As an undergraduate student and field hockey player at Stanford University, academic and athletic success felt like forces that dominated Elise Ogle’s life. Those pressures took a toll, one that was difficult to recognize at the time:
“You can see the first-hand effects of that [pressure] on mental health when you don’t get the support you need, or just understand enough about your own mental health to be able to recognize when you’re slipping,” she says.
The 28-year-old San Jose resident, now Head of Content at Limbix, says she struggled with depression throughout college and was hospitalized. Not long after, her close friend and roommate committed suicide. “That was a really big turning point in my own mental health journey,” Elise says. It became more apparent that so many people are experiencing mental health challenges. Simply knowing where to start finding help — not to mention navigating a labyrinth of insurance logistics and red tape — could feel daunting for anyone, let alone those in crisis.
Elise, who studied communication and psychology, began thinking differently about what brought her meaning in life. She also began working in a lab, helping researchers explore the effects of new media on psychology and behavior. She stayed at Stanford to pursue her master’s degree and work in the Virtual Human Interaction Lab, studying the effects of virtual experiences on empathy.
Though her roots were in research, Elise found herself drawn to the narrative aspect of her work: “creating these stories, telling these stories, and being able to see this thing in my imagination actually come to fruition,” as she puts it. But beyond advancing research, Elise wanted to apply technological innovations in real life.
So she searched for a company that could marry her academic interests and passion for mental health. She found that sweet spot in Limbix in 2018; today, Elise creates content for the digital prescription therapeutic, Spark. She also coaches field hockey for teenagers and college club teams, describing her mission on the field and at Limbix as two sides of the same coin: motivating teenagers to work hard, develop skills, and experience a sense of mastery.
We sat down with Elise to learn more about her approach to content creation and the steps required to bring clinically effective copy to a smartphone screen. Our conversation has been edited for length and clarity.
The first challenge is access: being able to get help when you need it, and even the basic understanding of what the appropriate help is. There’s still a lot of stigma around mental health. Certainly when I was growing up, it was never something we learned about. Understanding more about your own mental health can help people understand when it’s time to access a different level of care, and even to know what to do to take that first step.
Another challenge is how to navigate the mental healthcare system. I looked for a therapist after quarantine started, and holy moly — it was really difficult, as an adult. I can only imagine how much harder it would be for someone who doesn’t have the support that I have.
Then I think there’s a gap in support as far as empathy goes. It’s hard to get to the point where you recognize that you need help, and even harder to convey that to someone. Whether you’re reaching out to a friend or family member, or your primary care provider, or to a therapist — making that first initial contact is really difficult when you’re experiencing emotional distress. It’s important that people are met with support and validation right away, and that their feelings are not dismissed. Everyone is living a different story and has a range of emotions as they seek care. It’s important to meet people where they are.
Definitely my personal experiences with mental health and coaching. My husband is a full-time youth coach, and, observing his interactions with the kids he coaches, you can directly see the benefits of having someone in your life that gives you support. I’ve seen all types of kids, and different types of parents and support systems around each kid. With that high-level understanding of what some people have that other people don’t, I see how important it is to have someone step in when you need it. It’s energizing to be able to be that for someone, and to work on a technology that can hopefully make that accessible for many different types of people. It’s also energizing, in the day-to-day sense, to talk with teens through co-design or feedback sessions. They are the reason that we do what we do.
There’s a lot of different stakeholders in the creation process of the prescription digital therapeutic, beyond just the people who do the writing, like myself. There’s product design and user interaction with that product. Other important pieces are safety and clinical efficacy — making sure that we create something engaging and that teens want to use, but also making sure everything in the app is evidence-based. Then there’s another element, running clinical trials, with specific considerations for clinical trials for a medical device.
It’s challenging to create content that meets so many different stakeholders’ expectations of what that content should look like. And to know that teenagers experiencing depression, a vulnerable population, are going to be interacting with our vision for the product. This is a relatively new space. It’s not like we could fit a cookie-cutter mold of a traditional company. But the fact that we’re pioneers is exciting.
My role at Limbix is to work with subject matter experts in adolescent psychology, take their research protocols and translate them into a mobile app that’s engaging for teens. I make sure that anything someone sees in the app is valid — that if you were going to face-to-face therapy, your therapist would be teaching you these principles. From a higher level, my role is to help teens feel empowered through the program to understand their depression and manage their symptoms.
I’m excited to create a tool that I wish had existed for me when I was a teen. That’s my philosophy generally, when I’m coaching as well: I exist as a coach to teach things beyond field hockey — guidance that I wish I had learned and gotten when I was their age. With access to that kind of support, people can grow so much faster. They can fail, too, but in a safer way.
That depends on where we are in our process. We have different phases of planning, building, and testing. Right now we’re in a building, or creating, phase. We have morning meetings to sync with members of our product team, iron out logistics and make sure we have the tools we need. Then it’s time to dive into the content creation process. I work closely with our product designer to build content, which means the copy, illustrations, and interactions that users will consume on the screen. We use software that allows us to collaborate on prototypes virtually.
To avoid long screens of text, we try to incorporate different ways to interact with the content so it’s more engaging. For example, there might be a task where the user learns about something, but receives reinforcement by dragging and dropping the right things in the right order. Another part of my job is conceptualizing illustrations and short animations used to augment the text. We want to use art as a tool to better teach something and recognize that people consume information differently.
We start with looking at existing protocols for teaching behavioral activation — especially those geared toward adolescents, which have different nuances than adult protocols. Then we pull out the most important user needs for that protocol. Let’s say we were focusing on one element of activation, like problem-solving. I would focus on the protocols that have taught problem-solving, and from there, identify high-level points the content must include.
Some team members with PhDs serve as our internal experts, but we also work closely with psychologists at the National Mental Health Innovation Center. I’d talk to them about user needs that we’ve identified, our vision for the outcome and the outline of this particular part of the program. We then iterate on it until everyone feels like the content teaches the most important points to the user.
From there, I get into fleshing out the outline — actual words the user will see. I work with our product designer, who adds those interactive elements I talked about. We create individual tasks that will appear in the app — step one for problem solving, step two for problem solving, which make up the path the user goes through. From there, we keep iterating until we have a working prototype — a series of screens with either placeholder illustrations or ones I’ve mocked up.
We go back to our subject matter experts to get feedback on what we’ve created and to make sure everything is clinically valid. We also get their thoughts from a provider’s perspective, to see if they have different ideas for interactions that could take place that might achieve better aims.
We have a couple of ways in which teens can give feedback and get involved in the creation process. One of those avenues is joining us for user research. We have a UX researcher who organizes teens that have experienced or are experiencing depression to share thoughts and feedback on upcoming content, designs or product features. We do general feedback sessions with concept testing.
There are also avenues where teens can participate in what are called co-design sessions, which includes more design-type activities. We talk about the goals of what we’re trying to accomplish, and teens help us conceptualize different interactive elements or content they feel would be relevant.
Then we also have teens who enroll in our clinical trials. If they’d like to, they can join us after for more feedback sessions to talk about their own specific experience using the app. They can discuss areas they thought could use improvement or that they really liked.
It comes back to talking to teens and hearing their feedback, especially those participated in our clinical trials. What’s also really cool is working with such an interdisciplinary team. We have engineers, we have designers, we have researchers — all of these smart people who work really hard and are putting all of that energy and effort into building something that’s going to help people.
I find hope in the meaning behind what we’re doing — bringing it back to that user. I could have been that user, or my friend could have been that user. I’m always remembering our mission.
If you’re interested in learning more about Limbix and our ongoing trials, visit limbix.com.