychology, 11, 858. Doi: 10.3389/fpsyg.2020.00858

[21] Zhu, J., Wekerle, C., Lanius, R. & Frewen, P. (2019). Trauma- and Stressor-related History and Symptoms Predict Distress Experienced During a Brief Mindfulness Meditation Sitting: Moving Toward Trauma-Informed Care in Mindfulness-based Therapy, to Mindfulness. Mindfulness, 10, 1985-1996. Doi: 10.1007/s12671-019-01173-z