UX CASE STUDY
EFFECTIVELY
The DBT App
EFFECTIVELY: The DBT App
A conceptual therapy tracker designed for precision planning and deep learning in support of professional and self-directed DBT:
DIALECTICAL BEHAVIOUR THERAPY
Tools & Platforms
Figma
Figjam
Adobe Illustrator
Introduction
What is DBT?
DBT is a practice-based behavioural therapy that helps clients develop skills for improving the regulation of intense emotion.
Areas of Focus In DBT
1
Mindfulness
Practice
- Practicing mindful awareness of the present moment
- Finding intuitive balance between reasonable mind and emotion mind, referred to as wise mind
2
Interpersonal
Effectiveness
- Skills for pursuing, maintaining or ending relationships
- Establishing healthy boundaries
- Processes for validating the self and others
3
Emotion
Regulation
- Skills for regulating emotion by reinforcing structured, habits
- Increasing emotional self-awareness and planning ahead for nervous system regulation
4
Distress
Tolerance
- Skills for surviving emotional crisis after exiting the window of tolerance physiologically
- Minimizing risk of harm to the self or to relationships during episodes of intense negative emotion
Problem Definition
The therapy is dense, requiring a significant amount of commitment to reviewing lessons and documenting practice outside of therapy.
Solution
A mobile therapy tracker which allows users to:
(1) access the therapy manual
(2) review and document practice of therapy skills
(3) set important reminders to keep on top of therapy, given its complexity and density
(4) triage difficult emotions in order to find the best skills to use in the moment
Create customizable cards for each week of study; add elements to the card (handouts, worksheets, notes, images, media links)
Make use of the built-in calendar and sync with popular calendar apps to keep track of upcoming sessions and therapy tasks
Access a mobile-friendly therapy manual, create instances of handouts and worksheets, and set custom reminders
My DBT Experience
What I was Responsible For as a Participant
- Attending weekly group sessions for 6 months
- Reviewing lessons (referred to as handouts) and documenting my practice of the skills using structured journaling pages (referred to as worksheets), outside of therapy
- Completing mood assessments and feedback forms before and after each session
Challenges I encountered
1
INTERFERING FACTORS included:
Inconvenience of the paper binder format
Forgetfulness and resistance to scheduling time in the day for review and practice
Fears of failure and doubts about therapy efficacy; “Am I doing this right? Is this really going to work for me?“
Avoidance due to the challenging nature of emotional self-reflection; emotions attached to some memories or recurring events can be painful to re-live or examine closely
2
PRACTICAL CHALLENGES included often being physically preoccupied with things like work, errands, socializing or physical activity.
Adaptations I Adopted
1
DIGITAL/MOBILE TRANSCRIPTION using Google Drive/Docs; this strategy was somewhat effective, but I was inconsistent in my implementation of the strategy
2
PODCASTS helped me review skills and reinforced my learning; they also became a jumping-off point for learning about the broader therapy ecosystem
What If I had A Mobile App To Help Me Document My Practice & Stay Accountable?
Competitive Analysis of Existing Solutions
✅
Rich with material and the opportunity to engage with community
✅
Experts agreed it is worth the price to learn DBT
💔
Cost of premium was off-putting to some users
💔
Trust was broken due to issues with content quality and an under-responsive developer
✅
100% free to use
✅
Contains some useful (but basic) information
💔
Lacks the necessary dimension for deeper learning and documentation
💔
Clunky features and language accessibility issues
Literature Review
Podcast: Expert Analysis
Text:
[Licensed Therapists] Kate and Michelle review four free DBT apps: DBT Coach, DBT Travel Guide, DBT Trivia and Quiz, and Simple DBT Skills Diary Card. For each app, they provide an overview of its features and discuss what they each liked and disliked about it.
Early Concepts
The scrollable Timeline would enable users to document their practice and lesson review using a system of Cards and Elements placed in sequence.
The app would provide high-quality, immersive mindfulness meditations.
The Meta-Narrative is a feature conceptualizing the use of generative-AI to provide a form of robo-therapy.
A precisely trained LLM (Large Language Model) would be leveraged to help users draft an ongoing, interactive narrative journal of their experiences.
The user would be prompted to journal about real life situations and outcomes of skill usage, which would allow the generative model to provide further insight and suggest skills to use in the future based on contextual clues provided by the user in the journaling process.
Are Therapy Apps Effective?
Investigating Efficacy of Mobile Therapy Apps To Validate The Business Case
Literature REview
Reviewing literature helped me validate a business case, as well as discover and establish several heuristic benchmarks for effective therapy apps.
Some qualities of high-efficacy apps include:
- Simple UI to reduce cognitive load
- Usage reminders
- Real-time engagement
Getting to Know Potential Users
How do graduates of DBT programs practice skills today?
Using Generative-AI to DRaft Interview Questions
I experimented with generative-AI to help me design the interview questions and structure.
I reviewed and edited the generative outputs, assessing for ethical rigor:
- Do any of the questions infringe upon the rights of interviewees?
- Are they appropriate to ask?
- Is there a risk of harm to participants baked into any of the suggestions?
Informed Consent
I researched and drafted consent forms for participants to review before interviews took place. I made sure that participants were aware of:
- The nature of the subject matter being discusse
- The fact that they could end the interview and withdraw the consent to their data at any time during or after the interview
- The fact that they had full autonomy over what was shared, as well as the right to refuse answering questions they did not want to answer
User Interviews
I asked users:
- If they could recall the four main areas of focus or “chapters” of the manual:
- (i) mindfulness practice
- (ii) interpersonal effectiveness
- (iii) emotion regulation
- (iv) distress tolerance;
- To name the skills they could recall by memory alone;
- To describe their process for managing episodes of intense emotion (or an emotional crisis), by their own definition.
Creating User Personas
I developed fictionalized user personas from real data gathered during user interviews to create realistic portraits while also maintaining anonymity of research participants.
Journey Mapping: How Does AN Informed User Access skills without an App?
I created a journey map exploring the process of accessing DBT skills once a user has finished a therapy program.
I based the journey map on experiences described by a research participant, and anonymized it under the user persona, Neev.
I broke the journey down into phases I refer to as Discovery, Understanding and Implementation.
Journey Mapping: Identifying User Pain Points
I recognized several pain points in this journey map:
💥
Resource Gathering
Accessing the DBT Manual and the library of available skills was a multi-step process requiring strategic thinking
💥
Interpreting Information
Discovering precisely which skills to use in a given scenario consumed time and cognitive resources
💥
High Cognitive & Emotional Load
The process overall used up a significant amount of available cognitive and emotional resources. It even required refilling the user’s internal battery using food and rest
How do we know what skills to use and when?
Common Challenge: Difficulty recalling skills
Common across in-depth interviews with DBT grads was a difficulty recalling many of the skills without referring to the manual or another resource such as a search engine.
Hypothesis
- Clients of DBT are less likely to recall/use complex skills during an acute crisis due to an inhibited capacity to think strategically;
- Physiologically in these scenarios, the limbic system is actively taking resources from the frontal lobe, which reduces an individual’s capacity for planning and processing using higher-order executive functioning.
Proposal
- Different situations call for different skills. For example, the skills in the distress tolerance module are specifically designed for when clients have exited the window of tolerance for managing an acute episode of intense negative emotion.
- However, the specific distress tolerance skill will change depending on the nature of the crisis, or the root emotions defining the experience.
- If we can help users triage the nature, as well as the intensity of the episode, we may be able to help them access precise set of skills for the given scenario in realtime.
Feature Audit:
Crisis Triage From
DBT Travel Guide
The DBT Travel Guide app includes a feature of this nature.
Heuristic Evaluations
Documenting and evaluating qualities of interaction, hierarchy, visual design and accessibility.
Visually mapping a specified emotion (sadness) to its skill suggestions, grouped by therapy module; examining which therapy modules are referenced, and considering what other skills could be suggested.
Pros ✅
✅
Simplified skill sheets with approachable language
✅
Easy and fast; low barrier for accessing skill suggestions with relevancy to an emotion of a specific nature
Cons 💔
💔
Lacks true experiential depth
💔
Visual design issues: text sizes, visual hierarchy, colour contrasts
💔
UI redundancies: some buttons responsible for determining the severity of the crisis lack purpose, lead user to dead ends
💔
Lacks in the ability to document usage or provide feedback to users; fails to pursue useful follow-up engagement
Designing
A Revised Crisis Triage Feature
Research
Analysing the DBT Manual
- I searched the manual using key terms: ‘crisis’, named-emotions (sadness, anger, shame, etc.)
- I earmarked the relevant handouts and worksheets
Reviewing Academic Literature & Diagnostic Texts
- I reviewed literature to find commonalities across different mental health conditions and symptom profiles where DBT will either commonly or possibly be prescribed.
Summarizing Research
- I summarized research into categories and subcategories of common difficult emotional experiences and intensity of the experience.
- I selected an initial emotion—anger—to delve into more deeply for the purpose of prototyping the revised feature.
Sketchnoting & Mind Mapping
Mindmap: Starting from a How might we… statement
Mindmap: Questions and possible solutions
Ideas: How might we help users access the DBT Manual and/or skill suggestions?
Idea: Use an AI-powered platform or tool
Idea: Consult with a professional
Idea: Consult DBT Manual
Ideas: Define the nature and intensity of the crisis using a questionnaire and filtering system
Wireframe & Mindmap: Exploring the triaging format/flow
Mindmap: Triaging anger using non-clinical language; connecting scenarios with relevant skills
Mindmap: Qualities of anger, processes and visual metaphors
Prototyping Flow:
Triaging the Intensity of The Emotion
Once the user has selected the core emotion, they report its intensity.
After reporting intensity of the given emotion, the user is provided with relevant skill suggestions.
User Flow: After selecting the emotion at the core of the crisis, the user determines the intensity;
A brief introduction reveals the nature of the incoming skills:
(i) survive the crisis immediately
(ii) manage the crisis using some problem-solving skills
(iii) understand and problem-solve the emotion or situation with more nuance
Improving the UX of DBT Travel Guide's Crisis Triage
🌟
UX Improvement #1
Using non-clinical language; this is a quality of high-efficacy mental health apps indicated by the literature
🌟
UX Improvement #2
Replacing the GREEN>ORANGE>RED button hierarchy with a YELLOW>ORANGE>RED hierarchy to:
- Signal the heightening intensity of emotion, and
- Replace the redundant green button interaction (which currently leads users away from the skills) with a more meaningful interaction that prioritizes further engagement with skills.
🌟
UX Improvment #3
Offering the user a more precise set of skill suggestions dependent on the reported intensity of the emotion, rather than a exhaustive list.
Feature Prototypes
Design System
Typography
Placeholder text
Colour
Placeholder text
Layout
Placeholder text
Iconography
Placeholder text
Components
Placeholder text
Variables & Styles
Placeholder text
Home Screen
Timeline, Cards & Elements
High-Fidelity Wireframe: V1.0
Frame 1: Create a Card to be placed in sequence on the Timeline
Frame 2: Add Elements to Card
Frame 3: Search for a Handout in the Add Handout menu
Frame 4: Organize the Elements present on the Card with Tap/Hold and Drag/Drop interactions
Frame 5: Elements of the Card are compacted, with the Media tab open/expressed; a linked podcast is playable in-app
Figma screens are accompanied by narrated walkthrough of interactions and menu flow
DBT Manual: Handouts & Worksheets
High-Fidelity Wireframe: Example Handout
The DBT Manual Handouts and Worksheets are accurately transcribed from the source material and optimized for mobile interaction, so that users can effectively go paperless if they so choose, and can follow along in a structured DBT program using the app alone.
Other DBT apps either condense or paraphrase the skills, which turns app usage into more of a supplementary activity rather than a trusted companion tool to structured therapy.
Users will have the option to download simplified PDFs of completed or blank worksheets in letter size for printing or optimized desktop viewing.
Calendar & Reminders
Final Prototype
Explore the ongoing prototype in Figma
© Copyright. Matthew Crans. 2025.