Expression-in-action and Expression-on-action: A Systematic Review of Mediums for Expression in Mental Health

Research Background and Issues

• Problem Identification and Challenges:
  The author identifies that in the field of mental health, the role of expression is often marginalized or systematically excluded from technology and system design. Existing research on expression tends to be fragmented and lacks a comprehensive understanding. This limitation not only restricts the space for technological innovation supporting expression but may also lead to the absence of authentic data in personal experiences and daily mental health management, further impacting self-reflection and clinical treatment.

• Importance of the Issue:
  Expression is crucial for mental health management, enabling individuals to externalize their internal states and experiences (such as emotions, thoughts, and physical sensations). This externalized information is essential for self-understanding, self-reflection, and clinical treatment. However, current healthcare systems and technology designs often prioritize objective diagnosis while undervaluing the subjective experiences related to mental health, exacerbating the abstraction or absence of emotional data.

• Research Motivation and Related Work:
  Existing technologies (such as social media and self-tracking tools) may reinforce biases or stigmatize mental health issues. Additionally, different modes of expression (e.g., text, images) may be constrained by tool design (e.g., text-based expression may be infeasible when cognitive or motor abilities are impaired). Therefore, there is an urgent need for a new theoretical framework and design approach to support diverse forms of expression, focusing on subjective human experiences.

Solution

• Proposed Method or Solution:
  Through a systematic review of 105 related studies, the author introduces two innovative concepts—“Expression-in-action” and “Expression-on-action.” The former emphasizes capturing immediate and fleeting psychological states, while the latter focuses on retrospective expression of past experiences. Additionally, the author proposes a framework comprising three design stages (capture, record/process, and feedback) to support expressive behaviors in mental health contexts.

• Innovative Aspects of the Solution:

  1. Conceptual Innovation: Expression-in-action focuses on immediate expression, highlighting the transience and situational nature of emotions; Expression-on-action supports broader experiences through storytelling or symbolic representation of past events.
  2. Design Framework: The three-stage framework not only emphasizes the data collection process typical of traditional self-quantification systems but also significantly expands the scope of support for expressive behaviors, particularly in the feedback stage by considering how expression can be transformed into visualized data or distraction mechanisms.

• Implementation Steps and Key Technologies:

  1. Capture Stage: Utilize multimodal media (e.g., text, bodily movements, images) to capture immediate or retrospective expressions, and explore how non-agentive and agentive characteristics of media influence expressive behaviors.
  2. Record and Process Stage: Design data recording and integration functionalities for non-digital media (e.g., handcrafted items) while incorporating technologies such as textile electrodes or pressure sensors to process experiential data generated during expressive behaviors.
  3. Feedback Stage: Apply digital feedback mechanisms (e.g., light or vibration) to provide distraction mechanisms or create visualization tools to help individuals reflect on emotional data.

Research Outcomes

• Specific Findings:
  The study categorizes expression groups into three major types: “demographic groups” based on age, gender, occupation, etc.; “condition groups” based on mental health status; and “state groups” centered around recovery or medication management. Additionally, it identifies three types of media (embodied, embedded, and a combination of embodied and embedded media) and two expression modes (multimodal and unimodal expression).

• Comparison with Existing Solutions:
  The author innovatively proposes new expression classifications (Expression-in-action and Expression-on-action), providing deeper support for diverse, subjective expressions compared to existing frameworks emphasizing overall data flow processes (e.g., Stage-Based Model or Lived Informatics Model). Furthermore, the proposed design framework introduces a novel contextual information layer, considering the impact of socioeconomic and cultural backgrounds on expressive behaviors.

• Experimental or Evaluation Results:
  The systematic review reveals widespread diversity and complexity in expression within mental health management. For example, children tend to use storyboards for expression during recovery, while adults may avoid detailed emotional expression.

• Limitations and Future Directions:

  1. Limitations: The reviewed literature tends to focus on specific expressive tools or scenarios, potentially failing to fully capture non-technological forms of expression. Additionally, this study primarily explores theoretical frameworks, lacking empirical or user testing to validate the practical application of the framework.
  2. Future Directions: Future research is recommended to integrate design and empirical studies, such as exploring how novel media and modalities can capture complex or blended psychological states, and further investigating the deep impact of demographic characteristics (e.g., cultural background) on the selection of expressive tools.

The above analysis comprehensively summarizes the core content and contributions of the research. If you require further detailed information or expansion on specific sections, feel free to request!