Published October 14, 2011
Curing Anxiety with Games
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Justyn Iannucci

What comes naturally to you? Waking up seems like an obvious choice. Perhaps going to class every morning? Having a conversation, maybe, or texting a friend about the latest gossip? For most, these daily activities have become a convention, something they’ve dealt with so often it’s become second nature. Why would you need to think about the way you tie your shoes when you have homework, clubs, sports or “the future” to worry about?

However, for some, this doesn’t hold true. What many view as mundane, whether it’s greeting a passing friend, answering a question in class or even washing their hands, can be a daunting obstacle for those suffering with social anxiety or obsessive compulsive disorder. Scientists and researchers have been trying to determine the causes of these disorders in teens for decades, just as intently as they have tried to find effective treatments. A small team of RIT students and faculty, tucked away in a small computer lab, is attempting to combine therapy with an unexpected field: video games.

Led by Stephen Jacobs, an associate professor in the School of Interactive Games and Media (IGM), the team is working to combat anxiety disorders. To that end they’ve developed a video game that will help patients deal with anxiety by making them the star of their own world. Players’ personal interests and problems affect game play, and game progress is matched by patient progress.

BUILDING A TEAM

While Jacobs may be leading the project, he’s far from alone. Dr. Laurence Sugarman, director of the Center for Applied Psychophysiology and Self-Regulation; and Robert Rice, an assistant professor at St. John Fisher College’s Mental Health Counseling Program, have contributed their knowledge on psychophysiology and therapy to the project. The faculty oversees the technical team, consisting of three Game Design and Development students working on the project as a co-op: third year Ivy Ngo, fourth year Jack McDonald, and fifth year Kenneth Stewart II, who is double majoring in Computer Science.

“I focus on, simply put, helping young people use their innate abilities to control stress and cope [with problems],” says Sugarman, lounging on a couch in the IGM offices. He is surrounded by most of his team: Stewart, quiet but focused; Ngo, cheerful and excitable; and Jacobs, a natural ringleader who heads the discussion. While the team initially does not seem complimentary, their friendly and helpful nature makes it evident they were born to work together.

Sugarman reveals that the impetus of the project was a conversation between himself and Rice, both of whom worked as pediatricians in the Easter Seals Diagnostic and Treatment Center in New York City. Sugarman’s focus lies in psychophysiological self-regulation, which he defines as “the clinical work that has to do with joining your brain and your body,” while Rice’s focus lies in helping patients think about and externalize their problems differently. Both Sugarman and Rice were hoping to find better techniques to help their patients, as they both tended to hit the same road block: disconnect. Explains Sugarman: “My clients were looking at biofeedback screens [of themselves] that had come with this proprietary software and [were] saying, ‘this doesn’t really relate to my life.’”

Sugarman joined the RIT faculty towards the end of the 2009 academic year and expressed his desires for a project that could meet the needs of his therapeutic work while staying relevant to his patients’ lives. Sugarman had considered turning his project into a video game, and following a meeting with Jonathan Schull, the director of RIT’s Center for Student Innovation, he met Jacobs.

“I started talking to [Sugarman and Rice] about how game design starts off and I gave them some starters,” recalls Jacobs, “and I had this general agreement to kind of, on the side — over however long it took — put something together [with them].” The three of them met on and off over the course of the following year, until Sugarman received a grant from RIT’s Office of the Vice President for Research. Jacobs says that this “fast tracked the project, and we went to interview students.”

Jacobs knew that he would need three students: Two who were technical, and one who was artistic but still had a technical background. He first approached Stewart, whom he had worked with before in class, a research fellowship and an independent study. Stewart was available, and after going through the interview process, he “came out at the top of the pack.” Next, Jacobs sought his artistic team member, and so he spoke to faculty in the New Media Interactive Development department. He was pointed in Ngo’s direction, and after seeing her work over her shoulder while walking through a lab, he “checked her off in my head right away.” McDonald was the last member added to the team. He came entirely through the interview process and “seemed the best choice of the folks that we had interviewed.”

SCULPTING A CAME

Justyn Iannucci

“We originally planned this out for several different settings, but right now we‘re working in a school setting for kids ages eight to college age,” explains Ngo, leading the discussion of the game and its mechanics. Players control an avatar of themselves that they can customize to their heart’s content. During the game, players have an “Inner Motivational Projections,” or “imp” on either shoulder. One of the imps represents the person the player would like to become, while the other is the characterization of their problems.

Before starting the game, players set a list of their personal likes and dislikes. During gameplay, the player moves through a school hallway, the first and thus far only developed setting, interacting with assorted computer controlled non-player characters (NPCs). “And during this whole process, we’re keeping track of your breathing rate [and] your heart rate,” explains Sugarman.

When beginning, a player could put down “talking to people” on their list of dislikes. This player would be walking through the hallway, and when an NPC tried to start a conversation with them, the player’s stress level would spike. Adds Ngo, “In game, it makes it so that conversations don’t run out as well, or that you’re late to class, or just depending on what thing you’re interacting with at the time, you tend to get a worse response.”

In the same example as above, let’s say the player put down “trash cans” as something they really liked. If there was a trash can in this hallway, and an NPC approached the player for a conversation, the “problem” imp would pull them away from the NPC and towards the trashcan, while the “positive” imp would encourage them to approach the NPC. The ability to approach the NPC relates to the player’s actual breathing and skin conductance metrics. “A lot of the skills that allow you to be in control are the same things that allow you to be in control in real life,” explains Sugarman.

There is also a minigame within the game, which Ngo compares to any role-playing game. “You have stats which reflect your ability to talk to people, and playing this minigame will affect those stats.” Additionally, relationships with NPCs will carry over from session to session, making it possible to develop friendships or rivalries. “Once you have seven friends, you get to start a food fight at lunch,” adds Ngo. “It’s one of the things we’re planning on doing.”

A repeated comment during the interview was the team’s desire to make a “serious” game over a more commercial, “entertaining” game, although they still think players will have fun with it. The team intends for the game to be used primarily in therapy sessions between doctors and their patients, but they hope to build another version to be used at home by patients between sessions. This data would then be transferred over to the therapist’s office, so their progress could be monitored.

MOVING FORWARD

The team hopes that they will have a working prototype by the end of the students’ co-op period this quarter. They expect this prototype to demonstrate the core mechanic with the imps, and hope to get feedback from Sugarman’s and Rice’s patients to know what they should add, improve or change. “In an ideal world,” says Jacobs, “we would like a polished version of the first level and maybe a second level with some of [the aforementioned] minigames before the beginning of the next academic year.” However, there are several factors that determine the possibility of progress, primarily concerning how many more students they can find to assist the project in upcoming quarters.

The team is clearly ecstatic to be working on this project, and are completely aware of the possible positive effect this could have on the scientific community: “It makes me feel good that I am working on something that can make life easier for children,” says McDonald in an email. Adds Sugarman, “It’s always great that when something makes sense to you or feels like something you need to do is something that’s affirmed by the community.”

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