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Biofeedback Games that Promote Emotional and Mental Health

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Biofeedback Games that Promote Emotional and Mental Health
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Worldwide, anxiety and depression are the leading cause of disability, and the most prevalent mental health problems. Innovative, scalable and engaging intervention approaches that target these mental health concerns are urgently needed
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form and all the young rule and all the means and
be thank you very max and so
soon as I get my slides and I can talk examiner can I can do otherwise and so today I'd like to talk to you about and a program of
research and an approach that we've been taking trying to develop and evaluate gains that are and designed to promote emotional health
and well-being in children and adolescents in particular and I wanna tell you particularly about some of the biofeedback games that we've been designing and testing and a little bit about myself
I I and a developmental psychologists by graduate training and I got my PhD University of Toronto most of my research has been on trying to look at the interventions that work for children that have anxiety and depression problems as well as aggression and for a long time I try to look at the kind of conventional programs like cognitive behavioral therapy which if you were in the last session you're a little bit about and that's basically the evidence-based practice for children with anxiety and depression problems and for a long time I ran randomized controlled trials with these conventional programs in schools and in mental health agencies and we continue to get reasonable results there the small to moderate effect sizes that we are normally most people get but when they run these trials which means that anywhere between 40 to 60 % the kids aren't benefiting but we still find a reasonable factory for psychology that's pretty good actually but I started to get really frustrated with those results and so what you see now is really the results of what pushed me into thinking about games for mental health so here's the
problem the World Health Organization a whole lot of other people a lot of research in meta-analyses have shown us the anxiety and depression are the leading cause of disability worldwide I can give you numbers they run in the tens of billions across the world about 1 in 4 children or adolescents so up to 18 years old it has a diagnostic that diagnosable anxiety disorder this is the same for depression 1 in 4 of us here in the room has been diagnosed or is diagnosable almost everyone I think all of us know somebody with anxiety depression if we ourselves and not suffered it's a huge problem and about 40 per cent of people suspected to have a promise but uh remain
undiagnosed in terms of prevention and treatment as I said we generally get the small to moderate effect sizes and 80 per cent of people who really need the help don't seek treatment mainly for 2 reasons 1 is stigma so we don't wanna say that were having problems that were vulnerable especially adolescents and 2nd is detection problems that teachers parents and they even mental health IT and experts who were more concerned with aggressive behavior problems can't see the anxiety and depression early enough to get the help the people need but certainly GP is general practitioners are having a really difficult time identifying these people but
so 1 of the ways that we can I address a whole lot of problems when it comes to the treatment and prevention of mental health concerns might come from the use of video games so let me tell you why 1st in most of our conventional programs kids are bored it's a lot of these didactic kind of thing that I'm doing right now with you the kids listening taking notes on the thinking traps they have and how they should think that change their thinking problems into more positive habits and we give them lots of exercise and homework to take home but it's dead boring under normal circumstances they also don't get to practice the skills that we try to give them in emotionally engaging context those of the context where they most need the skills they need to learn how to use their restructuring and reframing of cognitive bad habits in the context when they're really anxious or when they're feeling depressed and isolated so they don't get to get out practice usually in a conventional programs cost and access you there's almost no that it's it's a big problem with games you have very little stigma as well there very few people that wanna go into a a school program and say please sign me up I have a problem with depression anxiety and I'm a 16 year old this huge stigma but if you had teams that could actually train K as same kind of skills you might have a different effect on kids and personalization usually what we do in conventional CBT programs cognitive behavioral programs is we take the same program and we give it to a classroom full of you guys right and we say this is the kind of things that you all have to learn equally at the same time at this with the same amount so there's no personalisation to each of our own issues what kinds of anxieties we have with social anxiety or do we have phobias of heights and so what personalization is an a wonderful thing that games can give they can eat at the offer this opportunity to tweak and dynamically adjust to each player in where the state that they're in emotionally in terms of this as skills they know and so on and most of you know here most of you play games and you know that they had just to the the let let the level and the skill at capacity of the player the
so we have recently an army more recently in the cup last couple of years out launched again gem lab which is 2 games for emotional and mental health and we have the 3 sort of pillars to the gem lab we have research which is really important that comes obviously from academic background and we're really interested in disseminating this research and I 1 end of the and was talking about some less conventional ways of disseminating research and that we're thinking about and then we have gained design and this part is what's pretty pretty much litany up for the last 2 years is working with artists and designers together with the scientists to design games actually will not only help kids get better but also do like them engage them and bring them into a space that is an artful and experience that they can and transform their own emotional
habits so let me tell you about some of this multidisciplinary game designer were involved in
skull the gem framework and where really coming
from a perspective that is some of you know the sort of what they're calling serious games world and you know that there's a whole lot of people in the education space in medical space trying to can create what's called serious games I hate the term serious games I hate it because the whole reason I went into game design using games and i in these intervention purposes was to stop it being serious with kids was to go to the level these giving the put to like you what would make you want to learn something you knew what would make you transform your habits that you have grown into 4 8 10 12 14 years and space to respect them it's a place where you want to play with them and I don't think that serious so it this is a lovely quote that I love then it really points to what we do at the gem lab is to try to prioritize art at the same level as the science and deep down a scientist I will show you randomized controlled and data but I wanna say that is really really important also prioritize the art so Leo Tolstoy said real science studies and makes it accessible that knowledge which people at that period of history think important In real art transforms this trees from the domain of knowledge to the domain of feelings and love that's exactly what I'd love to try to do the and so
on and how many of you know Maurice index work the that was about race and many at least half of you know no matter what country mn and so he was a real strong proponent of writing for children at their level which means at the same level that you and I are at it meant writing about the range of emotions not happy happy to enjoy it once but the anxious once the angry frustrated ones and the depressed 1 so in all of his books he had this range of emotions depicted and that's what we wanna do our
games he said grownups desperately need to feel safe and then they project onto the kids but when none of us seem to realize how smart kids are they don't like what we write for them what we do shop for them because it's vapid so they'll go for the hard words that go for the hot concepts will go for this stuff or they can learn something not didactic things but passionate things and that's how we overcome are
demons that's how I think we get through our anxiety in isolation and sadness is by overcoming them and and addressing them and of course games are this
beautiful context games are emotional at the very best and artists as artistic interactive pieces games can 1st of all mirror one's emotional experiences and provide rich experience for self-reflection and eliminate pathways to choose transcend pain that's how I think of games the best of games and the the some of my you know favorites that many of you may have recognized so what we
do in the science part of it is that we start off with this framework where the scientists and academics get together with conditions so these are that clinical PHD and Masters clinical and conditions in mental health agencies and we sit together with the use or players and you're experiencing anxiety and depression and we think about how we can take the scientific principles meld them with the clinical techniques and then work with game designers from the very beginning this is at the level of when we're even applying for grants and talk with them about what a game would look like that would have an impact on but but still use clinical principles that have an impact on anxiety and depression and then we do research both outcome research with randomized controlled trials as Wells process research this is research where we look at what the actual game players in the game did and we track it in Game with back and data but also by coding what happens to the face of the children when they're playing the games and then we look at what patterns are associated with better versus worse outcome so that we can then feedback that research data into the game design and strengthen Taylor those games but finally we wanted disseminate to schools to mental health agencies and so on this is the obviously the the part that we want have an impact with the research on Anna development but we also want to commercialized and have no idea what the script things had that in academic context it's immediately where everybody come to the dude mother dies and yet and I wanna make a very very strong case for the fact that as academics need to get the hell off of our ivory tower and come down to the place where the parents and kids are actually accessing these products that could actually help them it is not equal to make money if we can then take that money and make more games that help more people and actually this is the way to have access probably in an unprecedented way that we we've had so those was the the end of my talk but not all excited
on during our design process we've worked with us and we continue to work with really important partners out in the commercial and professional game world so people who were working at entertainments arts in Microsoft on people at USC and Robin honey Keith and who was the proof that and exactly producer journey on and so on and these people are the ones that are actually designing the games with us and helping us they know how to do this for and entertainment purposes and the really important for
our group so it seems simple right we take science take the scientific principles we translate them
into game mechanics the beautiful engaging we then change something in the
mind by these kids playing the games and we have happy healthy people and gratified that simple I'm not going to get into this because
of time constraints but we have a whole process that is an entirely different talk that really goes into how we create a vision and creative brief that that focuses on us on the vision and they're separated the game design and the intervention a psychological change goals are actually different at 1 point they interact with the different and we need to keep that that separate so that we look at user platform specifications back and specifications and so on then we take our vision there in the middle and we paper and pen and paper and clickable prototype it so that we have that we make sure that we're looking at the same thing and we pilots and validated both in terms of the playtesting usage as a test and an end user engagement but also in terms of a psychological mechanism that mechanisms that all happens before any code is done and this is really important for those of you who were interested in designing and developing these games because people go in go couldn't decide killed aims of goes immediately the code and there's so many specific so you have to get down in terms of undersigned standing psychological mechanisms but also the game
mechanics because the bottom line and the becoming a lot of funding can go to waste love this quote by Frank Lloyd Wright you can use an eraser on the drafting table or sledgehammer on the construction site and the reason we do all this back in work before we started encoding is because it's really really expensive to start changing beautiful games after they don't work the so
what we do in our processes we still start then finally with a coded playable prototypes the and we have 2 streams of development that goes on and the interactive so game design perceived in intervention design proceeds but they have to inform 1 another and just to take a piece of that and tell you a little bit more about that I'll just give you an
example so in terms of the game design in the 1st playable prototype what we want know is do we have kids engaged to they like it is a fun and do we have the ramp up rights are they getting trained up on the scale that we want really quickly do they understand how to play the game really basic suffer begins at in terms of psychological or intervention design are we actually triggering the emotions we want we want to trigger anxiety so that we get these kids to go through insights are they feeling anxiety in a game and reactants a lot of people start a game and they start feeling manipulated because we know it's a good good games do we have any of that and then they stop ignore that game right so do we have any reactants replicas if so we have to be infinite down cognitive load and so on these just 1st things that we have a 2nd prototypes that
2nd prototype then gets based on that data gets then had tested for more refined issues not only engagement but now does a mechanic work and that is a replay ability to people care about playing the game over and over with the kid pick it up by themselves in terms of the intervention design are we actually having an impact on anxiety depression or and things like connection when we wanna build social or interactive games so this is sort of the process the general process that we go through let me give you an
example of a and a couple of the games were
working on the 1st is my light the so my lightener that feedback 3 D and video game to prevent and treat anxiety and you'll see names under their which are great graduate students in my colleagues that are working on the spur of projects game play was very um game design studio that we worked with and so the game works like this is the
neurofeedback game you put this headset on and it reads your brain waves as a 1 channel EEG headset and OK the more relaxed you the brighter your light shines in this game the more anxious you the darker when scary things happen in the game you become anxious and it gets darker in order to be able to go through the game is a haunted like many horror game for kids and its end because the important thing here is that they get to learn to recapture the calm after they've been scared in that they can do it this to
evidence bound techniques that we took from clinical treatment that we know work in clinical treatment 1 is exposure therapy simple idea what which do in clinical contexts is that we train and patients to be able to deal with their fears by coming closer and closer to the thing they fear while they engage in a relaxation techniques like deep breathing muscle relaxation and so on OK so that's exposure therapy and this is exactly what they do in the game they go in they have to go and face the spheres in the game and they get over their fears by calming down so the light exposes the darkness underneath and we
also use attention bias modifications of people who were anxious like if I was anxious right now giving a talk they are a hyper vigilant to cues that a negative in their environment and they don't pay attention to potentially positive cues German audiences and Dutch audiences always trigger my anxiety because they have flat affect Canadian audiences which I am Canadian do the polite smiling think and so my hands how sorta gets triggered here and does not thinking about and it's a really interesting and completely consistent thing right so anxiety disorder people there would only be focusing on those negative faces and I wouldn't be focusing on the delay for positive smiling faces as well what we try
to do with attention buys modification is get people to focus more on the positive and less on the negative through a whole bunch training is the game but a trailer for the game the the the
a a so that's had set out I'm
really loosely have to face the scary things that Paul's and you think of it as the the show
all of a sudden this modification have this is smiling face
How can I really hard to remain calm in the context of the scary thing is that this is think of and
and so on and on and
and increasingly harder so the theory behind them
and and the the and the and this over and over again this
time of 6 hours of game play
and so what we do in terms of the research aspect is we test 1st the design aspects so were they actually engaged in what we design for them to be engaged with so in other words if they're running away from all the scary stuff but they're not they're not actually motivated to stay there to try to keep calm and uncloak those negative things we screwed up something we have to make sure that the design is motivating the reward system that we want from them right that you love this picture but on and we also do a
lot of videotaping of the kids and we look at and code for that affect emotional and expressions on the faces to make sure that and they are experiencing anxiety fear spreads but also the concentrating the delighted and and so on and they were really happy to know that
is that we last year that we got to a nomination for the most significant impact and at games for change which is something they were at least on the right on track for
OK and then we do these pretty intensive randomized controlled trials OK we screen about 12 hundred kids and and we look at the total anxiety before they've played a pre post is after they played and follow up really importantly is 3 months after they've stopped playing the game or whatever the control group kind so I'm AEC again tell you about 0 sorry this is not at the rate of order OK plot that let me just show you this
OK this is the 1st study them and tell you that the mine lights started high anxiety the kids got less anxious significant less anxious at posttreatment so after playing for 2 and half weeks and then after they stop playing the anxiety remained low this is a huge huge promising effect for us the control group which was another game did improve as much from pre-to-post but eventually caught up so we were at least In a promising space but we were still worried maybe a game isn't as effective as it could be we made some tweaks and then we have now I can assure you the whole thing sorry here so this is the 2nd 2 lines you'll see is random at the 2nd randomized control trial with a 2nd group of 12 hundred had their kids who were assigned to either mine light or cognitive behavioral therapy now done with their and and we tried to compare the 2 and what you see is perfect almost overlap in impact kind of URI overlap between the data where we are basically being as effective as a game as cognitive behavioral therapy and the improvements last and continue wants us something about the game they continue to take on equally as a therapeutic context to review your encouraged by that in terms of
next steps would like to be able to port to mobile so that a lot of other people wanted and other kids will be able to use it on I am iPads we wanna use of heart rate variability and instead of or additionally to the narrow feedback and because it's just a little not more accessible we wanna commercialized so that a lot of people get this into their hands so instead of having just 300 kids that I have access to and add context of a school we wanna be able to get this out into the hands and formal price by the winner of the packets it is quite cheap on and then we wanted to uptake research how many kids acts as a handy families by the game in which the impact later on I wanna just
ended my last 3 minutes with and a discussion about deep which is a biofeedback game that uses a
belt and n is the VR game and to give you a very short
um that the the
the and
and the theorems and meditative virtual
reality games that you control by breeding
like a lot of people have had problems with anxiety and occasional bouts of depression over the years of 1 of the most
effective ways for me to navigate this this thing is true reading
exercises pranayama yoga and meditation it so happened that when the Oculus
Rift was 1st Oaxaca was going through particularly difficult something that was rather intense when my Oculus finally arrived I started to build meditation chambers star field of ocean
scripts to just kind of sit in and to just be outside of the world of causing this eventually it occurred to me
that perhaps it will be possible to incorporate the
breathing exercises as well and so from there managed to pack together some early versions of the breeding of using that we know and stretch sensors and a lot of good so
control so the idea is that as you
breathe in you go up in this and underwater landscape as you breathe out you go down and we train non didactically without ever saying anything these this deep breathing diaphragm reading that we know physiologically regulates people and again we're testing for emotional Design were also
now looking at the extent to which people pick up this breathing and technique through the game how fast and the different types of people who come into the game and the different patterns of change so that eventually what we can do is take that data and tailor it and using a i system that changes the environment that these people are in depending on where they start off with so that the the experience is tailored to each person but so I'll end
with this last part where we're
going is it an interaction in social games the DPR game as well as my might we want to make social so that we get kids working together and playing together to help each other's anxiety levels of depression as well as parents and children working together and really the social atmosphere is where we wanna
go because we're not into the idea of kids stuck on the phones I'd have has all the time what we really want is these kids to be able to have a context where they can safely engage in those things and put them down and be confident and happy and connected socially with others in their environment so that's where we really wanna get to
is is going from our research to validated mechanics to commercialization that might have been impact it's unprecedented for us in clinical psychology thank you very much
you thank you we now have some time for being 1 of the questions so far this
1 no my son like UGC makes life events get and
you no because I was at a time when
you have a going could any other questions this I is 1 in the back None of these of the mind because we wanted to the from which all thank you how much
funding data for the lab uh the mind
this is the 1st question everybody once said that the game cost approximately 250 but it's that's a huge huge discounted price because we did
a lot of in-kind research and so on so I would suspect if you're really doing this kind of level again it would cost about twice as much right now now in I
actually use the door there was just 1 to save a really idea and you think you have to keep you keep doing is the 1st thing I think it's great and because we don't have much time
left I would say we just go with the VECSYS within fake they cyanides research
you know many things