Hello and wellcome to my presentation on "Playful User-generated Treatment".
Around 8 % of the western population are afflicted by a simple phobia such as fear of heights
This fear can stand in one persons way and
a treatment is oftens recommended. The most common therapy for such phobias is
exposure therapy. “Exposure therapy is a psychological treatment
that was developed to help people confront their fears. [...] In this form of therapy,
psychologists create a safe environment in which to ‘expose’ individuals to the things
they fear and avoid."[4] Reliening on physical stimuli, it can be challangeing
to implement and manage the exposure therapy. Therefore, a growing body of work is evidencing
that exposure therapy can successfully take place in VR -- VRET
However, only very few afflicted people undergo a therapy [74] and even if they do, many abandon
it, often due to a lack of motivation [5, 16, 20, 50].
Game design has been successfully applied as a motivational strategy in many areas among
health and therapy. But, there has been little research that systematically
analyzed effects of game elements on mental health [13].
It can be argued that common game design pattern may interfere with requirements for a successful
treatment. Therefore, first we were interested in (RQ1)
"What are the specific requirements for a game-based virtual reality exposure therapy
application?" We started with a requirement analysis from
two interviews with professional therapists who had a background in traditional exposure
therapy. Both therapists were supportive towards employing
game design for VRET We coded the interviews and derived 5 requirements:
R1: Motivation: VRET should emphasize the sense of autonomy.
R2: Communication with the therapist is essential (motivators, educators and companions )
R3: Scenario habituation: the patients need enough time to reach habituation.
R4: *Non-distracting tasks*: the patients should focus on the exposure and DO NOTHING.
R5: Physiological sysmptoms: VRET should not affect negativelly, i.e. basic usability
After identifieng game design as a valuable approach to engage UX in VRET we looked at
"How can motivational game design be applied to virtual reality exposure therapy?"
From the literature, we found 'emotional challenges' that confront players with emotionally salient
material through narratives, frightening scenarios or strong characters [30, 37] as our design
direction. Our design address intrinsic motivation through
creativity. The approach splits the VRET experience into
2 distinct phases: 1. The design phase, where participants use
a terrain editor in VR to create their exposure 2. The actual exposure phase, in which the
participants enter their (self-designed) terrain at full scale
It is designed to foster intrinsic motivation by creating an engagement with the exposure
through playful creative action (R1 Motivation). Further, it empowers patients to adjust the
degree of exposure It can also be included in the preparatory
talks between the therapists and the patients in VR (R2 Communication)
We evaluated the game design in a lab study with 31 non-acrophobics.
The study investigates the effect of content creation on player experience and height perception.
Our study included 2 conditions in a mixed between-subjects setup with repeated exposures
to different heights. We measured motivation, affect and anxiety
on subjective self-reports in VR.
In the PUT condition (PUT) the participants shaped and decorated the terrain which they
then entered in first person. In the control group (CTRL) the subjects could
only view a pre-defined terrain they were about to enter.
This is how the VR experienced looked like Our results show:
The results show that the VR experience created some sense of anxiety with no difference between
the conditions. Between conditions, we measured a higher interest-enjoyment
in PUT over CTRL Qualitative responses tend to support that
PUT facilitates creativity, enjoyment and the sense of „being related“.
After we found PUT as a considerable game design, we aimed to validate the apporach
with regard to its applicability in a real-life therapy scenario.
Therefore, we surveyed a distinct group of 6 therapists
The online survey was targeting questions concerning the PUT.
The experts watched a 3 min video which explained and corroborated VRET and demonstrated the
PUT design. All experts agreed that giving the patients
the opportunity to create the environment for later exposure is a valuable approach.
The majority stated that separating therapy into 2 steps (design and exposure phase) may
have a positive impact on the course of therapy. The usefulness received a score of 3.7 out
of 5 The distraction of the design was conidered
low with 2 out of 5. Some therapists would like to cooperete with
patients during the design phase Several statements were made that VRET should
only accomplany ET but not replace it. An extended version and an indepth discussion
of this expert survey is provided in our concurrent late breaking work
We investigated game design for VRET with a multi-angled approach.
In the requirement analysis, We found the combination of motivating (R1) and non-distracting
game design (R4) a specific requirement for VRET that is rarely discussed in the literature
on games for change. The requirements led to the PUT design approach
that separates ET in VR in two phases of design and exposure.
Our two validation studies show that PUT is well applicable.
In particular, the user study reveals that the users’ content creation increases interest
and enjoyment without notably influencing affective measures during the exposure.
These triangulated results corroborate that PUT appears to be a viable concept that warrants
further development and study.