﻿As a fan of horror games, I happily rush into the arms of whatever scares me, but not everyone is so
poorly wired for basic survival. Sometimes people
- even gamers -
are faced with experiences so terrifying, it can keep them from playing a game they might otherwise enjoy.
The ability to terrify is a greater power than we realize – but it's one that’s actually being used to heal people.
And although game developers are well aware that they have this power, they’re only just starting to use it responsibly.
Games have gotten really good at replicating the physical sensation of being anxious,
because we all totally need help with that right now. When a hunter closes in on you in Dead by Daylight,
you can hear your heart start to speed up –
[sound of a heavy heartbeat]
- and you know you need to hustle.
In Alien: Isolation, the dynamic soundtrack hits you with a painful stinger to really underline the tension,
[high-pitched strings whine]
and then makes you hold your breath to avoid being found.
The Last of Us Part 2 uses this anxiety-driving capacity to turn otherwise familiar platforming
sections, into moments of acrophobic character development for Abby.
The game features a dynamic system that increases Abby’s reaction the more you lean over a ledge;
her breathing increases, the camera loses focus, the angle changes and we get just... just a whiff of
fish-eye to really make us feel the uncanniness. These games emphasize this physical reaction
to put your brain in the emotional space of feeling afraid. Which is a brilliantly
backwards version of how jumpscares work...
[the door slams open as Ripley grunts in fear]
There’s a sudden sound or movement that startles you, triggering a physiological response which indicates to you that you’ve been scared.
But here, you experience someone else having a physiological response which causes you to think
"oh, I should be concerned too," so your body starts to react in kind.
There’s a whole host of games that are anxiety-inducing without really intending to be.
Yeah, I’m talking spiders. And giant spiders.
They’re a classic game enemy, a mid-level creature that always announces its presence with a smattering of webs.
For me, donking a spider upside its many-eyed head is just another gameplay experience,
but for people suffering from specific phobias, it can be a deal breaker.
ADAM: And we just noticed that there was an intense fear... just... paralyzation of when they first, when players would first see the spider,
either in the video or even on, laid on gameplay, and they would just walk away.
JENNA: Adam is the Director of Grounded, a survival game that’s got more than its fair share of legs.
ADAM: We knew that the spiders are scary.
You know, there was a lot of jumpscares on the team already. But I think that was the
first time when we really started discussing that at a more serious level on the team.
JENNA: Generally speaking, most game developers want people to play,
and like, their games. And the team at Grounded especially wants their game to be playable by
everyone, including people suffering from arachnophobia, so they knew they had to
find a fix for their spider problem. But when you’re dealing with serious phobias, you have
to understand exactly why people are afraid, in order to know how to deescalate that fear.
Luckily, neuropsychologists have already spent decades researching why games can
make people anxious – and how they can be used to treat mental illness.
SKIP: I always make sure
that I include the term exposure therapy because it's not VR therapy. VR is a tool.
The therapy is exposure therapy. That's what we're delivering.
JENNA: This is Dr. Skip Rizzo, the neuro-psychologist who
directs the medical virtual reality lab at the University of Southern California.
He’s part of a team of researchers using VR to treat veterans suffering from PTSD.
SKIP: PTSD is the result of somebody having
a series of highly stressful events or one very impactful threatening event.
So you see people three months down the road,
still feeling as bad as they felt the day after the traumatic event.
And that's not a sign of weakness. It's not
any kind of a judgement, value judgment. It's just the way people’s brains react to
certain traumatic events and the residual impact that those traumatic events have on the brain.
JENNA:That trauma can manifest itself as PTSD or in some cases, as a phobia. To absurdly oversimplify things,
the thinking part of your brain can be totally aware that you aren’t in danger
– you’re on land, sharks can’t get to you.
But the feeling part of your brain is convinced that you are under serious, imminent threat
– because what if land shark?
When triggered, the feeling part of your brain will put your body in a state of stress that is, in a word, bad.
PTSD and phobias can be treated with exposure therapy, where a patient is
presented with the fearful situation but in a safe space, and given time to deescalate
their emotional response. They’re basically relearning how to feel about an experience.
SKIP: But they would do it because they knew it was
VR in the frontal lobes, but their limbic system was reacting like it was a real thing. And that
was enough to show this what we call extinction learning, where you're exposed to what you,
you're fearful of. But you're in a safe place, and nothing really bad happens. And as you expose
yourself repeatedly, the fear extinguishes the limbic system, the amygdala gets less activated,
maybe a little bit more frontal lobe control of modulating emotion, and so on.
JENNA: Traditional imaginal exposure therapy relies on patients imagining themselves
back in the traumatic situation, which in and of itself is traumatizing. It’s still a useful
therapy, but having a game or VR-based scenario removes the patient’s burden.
SKIP: VR’s ability to sus-,
to get people to suspend disbelief, where they know they're in a lab or a conference hall,
but their brain is reacting emotionally to the stimuli in the VR environment. And that's what
we try to leverage in all clinical applications, we want to capture that emotional reaction.
JENNA: Dr. Rizzo’s team uses an app they developed specifically for this purpose.
BRAVEMIND was made in the Unity Engine and features a variety of scenarios,
to address specific traumatic situations.
But that’s just the tip of the iceberg when it comes to how games are being used therapeutically.
SKIP: Helping to define a
treatment plan for rehabilitating brain function… working with people on the autism spectrum
for say job interview training … multiple sclerosis
or ADHD... pain management ... mindfulness... relaxation, meditation strategies ...
Part of what makes both games and VR so good at healing or messing up our brain-meat is what
psychologists call a “sense of presence,” which is kind-of adjacent to immersion.
SKIP: That's a technical description, immersion.
Presence is more the psychological reaction to that immersion.
JENNA: It CAN be affected by how good the graphics are, but it’s more about how personal or interesting
a simulation is to you, the player. The research conducted in the mid-90s,
with mid-90s VR graphics, showed that phobic patients still felt a deep sense of presence
when the simulation was specifically relevant to them…
by being terrifying.
So I might feel a high sense of presence when I’m fixing a generator and hear that heartbeat,
because I know I’m in danger
(of losing the game).
But I could hop into a VR sim of a glass platform hovering over the Grand Canyon and not feel a sense of presence
because I’m not afraid of heights.
I’m not afraid of anything except losing.
Players who have a strong emotional connection to a situation feel a high sense of presence.
But on the flip side, a low sense of presence is how you can end up with a Sea of Thieves developer who’s afraid of water.
JAMES: And my worst fear, ooh, I probably say, I probably say is probably drowning. I am really bad with water.
JENNA: James is a Lead Engineer at Rare and I was genuinely very surprised when he said this.
JENNA (Interview VO): That’s -- I’m so tempted to pivot this
entire interview to delving into that, because you are working on Sea of Thieves, correct?
JAMES: Yes, yes.
JENNA: Ha.. wha... Is that… Do you find that that comes up at all while you’re working on the game?
JAMES: No, I think that… my, my mind at least can like,
make that distinction between like the...
I don't mind going down into a shipwreck in Sea of Thieves. Because I know, there's that barrier.
JENNA: James isn’t phobic of water, just afraid, and his emotional response isn’t strong
enough to overwhelm the knowledge of his safety. His immersion may be
high, but his sense of presence isn’t so strong that it makes him stressed out.
Armchair psychoanalysis aside, I was actually talking to James because
he’s working on Rare’s continual quest to improve accessibility.
JAMES: Back, back at the start,
there was all the design notion that we should try and make the world tactile and sensible,
you know, if you're going to pick up a chest, you need to try and put some effort into it,
pick it up and leg it off. So we'll hold down the button for it, which sort of makes sense
in isolation, if you're trying to get to the level of immersion, but actually, then you
now look at it through the accessibility lens, and you don't need to hold it down.
JENNA: The Sea of Thieves team recently added an auto-float mode that cuts down on the
amount of button-pressing needed to swim. And this had an additional, unexpected benefit;
Thalassophobic players - that is, people who are afraid of deep water - can turn on
auto-float and remain blissfully above the waves like a sweet lil floatin’ coconut.
JAMES: So it's
a nice happy accident. And I think it leans into a philosophy that Xander Ashwell, our,
our accessibility lead at Rare, tries to push, like options, give people options, don't assume
you know what they want, give them options to try and tailor the experience to their own needs.
JENNA: Experimenting with options is exactly what they’re trying with Grounded over at Obsidian.
The “Honey, I Shrunk the Kids” aesthetic means that giant bugs are a given; you’re at the bottom of the
food chain now, and those ladybugs you used to sass are ready to even the score. But the team
didn’t want people to avoid the game just because of one enemy group, so they set about trying
to find a solution to that age-old koan, how spidery does a spider have to be, to be a spider?
ADAM: And what we
found that there was a lot of studies on why people had this reaction,
but not a lot of studies on like, if there's any sort of ways to mitigate it.
So they conducted studies themselves to figure out where on the spider the scariness is stored;
specifically, it’s not in the orbs. The result is this: a kind of spider-slider,
which also happens to be my favorite Steak ‘n Shake burger.
This feature works client-side, so my friend canbe playing at minimum spider
while I play at maximum spider. We both have the option that we want and that’s what
the future’s all about!
Equity, and maximum spider!
Both James and Adam were confident that this is the start of a greater
accessibility awareness within the games industry.
JAMES: The movement’s almost spread around the studio, that people realize
that accessibility is within the hands of the designers, the engineers, the the artists,
and so if people really care passionately about something they can try and push things through.
That’s incredibly important because, for all we talk about accessibility “options,”
they aren’t all that optional for a lot of people. A lot of the time,
it’s the difference between being able to play or not play a game,
and as I mentioned before, developers do… actually want you to play their games.
And if that means ethically removing the legs, mandibles, and eyes of a spider, by god so be it.
Tetris isn't something that is going to, you know, you can make a case that it transfers to real world activities,
but speed of processing, visual spatial abilities, the kinds of things that we try to improve with people brain injury,
you know, that... that's embodied in that game.