Designing Better Experiences for People Facing Anxiety

Content notice: high-level discussion of depression and anxiety; description of personal experiences with OCD and anxiety  

I touched the doorknob to open the door. One time. “One isn’t even. Not good”. I touched the doorknob a second time. “Two is the same as one plus one. One isn’t even. Not good”. I touched the doorknob a third time…

It would continue, each morning, until I got too tired to count, or my knowledge of large numbers was exhausted.

Image via author, modified from public domain image [Macguy314, reworked by Perhelion].

I look back on myself then, a child with OCD, trapped in my morning ritual, turning the doorknob over and over in an endless attempt to ease my anxiety. Perhaps my childhood OCD, this obsession with even and odd, the comfort of the symmetrical and the discomfort of the asymmetrical, prompted an early interest in math, then design.

As I grew into my middle school years, I discovered that a keen interest in math, coupled with an emerging interest in design, was not exactly the path to adolescent popularity. “What do you want for Christmas?”, my grade school classmates asked. “A bookshelf, just like the one Erica Kane has on ‘As The World Turns,’” I’d respond. The confused silence in response turned quickly into disgust, then bullying. I developed social anxiety.

Little did I know that many, many years later, the primary school misfits — those picked last at kickball and cricket — would collaborate on the contents of something brilliant: the World Wide Web. Many people with social and other forms of anxiety, and other mental illnesses around the world now work together in Web technology. Creating our own culture. And yes, carrying with us our own stereotypes, our own exclusionary practices.

For me, even writing this article didn’t come without intense anxiety. Discussing mitigating anxiety through UI and UX was not my first idea, and I was afraid the one I originally submitted may have been ill-received or construed as accusatory or derogatory. I was late with my first draft because I felt that the work was not good enough: I’m stupid, why would anyone want me to write an article? Same with the second draft.

I think many of us are familiar with this internal voice. The feeling of not being good enough, the fear of public scrutiny, the constant imposter syndrome. As a user experience architect, I wonder: how can we reduce anxiety in a field that is built upon open collaboration, open communication and knowledge sharing? As more and more of our lives are played out in digital space, can we mitigate anxiety in the tools that we create and use everyday?

Reducing Negative Online Interactions

Photo CC-BY alborzshawn.

Several years ago, I had a technical question to post on Stack Overflow. I searched the site extensively to see if it had already been asked somewhere; I’d seen so many negative and critical responses to other users who unwittingly posed a previously-answered question. Eventually, I went ahead and posted… and immediately received a number of disparaging and hurtful responses in return. I deleted my Stack Overflow account, citing these responses; soon after, I received a pleasant email saying the site was aware of the issue, that they were looking into ways to make user responses more supportive. (By the way, if they are looking for contribution toward this effort, I am available and qualify for the role: I have attended workshops on active listening, and I post questions about JavaScript that are improperly categorized.)

This problem isn’t unique to Stack Overflow. Online communities with the intention of providing help can often bring scrutinizing comments if the question is not stated or categorized correctly, and when new users don’t understand community norms. Online sites typically offer guidelines around posting, but such guidelines are often verbose and can be difficult to grasp for people new to the industry or space, people who aren’t primary speakers in the site’s dominant language, people who are experiencing anxiety around not being able to solve for a problem, and much more. Potential posters therefore may quickly scan the guidelines or avoid reading them at all. The heavy level of scrutiny in these environments can can be debilitating for someone already challenged with clinical anxiety, or the anxiety associated with the challenge they’re facing.

Addressing these issues, we find some sites already working to provide industry knowledge in a more supportive and welcoming way. For example, The A11Y Project — a community site focused on web accessibility — states their three principles as “Digestable, Up-to-date, Forgiving.” These principles help provide a guideline for design decisions made across the site, and we can apply similar principles to other community platforms. For example, guides for new users may be most helpful if they are brief and use simple language and examples. In a global technology community, we can work to localize and translate our content across a number of languages. We can also implement better ways to welcome new users; it takes a lot of courage to post a basic programming question in a public forum, and we should have constructs to support this. That could include beginners sections, and enforced policies around supportive and respectful responses, such as a code of conduct that is highly visible in the user interface. We can also reward responders for answering more junior questions, and help novice users reformat answers that could be better structured. With computer science now being introduced as early as grammar school, we have a responsibility to support the next generation of the digital community.  

Mitigating User Discomfort in Anxiety-Provoking Scenarios

Photo CC-BY René C. Nielsen.

There are so many places where design intermediates stressful scenarios: joining a new community, navigating healthcare, completing documents and paperwork, or applying for a job, are just a few that come to mind. As Molly Hammar discusses in “Top 11 UX Design Principles,” in these scenarios, feelings of confusion, uncertainty and lack of control contribute to a user’s anxiety. This takes a toll on their cognitive load, reducing their task performance.

The three-click rule is a popular UX catch phrase that suggests that pages should be accessible in three clicks. But research has shown that in actuality, what makes users feel at ease is intuitive navigation and a feeling of “control and progress toward achieving tasks”. Articles like “Testing the Three-Click Rule” by Joshua Porter have shown no increased likelihood of a user abandoning a task after three clicks as opposed to 12 clicks.

Instead of a “one size fits all” approach, making a user comfortable in scenarios which may trigger anxiety is key. Empathetic UX can alleviate uncertainty by orienting users to their location on a site. Task-driven UI guides a user through a process, letting the person know where they currently are, indicating the steps that have been completed, and allowing a preview of upcoming steps. A good example is a well-designed course on an eLearning site: A course is made up of multiple lessons. As a learner progresses through the course, the UI makes it clear which lessons have been completed, the current lesson, and the next lesson or lessons in the course. This helps build the user’s confidence in their ability to make progress towards a larger goal.

Giving users more control over their experiences can also play a huge role in reducing anxiety. People with varied levels of anxiety, myself included, may have a prevalent fear of making mistakes; here, allowing the ability to review, edit and delete associated input is helpful. I.e., when posting to a forum, allow the user to edit and delete posted content. This provides users with optimal control when collaborating, and allows them to modify or retract content which they are not comfortable with in hindsight.

Many people with anxiety are very self-conscious about they way they are perceived by others and can feel a great deal of distress if they present content that doesn’t properly represent them at any given time; for example, I find great comfort in the ability to delete a retweet on Twitter. In my case, I know rationally my fears may be unfounded as I rarely tweet and have very few followers — however, curating my tweets with the delete button periodically provides a sense of organization that is calming.

As designers, we should constantly seek ways to give users a greater sense of ownership and control over the interactions they have with our products.

Conclusion

Photo CC-BY Bs0u10e0, cropped.

According to the Anxiety and Depression Association of America, “anxiety disorders are one of the most common mental health problems on college campuses. Forty million U.S. adults suffer from an anxiety disorder, and 75 percent of them experience their first episode of anxiety by age 22.” It’s also important to note that anxiety often coexists with depression: according to depression statistics from the CDC, “about 9 percent of adult Americans have feelings of hopelessness, despondency, and/or guilt that generate a diagnosis of depression.”

Anxiety and depression are complex issues. As with other complex social issues, many of us wish we could do more to help. It can be overwhelming. Being overwhelmed can lead us to apathy rather than to action. But as developers and design practitioners, we can start by thinking more about the diversity of users who touch the things we make, including those with varying levels of anxiety, depression and other mental illnesses. While it’s only one piece of a very big picture, it’s a vital step in building a more inclusive, safe and welcoming world, online and off.