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An Interview with Autistica: Molehill Mountain Edition

Andy Clarke, Molehill Mountain Product Owner at Autistica, sat down with us to chat through Molehill Mountain, an app to help autistic people understand and self-manage anxiety.

What is Molehill Mountain and what is the purpose of the app?

Molehill Mountain is an app designed to help autistic people understand and self-manage their anxiety. We wanted to create a source of support that was digitally and freely available, as anxiety is very common among autistic people. It is estimated that 30-40% of autistic people have symptoms of anxiety disorder.

This is much higher than in the general population, where the percentage is 10-12%. Sensory issues are also common in autistic people and can be an extra cause of anxiety. In addition, common autistic traits such as rumination and alexithymia (a difficulty identifying emotions) can make anxiety worse and treatments such as talking therapies less effective.

How did Autistica begin the journey of creating a wellbeing focused app as an alternative outlet to existing resources?

Autistica initially worked with researchers at King’s College London on producing a CBT (Cognitive Behavioural Therapy) workbook for autistic people with anxiety. It was a printed guide with advice and activities. This was a great start, but the material seemed more suited to an app so you could access it anywhere and at any time.

Autistica and KCL then worked together on the first version of the Molehill Mountain app, which was released in 2018. This was a relatively small project, but allowed us to see whether there was an audience for this type of app.

This first version of Molehill Mountain was a success. However, there were features which had to be left out due to the pressures of time and budget. For instance, we had included a tips section but not the CBT activities. In light of this, Autistica and KCL then obtained a larger grant to build the current version of the app, which is when I joined the project.

 

What inspired Molehill Mountain, and how is it different to other mental health apps?

There are many anxiety apps, but none really focus on the specific needs of autistic people. By working with autistic testers, and autism researchers, we’ve been able to personalise the app in a way that makes it more relevant and effective for autistic users. For instance, most anxiety apps focus on phobias and general anxiety. Autistic people can experience these forms of anxiety, but they are also affected by social anxiety and sensory issues and these are reflected in the design of the app.

For example, we ask the user to log their anxiety. If you start typing “pla”, a neurotypical anxiety app might suggest “plane crash” as flying is a common phobia. However, we also suggest things like “change of plan” and “open plan office” as these are more relevant to autistic people. This sort of thing can seem unimportant from a usability point of view, but it helps an autistic user feel that the app is designed for them.

We also reflect this approach in the tips section. The first tip acknowledges that sensory issues such as crowded environments, harsh lighting, random noise and strong smells can be all be major causes of anxiety. You may not find these as prominently featured in a neurotypical anxiety app.

We give more space in the tips to conditions like alexithymia and rumination which are more common in autistic people and can affect how they experience anxiety or respond to treatment for anxiety. We also try to avoid phrases or advice which may be triggering.

Tell us about the development of the app through having input from autistic people with lived experience of anxiety

We involved autistic people throughout the development of Molehill Mountain. I started this phase of development by reviewing the first version of the app which included feedback from user interviews and user testing. We also went through the app screen by screen to check for any usability issues.

Together, this allowed us to identify some existing issues and possible solutions. I then did an online survey and followed this up with in-depth user interviews. At that point, I was particularly interested in hearing why people had stopped using the app. This was a good approach as the survey identified two useful groups: on one hand, there were those who didn’t find the app relevant to them and had abandoned it relatively quickly, and on the other, there were those who had used it so much, they had got bored of it.

We did some further user testing for our initial designs and went through several iterations of this. After launch, we then did a survey and some additional user interviews.

At each stage, we looked at several forms of data in parallel. I think that this is good advice for anyone developing an app or a game. Don’t just rely on one source of data or one approach to user research. If you have analytics data, do some user interviews as this can add depth (analytics can tell you what is happening, but not why). Likewise, the interviews can suggest things to look for in the data and surveys can confirm if an issue raised in a user interview is widespread or rare.

What do you think the main take-home is for people using Molehill Mountain?

If I was to give one bit of advice about using Molehill Mountain, it would be to “give it time”. Some people will download Molehill Mountain and do one or two check-ins before quitting. This is too early. We know that anxiety affects a lot of autistic people so they would see a benefit if they kept using the app for a little while longer.

This is very common issue and affects all self-help apps, not just Molehill Mountain. In this version of Molehill Mountain, I included some details inspired by fitness trackers like progress charts and check-in streaks to provide more feedback and encouragement.

You need to use Molehill Mountain for a while to start to see the benefits. For instance, we have progress charts in the app and it takes a week or two until you will start to see a pattern in the check-ins. You will also start to notice your most common anxieties and get to the more tailored tips.

 

Are you planning to evolve the app in the future?

At the moment, we’re taking a pause from actively developing Molehill Mountain. We could develop it further, but for now it seems better to take what we have learnt from developing the app and apply it to other issues. At Autistica, we have set visionary and ambitious 2030 Goals, which will help us achieve our mission to see all autistic people live happier, healthier, longer lives. The goals are centred around support post-diagnosis, employment, public spaces, annual health checks and attitudes to autistic people. I think there is great opportunity to develop apps covering these fields, and we will of course revisit Molehill Mountain in due course.

 

We’re always delighted to chat with the names behind the games, and this was no exception. You can check out the game highlight on our mental health related games and apps page.

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Hub World – Representation

Welcome back to Hub World!

In June, we spent time reflecting on the theme of representation. As people, we naturally look for representation – people and stories that connect with us on a personal level. As an industry, we still have a way to go in ensuring a diverse range of voices are heard, but we continue to see many brave individuals and communities pushing for change. 

This month, we will get straight into the stories from the SIOW community and what representation means to them. 

Suneet Sharma 

Sometimes my British Indian heritage and society’s heteronormativeness makes my gay identity sometimes feel stifled. These clashes of culture make it easy to withdraw and want to hide my sexual orientation, thus playing into societal stereotypes of LGBTQ+ people of colour. 

Opening up about this uneasiness has let me reclaim my identity and celebrate who I am. Persona 4’s depiction of Kanji’s Tatsumi struggling to accept his sexuality, represented through a fight with his inner shadow really struck chords with me. 

The depiction is controversial. But most importantly it’s there. A faithful depiction of a LGBTQ+ character. Not just queer coding. So to me that’s the most important thing- games telling these stories in an authentic way.  


Mel Plays Games

I’m a bisexual retro streamer on twitch. I also struggle with depression, anxiety, and chronic pains.

Being a Bisexual there is a lot of odd stigmas that pressure us. I have, as probably many before me get those odd “but you cant be a bisexual if you are only dating men” or “Bisexuals are always 50/50 of who they are attracted to”, this only serves to amplify stereotypes. It was hard for me to come out as Bisexual but even harder when I mention I’ve only dated cis men, it seemed then that I wasn’t Bisexual enough in some lgbtq+ communities.

Bisexuals experience high rates of being ignored or rendered invisible in the community. I felt left out and it had a negative effect on my health.

Finding a community that fosters a safer place for you to feel welcome has helped me feel more comfortable, I sat in a discord group once and listen to all the stories people talk about being bisexual and the stigma they go through every day, they gave me some helpful articles surrounding bisexual stigmas and now I know I’m not left out, it’s ok to be more attractive to men and still love women or vise versa, you still bisexual despite what you prefer to love the most.

Night in the Woods is a game I really felt connected to, the main character Mae especially, the whole game has a great understanding of going through emotional trauma and gives a good representation of mental health. Mae is dealing with depression and anger issues and trying to repress the feelings she is having, she’s a bit misunderstood but as you go along you see her more compassionate side. I love that about her, it reminds me of me growing up. It was a good escape to play through the story, made me feel ok with what I was going through myself, I felt at peace. If you haven’t tried the game out, I highly recommend you do.


Lilylefae

I’m Lily and I’m a streamer from Brazil. In general, coming to the US and adapting to a new culture was hard, but streaming gave me the opportunity to meet new people and make new friends. However, I love seeing other latinx content creators but could also definitely feel the lack of representation. A lot of the latinx streamers I see are born and raised in the US, most of them have an American culture and fit right in. I would love to see more people who have the same struggles as me, who overcame xenophobia and how they did that. I’d just love to see more diversity all around, not only concerning my culture, but every other aspect that needs representation too!


Karen Lee  

I used to spend much of my time in MMOs such as Runescape and World of Warcraft. Being a Canadian-born Chinese who moved to Hong Kong for much of my high school life, online games allowed me to connect back with my North American upbringing with like-minded folks. I mainly played from Hong Kong—meaning I’d stay up late at night so I could properly sync up my playtime with North American servers.

I truly felt that I belonged in these games, despite feeling different from my peers in Hong Kong. There was no judgement based on age, race, geographical location, or gender. We focused on the game and that was it.

I continue to love online multiplayer games. I’m overjoyed that I’m now seeing characters that align with my actual Chinese Canadian heritage! Frost from Rainbow Six Siege is an immediate favourite that comes to mind. However, I’m eager to see even more video game characters and stories develop around the unique culture of Asian-Americans in the future!


Richard Lee Breslin 

Representation comes all in forms. It could be skin colour, upbringing, sexuality, disability, mental wellbeing, and more. In one way or another, whatever our background, representation can be an important aspect of our mental health.

Other than being physically disabled, I’m an adult with autism and up until recently, I was scared to talk about my autism. I was concerned with how society might judge me, even some of my family and friends. However, with the help of social media, I learned that I’m not alone.  

There are loads of people like me from all backgrounds who are on the autistic spectrum. Autism is a different experience for each individual.  But the one thing that connects us all on social media, is that none of us are alone, and we’re all ‘ausome’ 😉”


Emma Withington is a freelance writer and Senior PR at Bastion who has worked on campaigns for a variety of titles, including Control and Final Fantasy XIV: Online.

She is currently spending time focusing on the wider community and how she can help others through her personal journey with mental health.

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