BackgroundRecent research has highlighted naturalistic uptake as a key barrier to maximizing the impact of mental health technologies. Although there is increasing evidence regarding the efficacy of digital interventions for mental health, as demonstrated through randomized controlled trials, there is also evidence that technologies do not succeed as expected when deployed in real-world settings.ObjectiveThis paper describes the naturalistic deployment of Pesky gNATs, a computer game designed to support cognitive behavioral therapy (CBT) for children experiencing anxiety or low mood. The objective of this deployment study was to identify how therapists use Pesky gNATs in real-world settings and to discover positive and negative factors. On the basis of this, we aimed to derive generalizable recommendations for the development of mental health technologies that can have greater impact in real-world settings.MethodsPesky gNATs has been made available through a not-for-profit organization. After 18 months of use, we collected usage and user experience data from therapists who used the game. Data were collected through an online survey and semistructured interviews addressing the expectations and experiences of both therapists and young people. Thematic analysis was used to identify key themes in the interview and survey data.ResultsA total of 21 therapists, who used Pesky gNATs with 95 young people, completed the online survey. Furthermore, 5 therapists participated in the follow-up interview. Confirming previous assessments, data suggest that the game can be helpful in delivering therapy and that young people generally liked the approach. Therapists shared diverse opinions regarding the young people for whom they deemed the game appropriate. The following 3 themes were identified: (1) stages of use, (2) impact on the delivery of therapy, and (3) customization. We discuss therapists’ reflections on the game with regard to their work practices and consider the question of customization, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model.ConclusionsThis study provides further evidence that therapeutic games can support the delivery of CBT for young people in real-world settings. It also shows that deployment studies can provide a valuable means of understanding how technologies integrate with the overall mental health ecosystem and become a part of therapists' toolbox. Variability in use should be expected in real-world settings. Effective training, support for therapist autonomy, careful consideration of different approaches to customization, the reporting of deployment data, and support for communities of practice can play an important role in supporting variable, but effective, use.

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Summary:We investigate the visual distraction of drivers when they use an augmented reality (AR) device (HoloLens) for video calling while driving. The work is motivated by the advent of novel AR technology and by research on context sharing between callers. Both suggest that AR might soon be appropriated for 2-way video calling in cars, yet little is known on how distracting this is to the driver. Our participants drove in a simulator while engaged in a Skype conversation. We compared a condition with a video presentation (through AR), and a speech-only condition. We found that participants hardly looked at the video, perhaps because it was not visible from peripheral vision without making a head movement. In this way, HoloLens was less distracting visually than a monitor display used in earlier work. Although less distraction is desirable, using HoloLens also has a drawback: when drivers did look at the video they had to turn their head away from the road to look to the right, and down. The work makes suggestions on how to further study the safety and other issues of this new technology.

We report on an experiment on the distracting effects of in-car conversations through augmented-reality glasses. Previous research showed that in-car phone conversations can be distracting, but that the distraction might be reduced if the remote caller receives visual information about the driving context. However, what happens if such video sharing becomes bidirectional? The recent introduction of commercial augmented-reality glasses in particular might allow drivers to engage in video-supported conversations while driving. We investigate how distracting such video-based conversations are in an experiment. Our participants operated a simulated vehicle, while also playing a conversational game (Taboo) with a remote conversant. The driver either only heard the remote conversant (speech-only condition), or was also able to see the remote person in a virtual window that was presented through augmented reality (video call condition). Results show that our participants did not spend time looking at the video of the remote conversant. We hypothesize that this was due to the fact that in our experiment participants had to turn their head to get a full view of the virtual window. Our results imply that we need further studies on the effects of augmented reality on the visual attention of the driver, before the technology is used on the road.