We propose the concept of a problem-sustaining pattern as a revision of the established concept of mental disorder. The proposed concept preserves valuable features of the established concept, such as recognition of the client’s hardships and scientifically informed justification of specific interventions. However, several assumptions behind the established concept have been widely criticized, both in terms of their clinical and moral normativity as well as their ontological and empirical soundness. We argue that a focus on problem-sustainment allows us to reframe the issue of demarcation in a way that helps avoid stigmatization while clarifying the role of client agency in diagnosis. We also propose a shift toward thinking in terms of patterns of dynamic interaction, which is more in line with current developments in complexity science. We conclude the article with a discussion of further research that would be needed to address various questions raised by our proposal.@en

Food waste remains a critical global challenge, undermining sustainability and straining food systems. This study investigates adaptable consumption as a transformative strategy for reducing household food waste, emphasising its role in enhancing resilience within food systems. Adaptability of consumption empowers households to adjust food-related behaviours in response to changes in food availability, household needs, and other disruptions. Through cultural probes and semi-structured interviews with 11 Dutch households (43 participants), this study identifies five actionable opportunities for supporting consumers in more adaptability toward food waste reduction: 1) supporting flexible meal moments, 2) reclaiming food edibility, 3) reintegrating food into routines, 4) integrating feedback loops, and 5) playing into life-changing moments. These opportunities represent critical moments in time, behavioural routines, or dynamics where food waste-reducing behaviours can be successfully introduced and fostered. The study identifies practical recommendations within each opportunity, including implementing sensory-driven food labels to guide safe consumption decisions, introducing storage tools to minimise waste, and leveraging digital tools to provide actionable feedback, which can support households in adopting sustainable and waste-reducing practices. By integrating such interventions, stakeholders can enable households to adopt concrete, sustainable practices that align with systemic goals for food waste reduction and resilience.

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One of the emergent approaches towards designing (for) transitions and transformations is the application of systemic design: the integration of systems theories and practice with design theories and practices. Within this field we identified two dominant perspectives and associate practices: using systemic visualisations as a sense-making tool of complex challenges, and ‘designing from within’ by means of collective designing by system stakeholders. In this paper we introduce a third perspective and practice that we call ‘systemic design reasoning’. This perspective combines the abductive reasoning logic of design with various systems theories and practices to develop ‘systemic design rationales’. We developed six systemic design principles to support this reasoning practice. Each principle is based on a specific systems theory and practice. We illustrate the principles with examples of their application in research and in education. We conclude with a research agenda to further the practice of systemic design reasoning.@en

Excessive animal protein consumption has led to calls for a plant-based protein transition. Plant-based diets can be fostered by design interventions, yet their effect on dietary choices depends on the framing that is chosen. The aim of this study was to understand which transition design frames (TD frames) are prevalent in existing consumer interventions in the Netherlands, to help transcend the dominant substitution pathway with alternative strategies for intervention. We explore framing through the lens of design, examining human-made interventions in a transition context, to complement the discursive lens that is common in transitions literature. Based on 62 existing consumer interventions and eight expert interviews, we identified eight TD frames. We find that market regulation and cultural interventions are strategic avenues to pursue. Reframing opportunities involve inclusivity, system breakdown and integrating multiple frames into single interventions. We observed that a design lens helped elucidate frame types that have not previously been identified in transitions literature.

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In recent years, more designers have been engaging in transitions, for which design expertise is used to develop visions of long-term desirable futures. However, little is known about how design expertise is positioned in transition visioning processes. In this case study, we follow a design agency in envisioning a future food system for a consortium working on the food transition. Based on our findings, we unpack several tensions that emerge between the transition context and design expertise. Such as the tension for designers to explore alternative futures that challenge the current system yet support stakeholders in seeing their place in the future. We conclude by reflecting on avenues for methodological development to optimally position design expertise for visioning in transitions.@en

There is an increasing interest in the public sector for the repertoire of designers and the value it can bring when working on complex societal challenges. However, what constitutes this repertoire is often not articulated clearly, or it is explained in such generic terms that it is hard to draw disciplinary boundaries. Drawing from literature, we identify four competencies—integrating, reframing, formgiving and orchestrating—as distinctive for the discipline of design. Through several examples we show how these competencies feature in the design process, and how these compe- tencies drive different design practices. Although these competencies have to a certain extent always been part of the design discipline, they need to be adapted to the context of complex societal challenges. Hence, we conclude this paper by discussing how these competencies are to be developed and adapted to strengthen the value of the design repertoire when dealing with complex issues in the public sector.@en

Background: Temstem is a smartphone app developed with and for clinical voice hearing individuals with the aim to reduce their voice hearing distress and improve social functioning. Methods: A randomized controlled trial with adult outpatients suffering from distressing and frequent auditory verbal hallucinations (AVH) was conducted. Participants were randomized to unguided ‘Temstem+AVH monitoring’ or unguided ‘AVH monitoring only’ (control condition). Assessments were performed at baseline, post-intervention (week 5–6), and follow-up (week 9–10). Primary outcomes were voice hearing distress and social functioning, as measured with Experience Sampling Method (ESM), consisting of multiple daily questionnaires during six days. In addition, voices and mood were self-monitored with help of a daily reflective questionnaire. Analyses were linear regression models (intention-to-treat). Results: 44 Participants were allocated to Temstem and 45 to the control condition. No significant differences between the groups were found on both primary outcomes. Conclusion: Our results do not support the effectiveness of stand-alone use of Temstem versus symptom monitoring on voice hearing distress or social functioning in voice hearing individuals. In order to potentially improve effectiveness of an mHealth tool in a population of people with frequent and distressing voices, we recommend to involve persons with lived experience in all stages of development and research; to thoroughly test the (technological) usability before performing an RCT; to test whether guidance of a therapist is needed to optimize effectiveness; and to provide prompts to remind the user to actually use the tool.

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In recent years, more designers have been engaging in transitions for which design activity is used to develop innovations that steer change. However, little is known about how designers develop innovations to foster change along a desired transition path. In this short paper, we explore how designers can develop joint innovations that steer a transition of the Dutch food system to embrace flexibility and cater to enough. We present a new practice called Adaptable Consumption, which aims to realign food safety, quality, and sustainability. Based on our preliminary findings, we discuss how our process inspires reflections on the transition and reveals key indicators for collaborative change. We conclude by reflecting on areas of the process that need further exploration in order to stage the process and design expertise effectively in this highly complex transition context.@en

In de Nederlandse veiligheidssector spelen grote, complexe vraagstukken zoals ondermijning, georganiseerde criminaliteit, cybercriminaliteit en toenemende (online) radicalisering en polarisatie. Dit type vraagstukken vereisen nieuwe manieren van kijken, denken en handelen om deze aan te pakken. Voor het brengen van nieuwe handelingsperspectieven op complexe maatschappelijke vraagstukken wordt steeds vaker samengewerkt met de ontwerpende disciplines. Deze samenwerking tussen publieke veiligheidsorganisaties en creatieve professionals is beloftevol, maar ook lastig en kwetsbaar. Want ondanks groot enthousiasme verloopt de samenwerking niet altijd even probleemloos. Allereerst zijn er botsingen in taal, cultuur en werkwijze. Waar de een werkt met heldere kaders, richtlijnen en protocollen, werkt de ander vanuit serendipiteit, associatie en ambiguïteit. Maar ook op een praktischer niveau valt een partnerschap lastig in te bouwen in de huidige systeemcontext. Wat koop je in als de uitkomsten van een proces nog onzeker zijn? En hoe past een verbredend en experimenterend proces in een organisatie gericht op efficiëntie en resultaat? In dit onderzoek verkennen we de vraag wat er nodig is om tot meer synergetische samenwerking tussen creatieve professionals en publieke veiligheidsorganisaties te komen bij het werken in partnerschap. Hierbij zien we synergetische samenwerking als de ontwikkeling van uitkomsten die zonder samenwerken niet tot stand waren gekomen. We richten ons op de (infrastructurele) randvoorwaarden waaronder synergetische samenwerking kan ontstaan bij het complexe ontwerpvraagstukken, en de mogelijkheden voor procesondersteuning die de kans op synergetische samenwerking vergroot. De onderzoeksmethode bestond uit twee delen: een meervoudige casestudie en een ontwerpend onderzoek. In de meervoudige casestudie onderzochten we vier exemplarische samenwerkingen tussen creatieve professionals en publieke veiligheidsorganisaties. Hierbij zagen we een aantal factoren die gezorgd hebben voor meer of juist minder synergetische samenwerking. In synergetische samenwerkingen zien we dat er structureel meer aandacht wordt besteed aan werken over grenzen: disciplinaire grenzen binnen het team, grenzen met het vraagstuk, grenzen met de organisatie en grenzen met de buitenwereld.Als uitkomst presenteren we aan de hand van vier grenzen waarover heen gewerkt moet worden 16 bouwstenen voor synergetische samenwerking, een eerste aanzet voor aspecten waar in de samenwerking aandacht aan besteed moet worden.Hoe die bouwstenen zich manifesteren in een samenwerking in de praktijk, en wat de ondersteuningsbehoefte van creatieve professionals en randvoorwaarden voor de verdere ontwikkeling van procesondersteuning zijn verkenden we in het ontwerpend onderzoek. Hiervoor hebben we een samenwerkingstraject gevolgd en ondersteund. We zien daarbij mogelijkheden voor de ontwikkeling van een portfolio van instrumenten of infrastructuur specifiek gericht op het ondersteunen van samenwerkingen. Hiervoor formuleerden we, naast de toegepaste procesinterventies, een eerste set van ontwerpprincipes die zich richten op het versterken van professionals in het continu werken over grenzen.We stellen zeer zeker niet dat iedere samenwerking tot een synergetisch succes kan leiden. Maar we hopen wel met dit onderzoek eerste handvatten te geven hoe samenwerken met creatieve professionals vaker tot synergie tussen partners kan leiden, en daarmee de impact op de grote maatschappelijke opgaven van deze tijd kan vergroten. Als afsluiting van het onderzoek geven we enkele richtingen voor vervolgstappen in (ontwerpend) onderzoek, en geven we praktische handvatten door middel van een procesontwerp voor elk van de vier grenzen gericht op professionals om in de praktijk mee aan de slag te gaan voor het inrichten van samenwerkingen.@en

Al jaren zijn mensen met een arbeidsongeschiktheidsuitkering in mindere mate aan het werk dan de rest van de beroepsbevolking. Dit verschil is groter dan op grond van hun beperkingen verwacht mag worden. Een groot deel van de ZW-, WGA- en Wajonggerechtigden kan immers nog wel (gedeeltelijk) aan het werk, maar dit lukt blijkbaar moeilijk. Verschillende professionals van UWV en van re-integratiebedrijven proberen in hun contacten met uitkeringsgerechtigden mensen zo goed mogelijk op weg te helpen naar werk. In dit onderzoek keken we naar hoe het gedrag van uitkeringsgerechtigden beschreven kan worden, welke factoren en dynamieken het gedrag beïnvloeden en welke handelingsperspectieven de uitvoering geboden zouden kunnen worden om tot effectieve(re) re-integratie te komen. We beantwoordden de volgende onderzoeksvraag: Hoe beïnvloeden dienstverlening en wet- en regelgeving het gedrag van uitkeringsgerechtigden bij re-integratie en welke (verbeterde) concrete handelingsperspectieven kunnen de uitvoering worden geboden om tot een effectieve(re) re-integratie te komen?@en

Many of our daily behaviours, e.g., our choice for transportation and our consumption behaviours, need to change in the light of the pressing sustainability issues we are facing. Yet, while many people value the environment, they do not always engage in the behaviours that are in line with these values, representing the so-called ‘value-action gap’. This paper argues that the value-action gap can to a large extent be explained by a choice architecture which promotes unsustainable behaviours. Therefore, we present a redesign of choice architecture in the context of meat consumption, to stimulate people to act in line with their values. Our experimental study shows that such a redesign leads to a significant increase in sustainable behaviour, without conflicting with people's values. This opens the discussion on how we design the architecture for such choices and adds granularity to the moral debate about nudging.

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Behavioural design is an emergent discipline that aims to harness design’s influence on behaviour in an intentional way. However, there is limited knowledge on how to translate knowledge on behaviour and its determinants to specific design properties in ways that can maintain such change. We adopt a user experiential view to discuss the role that artefacts and their materiality play in effectively changing behaviour by introducing the notion of appropriateness, a quality of user-artefact interaction that describes the fitness of an artefact to the user and context that may play a moderating role in effectiveness of a design intervention in contributing to behaviour change. Based on an in-situ exploratory study with two conceptual artefacts we show that this appropriateness could help to investigate the long-term effectiveness of artefacts.@en

Although the term social design is being widely adopted around the world, conceptual clarity is still lacking. The way social design is understood and executed can vary greatly. Without a shared conceptual foundation, knowledge exchange and development are restricted, and so is the professionalisation of practice. This paper brings forward a framework that unites all social design around an overarching objective to foster the common good but argues that design activities to do so may be driven by different values and focus on different outcomes. We identify five components of social design: (1) care-driven design activities for the wellbeing of underprivileged people, (2) responsiveness-driven design activities for good governance, (3) political progress-driven design activities for empowered citizens, (4) social capital-driven design activities for beneficial communities, and, (5) resilience-driven design activities for sustainable future systems. We describe how the framework helps explain, discuss and systematically study social design.

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Background: Temstem is a mobile application developed in cooperation with voice-hearing persons to help them cope with distressing voices. After psychoeducation about voice hearing, Temstem offers two functions: Silencing is a mode designed to inhibit voice activity through the processing of incompatible language; the Challenging mode introduces dual tasking (as used in eye movement desensitisation and reprocessing) designed to reduce the emotionality and vividness of a voice memory. Two different language games, Lingo Tapper and Word Link, are provided, containing both functions. This study aimed to explore the momentary effects of Temstem on voice-hearing distress, emotionality and vividness in a naturalistic sample of voice-hearing app users. Method: Temstem is freely available in the Netherlands. We collected data through the app from 1048 individual users who had given informed consent for the study. We assessed changes in pre- and post-session scores on distress, emotionality and vividness, and we evaluated differences in outcomes between the games and whether effects remained stable over multiple sessions. Results: Users had been hearing voices for an average of 4.95 years; 79 % had been informed about Temstem by a mental health therapist or coach. After a Silencing session, voice-hearing distress was reduced, t(958) = 27.12, p < .001, d = 0.49; the degree of reduction remained stable after repeated use, F(1, 7905.57) = 1.91, p = .167. After a Challenging session, emotionality, t(651) = 23.16, p < .001, d = 0.74, and the vividness of voice memories were reduced, t(651) = 22.20, p < .001, d = 0.71; both diminished slightly with frequent use, F(1, 2222.86) = 7.21, p < .05; F(1, 2289.92) = 4.25, p < .05. In comparison with Lingo Tapper, larger reductions were seen for a Word Link game: emotionality t(226) = 2.88, p < .005, d = 0.21; vividness t(226) = 2.29, p < .05, d = 0.17. Discussion: In this heterogeneous sample of voice-hearing individuals, Temstem appeared to be a promising coping tool; momentary voice-hearing distress and the emotionality and vividness of voice statements were reduced after a Temstem session. Despite important limitations and the need for more research, naturalistic studies of user app data may yield interesting and generalisable findings.

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Designers are increasingly tackling complex societal challenges and fostering system transitions. Transitions are long-term, multi-level, multi-phasal system changes involving numerous actors, requiring innovations that develop new relationships within the system. Therefore, the process of designing for transitions requires new ways of bridging system analysis and system synthesis. This paper explores the concepts of ‘transition readiness’ and ‘value conflicts’ as valuable indicators to bridge this gap and support designers in fos-tering system transitions. Synthesizing insights from literature and previous experience, we propose a first step towards an integrative model for mapping a system transition in a way that inspires design. Our model, called the Transition Readiness Profiles, anticipates the dynamics of a system transition and helps identify how and where design can inter-vene to accelerate the transition. It analyzes the transition at the individual-, organization-, and system level to understand the system dynamics and reveal what organizations can bring forward to foster the transition relative to others. The Profiles capture the relational dimension of a transition by mapping readiness, value conflict, and stakeholder relation-ships and dependencies. @en

Ob aufgrund der Finanzkrise, der öffentlichen Wahrnehmung eines massiven Überkonsums oder des globalen Klimawandels, immer mehr Designer*innen sind bestrebt, ‚der Gesellschaft etwas Gutes zu tun‘. Dieses Interesse scheint sich vor allem auf zwei Weisen zu manifestieren. Zum einen übernehmen Designer*innen und Designunternehmen bei der Produktentwicklung mehr gesellschaftliche Verantwortung.@en

Our globalised world is encountering problems on an unprecedented scale. Many of the issues we face as societies extend beyond the borders of our nations. Phenomena such as terrorism, climate change, immigration, cybercrime and poverty can no longer be understood without considering the complex socio-technical systems that support our way of living. It is widely acknowledged that to contend with any of the pressing issues of our time, we have to substantially adapt our lifestyles. To adequately counteract the problems of our time, we need interventions that help us actually adopt the behaviours that lead us toward a more sustainable and ethically just future. In Designing for Society, Nynke Tromp and Paul Hekkert provide a hands-on tool for design professionals and students who wish to use design to counteract social issues. Viewing the artefact as a unique means of facilitating behavioural change to realise social impact, this book goes beyond the current trend of applying design thinking to enhancing public services, and beyond the idea of the designer as a facilitator of localised social change.@en

Introduction Auditory verbal hallucinations (AVH) are prevalent experiences that can induce distress and impede social functioning. While most voice hearers benefit from antipsychotic medication or cognitive-behavioural therapy, additional effective interventions are needed to reduce the burden of experiencing AVH. Temstem' is an easily accessible and useable smartphone application that was developed by designers in close cooperation with voice hearers and experts. By using language games, Temstem aims to reduce distress and improve social functioning. Methods This is a single-blind multicentre randomised controlled trial with two arms: Temstem+AVH monitoring' versus AVH monitoring' (total n=100). Participants are adult patients who suffer daily from AVH and will be recruited in outpatient units. Primary assessment in daily life is made by the Experience Sampling Method (ESM) and daily monitoring with the PsyMate app. During an ESM period of 6 days, participants assess their mental state (including AVH and context) several times a day by filling in short questionnaires. There are three 6-day ESM periods: at baseline (week 0-1), post-treatment (weeks 5-6) and follow-up (weeks 9-10). In addition, during the entire 10-week study period, all participants monitor their AVH two times a day with a short assessment via the PsyMate app. Participants in the Temstem+AVH monitoring condition are provided with the Temstem app from week 1 to 6. Other assessments made at baseline, post-treatment and follow-up are based on questionnaires and a clinical interview. Ethics and dissemination The results from this study will provide an evaluation of the effectiveness of Temstem, a non-invasive and easily accessible app for voice hearers, and insight into the determinants of optimal use. Results will be disseminated unreservedly, irrespective of the magnitude or direction of the effects. This study protocol was approved by the Medical Ethics Committee of the VU University Medical Centre (METC number: 2015.435/NL53684.029.15). Trial registration number ISRCTN75717636; Pre-results.

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