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- All Subjects: Creative Project
- All Subjects: Mindfulness
- Status: Published
According to a survey performed by Pew Research in 2014, 40% of Internet users have experienced online harassment. 18% had experienced severe harassment – stalking, sexual harassment, physical threats – while 22% had only experienced less severe harassment, such as name-calling. Women ages 18–24 receive a disproportionately large percentage of all severe online harassment. The emotional trauma suffered from severe or long-term harassment can lead to (and has led to) fear, depression, and suicide in the worst cases.
The anonymity of the Internet partially enables online harassment, since it allows perpetrators to hide behind usernames or false images while they harass others — there is little accountability. However, 66% of online harassment happens on social media platforms, where people's names and images are usually readily available. This indicates that anonymity is not the only factor, and not even the main factor. Rather, the separation of the Internet from the physical world, that which makes it less "real," is what enables harassers to treat it as entirely different experience. They can say across a keyboard what they might never say face-to-face.
To increase my understanding of the problem, I made two three-dimensional pieces – a functioning clock and an exhibit wall. Each project explored different aspects of online harassment and implored the audience to keep compassion and kindness in mind while interacting with others digitally.
Another goal was to create a campaign which could tackle the problem on a larger, more definite scale. To learn from others' attempts, I studied two recent, real-world campaigns against online harassment, Zero Trollerance and HeartMob. Each of these received significant amounts of good press on online news outlets, but people who enjoyed or were helped by those campaigns were grossly outnumbered by those who criticized and even lambasted those campaigns, for various reasons.
I determined that the reactive nature of those campaigns was the main cause of their failure, so I created a proactive campaign with the goal of preventing online harassment, rather than correcting it. I designed the beginnings of "You & I," a multiplayer online game for children ages 4–6, which would encourage positive interaction between players through its very game mechanics. Ideally, the habits formed by the children while playing this game would carry over to their future Internet experiences, and a new generation of kinder, more cooperative, "native" Internet users would arise, reducing the amount of harassment seen on the Internet.
Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The associated practice challenges have led to the following PICOT question. In persons with mental health issues receiving care at an outpatient mental health clinic, does engaging in mindfulness practice versus no mindfulness practice change polypharmacy use over a 3-month period?
The project purpose was to evaluate the effectiveness of Insight Timer mobile mindfulness app at helping patients self-manage distressing symptoms and reduce polypharmacy. Over three weeks, mental health clinic nurse practitioners (NPs) voluntarily recruited patients (n=12) over age 18 using as needed prescriptions (PRNs), and agreed to use Insight Timer mobile mindfulness app for adjunct symptom management. Consenting participants downloaded the mobile app, and completed a brief questionnaire measuring PRN use at the start of app use, and PRN use at their next visit. A Wilcoxon signed-rank test indicated a 10-week mindfulness app trial did not significantly lower total PRN doses compared with pre-app dosing (Z = -.534, p = .593). Paired t-tests revealed no significant change in pre (M = 65.17, SD = 28.64) versus post (M = 67.75, SD = 20.22) OQ45 life functionality results (t(11) = -.420, p = .683) (d = .121) as a result of app use.
Clinically relevant results illustrated 83.33% of participants taking greater than nine PRN doses over the study period used the app six times or more in place of medication. High PRN users employed the app frequently in place of medication regardless of total PRN doses taken. Practice implications and sustainability recommendations include incorporating mobile app use in treatment plans for high PRN users and educating NP’s on the tangible benefits of mindfulness apps in reducing polypharmacy and easing symptom distress on an ongoing basis.
Keywords: mindfulness, mhealth, mobile apps, mobile smart phone, online, RCT, behavior change, polypharmacy.