The Efficacy of Virtual Reality Biofeedback Game DEEP:

Psychological Need Satisfaction, Motivation, and Anxiety Reduction

GAMES FOR HEALTH EUROPE 2016

L. A. van den BergMSc. Game Studies / graduate student MSc. Medical Informatics

DEEPA Virtual Reality Biofeedback Game

DEEPVirtual Reality Biofeedback Game

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• Developers: • Owen Harris • Niki Smit (Monabanda Play)

• Virtual Reality Biofeedback Game• Original goal: calm and soothe the player

DEEPVirtual Reality Biofeedback Game

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• Developers: • Owen Harris • Niki Smit (Monabanda Play)

• Virtual Reality Biofeedback Game• Original goal: calm and soothe the player• Takes place in an underwater world• No in-game objectives (e.g., collect points, etc.)

DEEPBreathing Mechanics

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• Controlled through diaphragmatic breathing. Semi-transparent circle that corresponds with the player’s breathing.

• ‘DEEP belt’

DEEPBreathing Mechanics

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• Controlled through diaphragmatic breathing. Semi-transparent circle that corresponds with the player’s breathing.

• ‘DEEP belt’• Demonstration:

VR & SERIOUS GAMES‘It’s not all fun and games’

DEEPCollaboration Developers and Researchers

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• ‘Let’s just make a game.’

• Collaboration Behavioural Science Institute & developers DEEP• ‘To further develop the game as a potential tool for prevention and treatment of anxiety using

biofeedback, relaxation, and other existing therapeutic elements.’

• Panel discussion tomorrow by researchers of the Radboud University.• Track 5 | Mental Health Part 2 (14:00 – 15:45)

PILOT STUDYA Summary

PILOT STUDYObjectives

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• Anxiety reduction

• Intrinsic motivation / willingness to play

• Two of the three psychological needs1

• Role of instructions

1Ryan, R. M. and Deci, E. L. 2000. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55, 1 (2000), 68.

AUTONOMY COMPETENCE

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PILOT STUDYInstructions

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• Two different trailers

‘SERIOUS TRAILER’ ‘NON-SERIOUS TRAILER’

Visual aspects to empathise anxiety reduction

“Featured in:” acclaimed associations

Quotes of players about beneficial effects

Instructive ‘serious’ closing message

Textual aspects that empathises fun and calming aspects

“Featured in:” news or entertainment platforms

Received nominations and prizes

No imposed goal in closing message

PILOT STUDYObjectives

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• Anxiety reduction

• Intrinsic motivation / willingness to play

• Two of the three psychological needs1

• Role of instructions

• Qualitative data:• Interviews• Observations1Ryan, R. M. and Deci, E. L. 2000. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55, 1 (2000), 68.

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AUTONOMY COMPETENCE

PILOT STUDYSet-up

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• Overview:

DEEPHeart rate (ECG)

LogbookExperience

(N = 41)

Block 1 Demographics

State Anxiety (STAI)Mood (PANAS)

(N = 41)

Block 2Mood (PANAS)

Motivation to play(IMI)

(N = 41)

Non-serious trailer

(N = 21)

Block 3State Anxiety (STAI)

Mood (PANAS)Needs satisfaction (PENS)*

Intrinsic motivation (IMI)Extra questions*

(N = 41)

Time

Serious trailer (N = 20)

*Permission and access to use PENS Metrics and Methodologies was granted by Immersyve, Inc.

PILOT STUDYSet-up

8

• Overview:

DEEPHeart rate (ECG)

LogbookExperience

(N = 41)

Block 1 Demographics

State Anxiety (STAI)Mood (PANAS)

(N = 41)

Block 2Mood (PANAS)

Motivation to play(IMI)

(N = 41)

Non-serious trailer

(N = 21)

Block 3State Anxiety (STAI)

Mood (PANAS)Needs satisfaction (PENS)*

Intrinsic motivation (IMI)Extra questions*

(N = 41)

Time

Serious trailer (N = 20)

*Permission and access to use PENS Metrics and Methodologies was granted by Immersyve, Inc.

PILOT STUDYResults

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• Marginally statistical significant decrease in anxiety levels after playing DEEP. p = 0.055There is no significant difference in anxiety levels between the two groups. p = .906

• Marginally significant difference in willingness to play between the two groups. Those who’d seen the serious trailer were less motivated to play than those who saw

the non-serious trailer. p = 0.059

• No significant differences found between the two groups with regard to psychological need satisfaction.

However, post-hoc research indicated that in-game autonomy can be a predictor of anxiety reduction. p = 0.04

• No significant difference in intrinsic motivation between the two groups. p = 0.94

• No significant difference in grading DEEP between the two groups. p = 0.43

• Qualitative data:Semi-structured interviews• 88% of participants described their experience as enjoyable.• The breathing controls were deemed difficult by 73% of the participants.• 15 participants felt that they ‘cheated’ with the breathing controls.Observational data• 13 participants spent ¼ of their gameplay duration (≥ 2:30) in a non-interactive environment.

TAKE HOME MESSAGESConclusions

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With regard to DEEP:1. Playing a ten minute DEEP session could result in anxiety reduction, demonstrating its potential as

an intervention for people with anxiety problems.

2. There is an indication that a serious trailer results in players wanting to play the game less when compared to those who have seen a non-serious trailer.

3. Post-hoc research revealed that in-game autonomy could potentially be a predictor for reduced anxiety outcomes.

• Improvements must be made to the game.

• Future research and testing is needed.

With regard to serious game development:• ‘It is not all fun and games’ - What do you want to test?• Explorative studies can provide you a lot of insight.

• Collaboration research and serious game development.

ACKNOWLEDGEMENTSA big thank you to…

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• DEEP Developers:• Owen Harris • Niki Smit

• Dr. ir. Marieke M. J. W. van Rooij• MSc. Joanneke W. Weerdmeester (PhD-candidate)

• Dr. Frank Nack • Games for Health Europe

QUESTIONSThank you for your attendance and attention!