Resilience in Youth: Presenting an App for Youth Experiencing Challenges Christine Wekerle, Savanah Smith (CIHRTeamSV)

1. #ResilienceInYouth:
Presenting an App for Youth
Experiencing Challenge
Child Maltreatment, Substance Abuse
and Interventions Symposium
2nd ISPCAN Caribbean Conference
December 2018
Montego Bay, Jamaica
Dr. Christine Wekerle, Department of
Pediatrics, McMaster University
Savanah Smith, Department of
Pediatrics, McMaster University
#CIHRTeamSV: https://www.researchgate.net/project/Understanding-health-
risks-and-promoting-resilience-in-male-youth-with-sexual-violence-experience-
CIHR-Team-Grant-TE3-138302

2. Resilience:
Legal and Rights Frameworks
UN Convention on the Rights of the Child1
o Calls for countries to develop legislation and implement
services to protect the rights of children
o Prevent violence and promote wellbeing (resilience)
o Canada is a signatory country
o The reporting of child abuse and neglect is mandated in all
provinces and territories within Canada (Child, Youth, and
Family Services Act)2
o In Ontario, Age of Protection: Raised to include 16 and 17
year olds3
o Yet, 1/3 of Canadians report experiencing abuse before age
16 (physical, sexual, and exposure to Intimate Partner
Violence)4
o The majority of victims (67%) report not speaking to anyone
about the abuse (i.e., family, friends, authorities)5

3. Positive Psychology
 Moves beyond disorder to optimal
human functioning6
 Positive experiences, states and
personal traits all contribute to
wellbeing
 Emphasizes the improvement of the
individual7
 Asks the question: What allows for
resilience?

4. Could a mobile-app intervention
bolster resilience in youth?
 Reports show that one quarter of Grade Four students have a
smartphone—with increasing numbers by grade until Grade
Eleven, with 85% owning a smartphone8
 Youth typically spend 6-9 hours online per day9
 54% of teens report that they spend “too much” time on their
cellphones10
 What if they were using even a fraction of this time to focus
on the positives and learn tools to increase resilience?

5. The JoyPop AppGoals:
(1)Promote positive emotionality and activity
(2)Promote safe social connectedness
(3)Provide support with day-to-day stressors and periods of
transition11-15
Psychological processes targeted:
Executive Functioning: A set of higher-order processes in the brain
that allow an individual to respond to external stimuli with goal-
oriented action16
Emotion Regulation (ER): A set of processes that enable an individual
to organize, manage, or modify their emotions (to positively adapt to
internal or external cues)17
Recommended Usage: Minimum of twice daily (Once in the morning
and once at night)
Support is always available: Call for help button allows the user to
access three helplines (i.e., Kids Help Phone, LGBT, Indigenous)
should they feel distressed at any point in the day

6. When the App is first opened daily: (1) the Guide to Diaphragmatic
Breathing; (2) Breathing Activity – Prompts Choice of Balanced or
Relaxation Breathing; (3) Happy Mood Rating

7. Controlled Breathing Exercises
o Teach user diaphragmatic breathing
techniques to decrease stress and restore
body to a resting state
o Two Options: Balanced and Relaxation
breathing
o Preset timing and rounds of breathing
with text prompt and visual tracking
diagram
o Some evidence that focused breathing
exercises may have positive effects on the
utilization of ER strategies18

8. Landing Page and Calendar
 Focus is on the positives
 Landing page allows the
user to access all of the
app features of Calendar;
Mood Rating; Journaling;
Activities [Art, Breathing,
ShapeShifter Game]; Circle
of Trust
 Calendar keeps journal
entries

9. Expressing Resilience via Journaling
o Express thoughts, feelings, and
emotions through words (and emojis)
o User is able to journal free flowing
thoughts, or respond to a pre-
populated question, prompts or quote
related to resilience
o Research has demonstrated positive
health and behavioral outcomes after
participating expressive journaling
interventions including improvements
in physical and mental health, higher
grades, elevated mood, and reductions
in distress symptoms19-23

10. From Mood Ratings to Actions
o User is first asked to rate happiness by sliding colour up or down with
their finger
o If rating is under 50% happy, user is asked to rate how sad, angry, or
‘meh’ they feel
o JoyPop will provide a prompt for an activity to increase mood
o Consistent mood imbalance and emotional suppression can lead to poor
mental health, negative mindset, resulting behavioral issues35
o Teaches the user to be better aware of their emotions, identify and
differentiate emotions, and create positive strategies to improve mood
(ER)24

11. Gaming for Focus: ShapeShifter
o Strategy games have
been linked to self-
regulation when played
consistently over time25
o Tetris has been shown to
decrease traumatic
memory flashbacks26,27
o There is evidence that
playing Tetris may have
positive effects on spatial
working memory28

12. Safe Social Connecting: Circle of Trust
o Allows user to input up to six contacts to
call when they are in need of support
o May contain family, peers, social workers,
mental health professionals, and mentors
o Establishing positive relationships has been
shown to decrease stress symptoms and
increase relational learning29
o Adult mentors help to shape “resilient
identity” of at-risk youth30
o Youth need to know that they are trusted to
make decisions, but help is always available
when they need it

13. Next Steps
 The app is currently being studied on populations
of youth transitioning from high school to
university
 Canadian child welfare foundation has partnered
with communication firm, Telus, to provide 2 year
data plan free to youth exiting system
 Adaptation of the app to fit the resilience needs of
Indigenous communities (i.e., holistic features,
“water tool”, language)

14. FUTURUM Articles:
Man Box: https://futurumcareers.com/thinking-outside-
the-manbox
JoyPop: https://futurumcareers.com/dr-christine-
wekerle-finding-joy-in-an-app
Resilience Activity Sheet:
https://futurumcareers.com/activity-sheets

15. References
1) https://www.unicef.org/crc/files/Rights_overview.pdf
2) http://www.children.gov.on.ca/htdocs/English/childrensaid/reportingabuse/abuseandneglect.aspx
3) http://www.oacas.org/2018/01/ontario-raises-age-of-protection-for-youth-from-16-to-18/
4) Public Health Agency of Canada. (2018). Family violence: How big is the problem in Canada? Ottawa,
Ontario: PHAC. Retrieved from: https://www.canada.ca/en/public-health/services/health-promotion/stop-
familyviolence/problem-canada.html?_ga=2.162634684.125106970.1528920153-1668390544.1528920153
5) Burczycka, M. (2017) Section 1: Profile of Canadian adults who experienced childhood maltreatment.
Ottawa: Statistics Canada. Retreived from: https://www150.statcan.gc.ca/n1/pub/85-002-
x/2017001/article/14698/01-eng.html
6) Sheldon, K. M., Fredrickson, B., Rathunde, K., Csikszentmihalyi, M., & Haidt, J. (2000). Positive psychology
manifesto. Manifesto presented at Akumal 1 conference and revised during the Akumal 2 meeting.
Retrieved from: http://www.optimalfunctioning.com/featured/positive-psychology-manifesto.html
7) Fredrickson, B. L. (2003). The value of positive emotions: The emerging science of positive psychology is
coming to understand why it’s good to feel good. American Scientist, 91(4), 330-335. Retrieved from:
https://www.jstor.org/stable/27858244
8) Steeves, V. (2014). Young Canadians in a wired world, Phase III: Trends and recommendations. Ottawa,
Ontario: MediaSmarts. Retrieved from: http://mediasmarts.ca/ycww
9) Common Sense Media. (2015). The Common Sense census: Media use by teens and tweens. Common
Sense Media. Retrieved from: https://www.commonsensemedia.org/research/the-common-sense-census-
media-use-by-tweens-and-teens
10)PEW Research Center. (2018). How teens and parents navigate screen time and device distractions. PEW
Research Center. Retrieved from: http://www.pewinternet.org/2018/08/22/how-teens-and-parents-
navigate-screen-time-and-device-distractions/

16. 11)Dumont, M., & Provost, M. A. (1999). Resilience in adolescents: Protective role of social support, coping
strategies, self-esteem, and social activities on experience of stress and depression. Journal of Youth and
Adolescence, 28(3), 343-363. doi: 10.1023/A:1021637011732
12)Kitano, M. K., & Lewis, R. B. (2005). Resilience and coping: Implications for gifted children and youth at
risk. Roeper Review, 24(4), 200-205. doi: 10.1080/02783190509554319
13)Smith, C., & Carlson, B. E. (1997). Stress, coping, and resilience in children and youth. Social Service
Review, 71(2), 231-256. Retrieved from: http://www.jstor.org/stable/30013020
14)Ungar, M. (2011). Social ecologies and their contribution to resilience. In M. Ungar (Ed.), The Social Ecology
of Resilience (pp. 13-31). New York, NY: Springer.
15)Flett, G., Flett, A., & Wekerle, C. (2015). A conceptual analysis of interpersonal resilience as a key resilience
domain: Understanding the ability to overcome child sexual abuse and other resilience interpersonal
contexts. International Journal of Child and Adolescent Resilience, 3(1), 4-33. Retrieved from: http://in-
car.ca/ijcar/issues/vol3/2015/Flett_et_al_pp_4-33.pdf
16)Hughes, C. (2013). Executive function: Development, individual differences, and clinical insights. In J. L. R.
Rubenstein & P. Rakic (Eds.), Neural Circuit Development and Function in the Brain (pp. 429-445). Oxford,
UK: Academic Press. doi:10.1016/B978-0-12-397267-5.00062-5
17)Hilt, L. M., Hanson, J. L., & Pollak, S. D. (2011). Emotion dysregulation. Encyclopedia of Adolescence, 3,
160-169. Retrieved from:
https://www2.waisman.wisc.edu/childemotion/pubs/2011_EmotionDeregulationHilt_Hanson_Pollak-1.pdf
18)Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused
breathing induction. Behavior Research and Therapy, 44(12), 1849-1858. doi:10.1016/j.brat.2005.12.007
19)Frisina, P. G., Borod, J. C., & Lepore, S. J. (2004). A meta-analysis of the effects of written emotional
disclosure on the health outcomes of clinical populations. The Journal of Nervous and Mental Disease,
192(9), 629-634. doi:10.1097/01.nmd.0000138317.30764.63

17. 20)Pennebaker, J. W., & Chung, C. K. (2007). Expressive Writing, Emotional Upheavals, and Health. In H. S.
Friedman & R. C. Silver (Eds.), Foundations of Health Psychology (pp. 263-284). New York, NY, US: Oxford
University Press.
21)Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating
variables. Journal of Consulting and Clinical Psychology, 66, 174-184. doi:10.1037/0022-006X.66.1.174
22)Sloan, D. M. & Marx, B. P. (2004). A closer examination of the structured written disclosure procedure.
Journal of Consulting & Clinical Psychology, 72(2), 165-175. doi:10.1037/0022-006X.72.2.165
23)Lumley, M. A., & Provenzano, K. M. (2003). Stress management through written emotional disclosure
improved academic performance among college students with physical symptoms. Journal of Educational
Psychology, 95(3), 641-649. doi:10.1037/0022-0663.95.3.641
24)Desmet, P. M. A., Vastenburg, M. H., & Romero, N. (2016). Mood measurement with Pick-A-Mood: Review
of current methods and design of a pictorial self-report scale. Journal of Design Research, 14(3), 241-279.
doi:10.1504/JDR.2016.079751
25)Gabbiadini, A., & Greitemeyer, T. (2017). Uncovering the association between strategy video games and
self-regulation. Personality and Individual Differences, 104,129-136. doi:10.1016/j.paid.2016.07.041
26)Holmes, E. A., James, E. L., Coode-Bate, T., & Deeprose, C. (2009) Can playing the computer game
“Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive-science. PloS ONE, 4(1),
e4153. doi: 10.1371/journal.pone.0004153
27)James, E. L., Bonsall, M. B., Hoppitt, L., Tunbridge, E. M., Geddes, J. R., Milton, A. L., & Holmes, E. A.
(2009). Computer game play reduces intrusive memories of experimental trauma via reconsolidation
update mechanisms. Psychological Science, 26(8), 1201-1215. doi: 10.1177/0956797615583071
28)Bikic, A., Christensen, T. Ø., Leckman, J. F., Bilenberg, N., & Dalsgaard, S. (2017). A double-blind
randomized pilot trial comparing computerized cognitive exercises to Tetris in adolescents with attention
deficit/hyperactivity disorder. Nordic Journal of Psychiatry, 71(6), 455-464.
doi:10.1080/08039488.2017.1328070

18. 29)Wekerle, C., Waechter, R., & Chung, R. (2012). Contexts of vulnerability and resilience: Childhood
maltreatment, cognitive functioning and close relationships. In M. Ungar (Ed.), The Social Ecology of
Resilience (pp.187-198). New York, NY: Springer.
30)Ungar, M. (2004). The importance of parents and other caregivers to the resilience of high-risk
adolescents. Family Process, 43(1), 23-41. doi:10.1111/j.1545-5300.2004.04301004.x