Context

Click Therapeutics is my company that creates experiences in the Digital Therapeutics space.

Elixir is our app that helps patients diagnosed with an opioid use disorder.

Elixir works as a companion to patient’s prescribed treatment. One of the features that differentiates Elixir from competitors are the brain training activities.

This case study will explore the research, design, and development process of Go/No-go.

Go/No-go

Go/No-go is a therapeutic gaming experience that teaches impulse control. Patients are tasked with reacting to neutral stimuli while not reacting to stimuli related to opioid use. This medically proven practice helps retrain and strengthen patient’s brains and memory, similar to other types of muscle training exercise.

Go/No-go also acts as an engaging activity that helps differentiate the program from therapeutic education or typical CBT SUD activities. It also serves as a distraction tool and game for patients to interact with that still has therapeutic benefits when a patient may be experiencing a craving event.



This case study will explore the research, design, and development process of Go/No-go

Exploratory research

Exploratory user research took 9 months. As a team we conducted 50+ interviews with patients and peer advisors. As part of the team I acted as research moderator or note taker during these interviews.

Research results

Participants overwhelmingly enjoyed the idea of brain training; often finding it more rewarding and more challenging than initially expected from the overview. Most participants wanted a scientific explanation of how the game strengthens their brain.

Through multiple rounds of user interviews with peer advisors and patients in recovery we determined to move forward with a two-part solution - Go/No-go and Working Memory Words.

“I’m interested in the finer details of the science behind these exercises. Whether these are conducted in clinical studies or what.”

-Research Participant / Patient

Value to the patient

Autonomy - this activity helps patients feel accomplished

Working Memory - Improving memory

Impulse Control - helps practice the ability to not react to triggers

Engagement - Both a distraction tool and game like experience

Cravings Management - reduces automatic responses to triggers and serves as a distraction tool

Starting at the end

Go/No-go final designs

The prototype was used in UX research to confirm patient value.

Value to the patient

Autonomy - this activity helps patients feel accomplished

Working Memory - Improving memory

Impulse Control - helps practice the ability to not react to triggers

Engagement - Both a distraction tool and game like experience

Cravings Management - reduces automatic responses to triggers and serves as a distraction tool

Onboarding

Onboarding informs patients about Go/No-go, why it’s beneficial, and how it’s played.

Five screenshots of a brain training app interface. The first screen introduces brain training and its benefits, mentioning a 3-minute learning session. The second screen explains the purpose of brain training, outlining benefits like improved attention and resistance to cravings. The third screen describes brain exercises as mental workouts similar to physical exercises. The fourth screen introduces a game called Go/No-Go aimed at mental strengthening and urges control. The final screen provides instructions for the game, using examples like 'dog' and 'ocean' to tap, avoiding words related to opioid use.

Instructions

Prior to the activity patients are taught how to play the game and which words to react to.

Five mobile app screens displaying a practice game. The first screen instructs users to tap word bubbles. The second and third screens show bubbles with the words "Book" and "Shoes." The fourth screen gives guidance not to tap words related to opioid use. The fifth screen displays a bubble with the word "Pain." All screens have a dark blue background.

Working Memory Words

“Working Memory Words” is an additional activity in the Go/No-go game.

Patients are presented with a list of memory words before the start of the Go/No-go activity.

After completing the activity they are tasked with selecting the memory words they remember from a longer list of random words.

A mobile app with four screens displaying a memory game. First screen: Instructions to avoid certain words. Second screen: A grid of selectable words for the memory list. Third screen: Selection feedback with some words marked as correct. Fourth screen: Results showing words remembered correctly and incorrectly chosen words.

Training score

About
Different stats for patients based on their progress.

Scope
• Display information as related to a magnified version of their summary score in combination with latency
• The average correct tap word speed
• An action tile to additional details of scoring mechanics

Out of Scope (backlog)
• Animations of scores with sparkles or ticker animation
• Progress over time of totals
• Comparison of scores
• Scores leveraged to dynamically surface appropriate tips to improve scores

Mobile app screen displaying training score with a total of 869. Sections showing accuracy in opioid words avoided, memory words avoided, and correct words tapped. Includes statistics on correct word tap speed at 1.635 seconds and a memory list of 3 words. "I'm done" button at the bottom.

Go/No-go under the hood

Working back through the full research, design, and iterative process.

Go/No-go user journey

There are 3 user journeys depicted in the chart. The user starts with a Go/No-go “Lite” where they are onboarded to just Go/No-go activity. The second time they do an activity they get onboarded to Working Memory Words. The third journey represents a typical Go/No-go + Working Memory Word list activity.

Flowchart depicting a training process with multiple stages, including '1st Day with GNG', '2nd Day with GNG', and '3rd Day with GNG'. It includes instruction steps, practice sessions, training rounds, and evaluations like 'Review Score' and 'Wrap Up Content'. Arrows indicate the order of operations.

Going back to early concepts

Early concepts are based on the input from the science team and user interviews done in the exploratory phase.

Concepts - concept exploration
Onboarding - onboarding to the activity
Practice round - instructions on how to play
Working memory words - memory exercise

Concepts

Very early concepts. The goal was to design an interaction based on evidence based science requirements and initial research. The patient is given 2 kinds of stimuli, neutral and “negative,” they are only supposed to react to the “negative” stimuli.

Illustration of a blue and red rocket aimed at a circle with the word "itchy" inside, on a vertical layout. Two buttons labeled "Shoot" and "Skip" are below the rocket.
Mobile app interface displaying a flashcard with the word 'trip' and a button labeled 'cta' below it.
Screenshot of a mobile game interface showing a gray road with words like "trip," "skin," "scar," and "hike" along it. The words "swipe to play" and directional arrows are at the bottom.
Word association network featuring the words 'basic,' 'trip,' 'hike,' 'scratching,' and 'itch,' connected by dashed lines.

Early designs- onboarding

Initial onboarding to the brain training Go/No-go activity based on early user interviews and requirements from science.

Patients were interested in learning more about the activity and how would it help them.

Series of mobile app screenshots explaining a brain training program. The first screen shows a brain illustration with text about strengthening the brain against opioid effects. Subsequent screens introduce the program's 13-week duration, daily exercises, and concepts of brain training, including descriptions of opioid-related challenges and methods to retrain and strengthen the brain. An introduction to a specific exercise, called Go / No Go, is also presented. Each screen has a "Continue" button for navigation.
A series of five mobile app tutorial screens for a cognitive task game called Go/No-Go. The screens explain the game's purpose, which is to train your brain to better manage responses by reacting to "Go" stimuli and avoiding "No Go" stimuli. Instructions include tapping positive or neutral words and avoiding negative words related to substance use. Users are advised to act quickly within 1.5 seconds. The screens include buttons labeled "Start" and "Continue."

Early designs onboarding - how to play the game

Intro to the Go/No-go activity and how to play.

Sequence of five mobile app screens showing a "Go/No Go" demo. Screens include a start button, words displayed in circles like 'Sock', 'Hat', 'Happy', 'Lapse', and a congratulatory message screen with a checkmark.

Early designs - instructions

GO/No-go practice/tutorial round where patients get more in depth instructions on how to play.

Screenshots of a mobile app's instructions and tasks for a word activity. The first screen instructs users to tap positive and neutral words. The second introduces words to avoid. The third shows specific words to avoid: Rabbit, Keys, Plant. The fourth displays a "GO NO GO" task. The fifth summarizes today's session with one round and words to avoid listed. Each screen features a dark background with circular text buttons and a blue continue or start button.

User testing

Understand reactions to Go/No-go prototype stimuli including sources of interest, concern, and confusion to inform continued design and development.

Testing

60-minute 1:1 interviews with patients + peer advisors:

N=4 peer advisors
Mixed demographics, education, and income levels
All in recovery for 5+ years and supporting others

N=4 patients
Aged 28-34; White (3) + Hispanic or Latinx (1); rural (2), suburb (1), city (1); HS graduate (2), some college (1), college graduate (1); HHI below 50k (3), 75-100k (1); CJS (3)
MOUD: Methadone (2), Suboxone (1), Sublocade (1); Mix of lengths from 1-6 months to 3-5 years


What we heard from patients

“Brain strengthens over time resonates because my memory is horrible. I've never heard that before. I knew you could strengthen your brain but I didn't know that someone who used opioids can do that.

I thought that I screwed my brain permanently... it's nice to know that I can come back and to be reminded of that;. most people who have this problem need to be encouraged.”

— Patient

“I'm impressed with the content. My only problem is it's a lot…especially longer parts of the app that are explaining how to use it, which definitely should be narrated.

Maybe one or two screens at the most - like one screen that says here's the door to what's coming up now, and then move to the next screen and it's narrated.”

— Peer advisor

Next iteration - Implemented changes based on user feedback

Onboarding - shortened onboarding
Practice round - added explanation to the practice round
Scoring - score at the end of the game

Reduced the number of screens in the onboarding flow based on the feedback from the user testing.

A series of six mobile app screens for a brain training program. The first screen invites users to start brain training for recovery from opioid use disorder. The second explains the benefits of brain training with an illustration of a brain. The third introduces the "Go/No-Go" game as a mental exercise. The fourth details the game's purpose to reduce impulsivity. The fifth screen shows how the "Go/No-Go" feature works. The sixth screen provides instructions for tapping random words, while avoiding words related to opioid use disorder.

Introduced clearer instructions in the practice round.

A series of mobile app screens displaying a practice exercise. The screens instruct users to tap on certain words, avoiding those related to opioid use disorder. Words include "Chair," "Ant," "Shoes," "Doorknob" for tapping, and "Injection," "Pain," "Heroin" to avoid. The screens emphasize not tapping words associated with opioid use disorder.

Added a score breakdown and more information on how it’s calculated.

Five mobile app screens displaying a brain training program. The first screen shows stars with "Excellent!" text. The second screen congratulates the user for completing training. The third screen displays a score of 175 for today's training with bars for impulse control and speed. The fourth screen is a reflection page encouraging the user. The fifth screen discusses next steps for brain training, with a brain illustration.

Second round of user testing

Understand reactions to Go/No-go prototype including intro, lesson, practice, words, difficulty, duration, score, and education - including sources of engagement, concern, and confusion to inform continued design and development.

Testing results

Participants generally perceived the brain training prototype as engaging and valuable, enjoying the interactive nature of the game.

Participants were mostly excited about the potential benefits of brain training and found the instructions and scientific explanation helpful.

Participants felt the practice round prepared them well to play Go/No-go but they found it too fast.

Participants found Go/No-go engaging but found some words unclear and/or impersonal, and wanted the game to become more challenging over time.

What we heard from patients

“It was fun. It would get faster and each level would be harder is what I assume. It would benefit all generations and anyone can pick up easily.”

— Patient

“The wording “review progress” - it would take me a second to know what that means. I'd rather it say “review stats”, something that suggests it would quantify my results in some way..”

— Peer advisor

Updates

Made updates based on the user testing feedback:

• Changed “View progress” to “View score”

• Added more in depth explanation of the score

Mobile app interface showing brain training scores. Left screen: "Your training scores" text with a "View score" button. Right screen: "Training Score" with a score of 869. Displays accuracy metrics for opioid words avoided, memory words avoided, and correct words tapped. Additional details include correct word tap speed (1.635 sec) and memory list (3 words). Option to tap for more info and "I’m done" button.

Next Steps

A lot of features didn’t make it in this round because of clinical trial timelines and lack of engineering resources.

Features that were part of this round:

•Pause button
•Score
•Levels
•Practice round
•Exit

Features that didn’t make it in this round:

• Score history
•Themes
•Animations