Evokation - let's create our way to greater mental health.

1. The Place. Where will you make a difference? Describe the institution, community, town or other geographic or virtual space in which you will focus your efforts.

Los Angeles. It's one of the largest cities in the world, with numerous large-city problems. There are myriad racial tensions, a long history of police problems. The city has historically attracted runaway children from around the nation. The local Catholic bishop was directly implicated in
covering up sexual abuse. And alongside these problems, there are many institutions and individuals committed to finding solutions. Between UCLA, USC, Cedars-Sinai Hospital, and the Los Angeles Veterans Hospital, the city has a large population of creative and committed
individuals.

I intend to develop and test my product here. Once finished, however, it can be used anywhere.

Fully complete, it will be most useful wherever social tensions are highest. Wherever in-group/out-group tensions make direct dialog most difficult, this product will still have the potential to greatly improve people's lives.

2. The Challenge. What will you aim to change, and for whom? Highlight what is the need that you perceive and who will benefit from this change.

Over the last decade, a number of tools have been developed to help people monitor and improve their mental health. These tools are being refined daily, and our understanding of how they work neurobiologically increases almost by the hour. But many people lack access to these tools. The
consequences are huge. Psychological problems unaddressed become physical problems. Where people who need psychological help are obliged to care for others (elderly or young family members, spouses, etc.) emotional or physical abuse can result. Subsequent mental, emotional, and physical problems can cascade, affecting wh*** families and communities.

Where psychological problems are traumatic, stemming from breaches of trust, the provision of help is especially difficult. Historically, care-givers for these problems have been difficult to train. People who are responding to abuses of trust, when they go into therapy, often find themselves accused: of "manipulation," of "attempting to sabotage the therapeutic relationship," etc. The danger trauma victims face in being re-traumatized in therapy is high. And this is in the rare and
fortunate case where help is available!

Very often, no assistance is available at all.

3. The Idea. Your solution – what is the action, product, service, project, change that you will initiate? Tell us how will your idea will
succeed where others have failed.

I intend to provide therapeutic self-help with an interactive therapy CD and social networking site. These materials will allow individuals in psychological distress to learn self-soothing techniques both affordably and safely.

My idea comes from a combination of software and therapeutic developments (many taking place in Los Angeles) and from my own experiences. I intend to refine what iscurrently available into something that can be widely distributed, at low cost, in a wide variety of communities. This product-service combination will combine smoothly with professional care, whereavailable, but it will also allow people without access to professional care to help themselves, and to form therapeutic communities that can self-monitor.

First, a review of what's currently available:

On the low-tech side, a number of workbooks have appeared in the last ten years. These include:
The Self-Esteem Guided Journal
http://www.amazon.com/Self-Esteem-Guided-Journal-Program-Harbinger/...

The Relaxation and Stress Reduction Workbook
http://www.amazon.com/Self-Esteem-Guided-Journal-Program-Harbinger/...

These books helpfully take you through proven programs of self-help for stress and self-esteem. They're well-written, easy to understand, and available in most library systems. The former is mostly composed of cognitive-behavioral (CB) techniques, like reframing. The latter has a
combination of CB techniques and physical exercises, like deep breathing, and progressive relaxation.

On the high-tech side, there are now immersive VR therapies, like that offered at USC's Institute for Creative Technologies
http://ict.usc.edu/projects

With this technology, a therapist works with a client on summarizing a traumatic event. The event is simulated by computer, and the client interacts with the recreated event, changing its outcome.

There are also online sites, like the Mood Gym in Australia
(http://moodgym.anu.edu.au/welcome), and CD-ROMs teaching CB techniques
(http://www.theage.com.au/news/breaking/cd-therapy-for-depression/20...).

Finally, there are many types of journaling software, which allow users to self-analyze in a variety of ways using search tools. The benefits of journaling have been shown clinically by Matthew Lieberman at UCLA, who has doc**ented the power of organizing experience into narrative to
ease pain (http://www.college.ucla.edu/news/07/feelings-into-words.html)

What's missing from these tools:

The problem with the books is that they're rarely in English. They're also an older technology; they aren't interactive, which may make them more difficult for some people to use. The problem with the VR therapy is prohibitive cost. Finally, the CB materials are designed to provide information. They don't allow the user to have one of the other signal benefits of therapy: the creation of safe space.

What I think can be assembled:

I propose to create a CD-ROM that provides information on techniques and journaling software, but which allow provides tools to allow users to create environments and characters. Users will be able to create a safe space for themselves, and also to, to a limited extent, practice interactions.

A social site will provide a group therapy environment, help users with the software, and provide connection to professional help where necessary. In this way, available professional resources can be spread over a large area. Most important, recovery will be put into patients' own hands.

Why I think it will work:

Over the last decade, I've experienced post-traumatic symptoms that have decreased markedly. One of the most useful tools I had was a private livejournal account. I could use tags to track entry content. I could design the space, and redecorate it at will. Most important, the journal was online. This meant that I could safely contain distressing material at a distance. Before my livejournal account, I had two choices when I had a bad nightmare. I could either try to forget it, or I could journal it. Journaling had a myriad of benefits, many physically appreciable. But bringing the
dream into sustained conscious awareness and having it physically near in the form of the journal was often too difficult - not that forgetting ever worked. The online journal allowed me some important control over the disturbing content I was dealing with.

Designing the journal environment also had profound beneficial effects. I was able to address a number of issues just by collaging free images, and changing them. I had tried this previously with magazines, but the market needs that magazines serve meant that few of the images were useful.

Although many of the technologies that would comprise my proposal already exist, I think the
material I would like to provide could go father, and utilize more of developing information about neurobiology and emotional development. Specifically, I would like the CD to provide the means for creating characters and playing out scenes. I think this would be useful because of two personal experiences:

The first is mine. About a year ago, my boyfriend headed off a developing panic attack I was
having by sitting down near me and smiling. He didn't say anything, but his posture and facial expression were open and calm. After about two minutes, I began to feel my body relax in response to these visual cues. The attack dissipated. It was significant to me that no language was used. We didn't talk. There was no need, in other words, for CB techniques like reframing. Whatever processing my brain was doing about incipient threat, it didn't need to be headed off verbally.

Afterwards, I started thinking about Civilization, which my boyfriend had been playing. Basically what he'd done was a lot like what those characters do - a certain range of physical expressions, displayed in an open-ended way. I wondered, if I had a Civ IV style animation of my boyfriend, could I use it in subsequent incipient panic episodes to calm myself?

Or, if I could develop a Civ IV style animation of people with whom I've had unpleasant interactions, could I use those animations to practice alternate, successful interactions with them? Could this be a tool, also, to minimize the effects of intrusive thoughts and memories?

This leads me to my second experience-based point. I know, from the experiences of my self,
my friends, and others, that human beings seem to have an underlying internalized parental figure. The need for the figure, it seems, precedes the parent. One of the common features of recovery in cases of child abuse is the victim's dreams about parents that serve those developmental needs. In other words - specific memories of hurtful parents are slowly
replaced by dreams and images of helpful parental archetypes.

Is it possible that this process could be speeded, or its benefits amplified, by giving people the means to create these figures and interact with them in semi-programmed environments? I'd like to find out with trial technology. And if the answer is yes, I would like to distribute it.

My goal and plan:

My goal is to create a CD-ROM that will allow people to use a library of elements to create avatars, and to keep journals. Support material will allow users to control their connection to the material they create (ie, with them in the living space, or safe in the nowhere of the internet). Social
software will allow people to share avatar designs, and talk about their experiences. The online site will be monitored by professionals, who will be able to bring psychological care to a vastly increased sum of people, intervening as necessary.

My plan is to spend the next year researching the state of the field of computer-assisted
therapy as I apply to medical school. Over the previous 2 years my research has been more informal, as I've been meeting science prerequisites. This year I will pursue this research directly, and may take it as an independent study class at SMC in order to get faculty support, and possibly to prepare a summary paper for publication. I will also begin to familiarize myself with the programming involved to create this product, so that I can better understand what I need.

I hope to take this project with me into medical school, and to test the product in combination with the college I attend. It's possible that I can use the relationships I've created with investigators at UCLA to do this. (I also hope to intern with USC's Institute for Creative
Technologies to create similar relationships.)

4. The Money. What would you do with your first US$1,000 given or invested in support of your vision?

My chief hope in presenting this Evokation is to receive mentorship. While there is much experience I can bring to this project, success will require the bringing together of many disciplines and much savvy. I would like to find and connect with others who feel this product could be useful.

The money will come in as soon as it is needed. I plan to do research in the coming year on my own. It is my hope to secure the necessary programming labor through a successful grant or time donation. Testing of the product I hope also to accomplish with grant money. I would plan to keep the $1000 in reserve for the first project need I could not cover. If possible, I would use it to build the prototype, or to cover costs for the first set of prototypes to be tested. Something that would let me say, "this thing here in my hand may change your life forever. And we Evoked it."