Serious Games Development and Applications 5th International Conference SGDA 2014 Berlin Germany October 9 10 2014 Proceedings 1st Edition Minhua Ma
Serious Games Development and Applications 5th International Conference SGDA 2014 Berlin Germany October 9 10 2014 Proceedings 1st Edition Minhua Ma
Serious Games Development and Applications 5th International Conference SGDA 2014 Berlin Germany October 9 10 2014 Proceedings 1st Edition Minhua Ma
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Minhua Ma Manuel Fradinho Oliveira
Jannicke Baalsrud Hauge (Eds.)
Serious Games
LNCS 8778
Development
and Applications
5th International Conference, SGDA 2014
Berlin, Germany, October 9–10, 2014
Proceedings
123
Lecture Notes in Computer Science 8778
Commenced Publication in 1973
Founding and Former Series Editors:
Gerhard Goos, Juris Hartmanis, and Jan van Leeuwen
Editorial Board
David Hutchison
Lancaster University, UK
Takeo Kanade
Carnegie Mellon University, Pittsburgh, PA, USA
Josef Kittler
University of Surrey, Guildford, UK
Jon M. Kleinberg
Cornell University, Ithaca, NY, USA
Alfred Kobsa
University of California, Irvine, CA, USA
Friedemann Mattern
ETH Zurich, Switzerland
John C. Mitchell
Stanford University, CA, USA
Moni Naor
Weizmann Institute of Science, Rehovot, Israel
Oscar Nierstrasz
University of Bern, Switzerland
C. Pandu Rangan
Indian Institute of Technology, Madras, India
Bernhard Steffen
TU Dortmund University, Germany
Demetri Terzopoulos
University of California, Los Angeles, CA, USA
Doug Tygar
University of California, Berkeley, CA, USA
Gerhard Weikum
Max Planck Institute for Informatics, Saarbruecken, Germany
Minhua Ma Manuel Fradinho Oliveira
Jannicke Baalsrud Hauge (Eds.)
Serious Games
Development
and Applications
5th International Conference, SGDA 2014
Berlin, Germany, October 9-10, 2014
Proceedings
13
Volume Editors
Minhua Ma
Glasgow School of Art
Digital Design Studio
Glasgow, UK
E-mail: [email protected]
Manuel Fradinho Oliveira
SINTEF Technology and Society
Industrial Management
Oslo, Norway
E-mail: [email protected]
Jannicke Baalsrud Hauge
University of Bremen
Bremen Institute for Production and Logistics (BIBA)
Bremen, Germany
E-mail: [email protected]
As games technologies have become more and more widely available, the ability
of games to engage users effectively in specific, designed activities has been seized
as an opportunity to use computer games for purposes beyond recreation. Since
the term ‘serious games’ was comprehensively defined in 2002, they have been
used as tools to gives individuals a novel way to interact with games in order to
promote physical activities, to learn skills and knowledge, to support social or
emotional development, to treat different types of psychological and physical dis-
orders, to generate awareness, and to advertize and promote in application areas
such as engineering, education and training, competence development, health-
care, military, advertizing, city planning, production, and crisis response to name
just a few. Many recent studies have identified the benefits of using videogames
for a variety of serious purposes. Serious gaming is a particularly timely subject
as there has been recent re-emergence of serious games design and production;
one 2010 market study indicated that the worldwide market for serious games
was worth e1.5 billion.
The aim of the annual International Conference on Serious Games Develop-
ment and Applications (SGDA) is to disseminate and exchange knowledge on
serious games technologies, game design and development; to provide practi-
tioners and interdisciplinary communities with a peer-reviewed forum to discuss
the state of the art in serious games research, their ideas and theories, and in-
novative applications of serious games; to explain cultural, social and scientific
phenomena by means of serious games; to concentrate on the interaction between
theory and application; to share best practice and lessons learnt; to develop new
methodologies in various application domains using games technologies; to ex-
plore perspectives of future developments and innovative applications relevant
to serious games and related areas; and to establish and foster a cross-sector and
cross-disciplinary network of researchers, game developers, practitioners, domain
experts, and students interested in serious games.
The 5th International Conference on Serious Games Development and Appli-
cations (SGDA 2014) was hosted by University of Applied Sciences HTW Berlin
in Germany and was co-located with the European Conference on Games Based
Learning (ECGBL 2014). SGDA 2014 appeared in the sequence of the successes
of the First SGDA held at Derby in 2010, the Second SGDA conference at Lis-
bon in 2011, the Third SGDA at Bremen in 2012, and the Fourth SGDA at
Trondheim in 2013.
The Conference was supported by the European GALA Network of Excel-
lence for Serious Games, FP7 TARGET Project, SINTEF, Glasgow School of
Art, University of Applied Sciences HTW Berlin, University of Bremen, BIBA-
Bremen Institute for Production & Logistics, Technical University of Lisbon,
INESC-ID/IST, Norwegian University of Science and Technology, University of
VI Preface
Derby, and a number of prestigious European partners. This year, HTW Berlin
hosted the fifth annual conference (SGDA 2014) during 9–10 October 2014.
18 full papers and 1 invited keynote covering a wide range of aspects of
serious games design and use were presented at SGDA 2014. Speakers came
from 14 countries throughout Europe and around the world, including Canada,
Australia, Malaysia and China. The papers are published in the Springer LNCS
8778. The keynote speaker was Dr. Stefan Göbel, Head of Serious Gaming in the
Multimedia Communications Lab (KOM), Technical University of Darmstadt,
Germany.
We would like thank all the authors, speakers, and reviewers for their contri-
butions to SGDA 2014 and welcome you to participate in our discussions at the
conference.
SGDA 2014 was hosted by University of Applied Sciences HTW Berlin, Ger-
many, in cooperation with the Digital Design Studio, Glasgow School of Art,
UK; SINTEF Technology and Society, Norway; Bremen Institute for Production
& Logistics (BIBA), Germany; and IFIP Technical Committee (TC14) Enter-
tainment Computing - Working Group on Serious Games (WG 14.8).
Conference Chair
Minhua Ma Glasgow School of Art, UK
Program Chairs
Minhua Ma Glasgow School of Art, UK
Manuel Fradinho Oliveira SINTEF Technology and Society, Norway
Jannicke Baalsrud Hauge Bremen Institute for Production and Logistics,
Germany
Program Committee
Björn Andersen Norwegian University of Science, Norway
Aida Azadegan University of the West of Scotland, UK
Jannicke Baalsrud Hauge Bremen Institute for Production and Logistics,
Germany
Rafael Bidarra TU Delft, The Netherlands
Francesco Belotti University of Genoa, Italy
Riccardo Berta University of Genoa, Italy
VIII Organization
Sponsoring Institutions
Glasgow School of Art, UK
SINTEF Technology and Society, Norway
Bremen Institute for Production & Logistics (BIBA), Germany
University of Applied Sciences HTW Berlin, Germany
University of Huddersfield, UK
Norwegian University of Science and Technology, Norway
Organization IX
Abstract. Several studies have shown very positive results regarding the use of
serious games as rehabilitation tools for individuals with physical disabilities,
mainly because the game environment gives them the necessary motivation to
continue their treatment with enthusiasm. Thus, the objective of this paper is to
describe the first steps on the development of a 3D game for physical therapy of
patients with motor disabilities as a result of neurological disorders.
1 Introduction
While keeping the entertainment, serious games are designed to solve problems in
various areas. Considering the health area, it is possible to highlight the important
contribution of these games in physical therapy and rehabilitation of patients with
motor disabilities due to several causes, including neurological diseases.
These patients require physical therapy programs appropriate to their problems in
order to improve as much as possible, their quality of life. However, the exercises that
traditional physical therapy provides are often boring and repetitive, which discour-
ages the individuals, causing them to abandon their programs before they have
finished, especially if they do not see short-term improvements [1]. Therefore, such
programs should be developed in environments that encourage patients to perform the
exercises with enthusiasm, so that positive results can be obtained [2, 3].
The results of several studies show that serious games create environments that en-
courage patients to perform the exercises with enthusiasm and relaxation, maintaining
them increasingly motivated, involved and absorbed in their rehabilitation. Usually,
these games integrate feedback forms that increase motivation and satisfaction, stimu-
lating the wish to complete specific tasks and achieve certain goals [4].
Though a number of serious games are presently being used in therapy of patients
with motor problems, it has been detected a gap with respect to games that are exclu-
sively intended to a broad spectrum of physical therapy exercises designed to improve
the mobility of patients with neurological diseases. Consequently, PhysioVinci is a
game in 3D environment, designed to overcome that gap.
Therefore, in this paper it is referred the motivation that serious games can provide
to patients who have to perform repetitive physical therapy leading to an improve-
ment in their mobility. As many of the mobility problems are the result of neurologi-
cal diseases, some of them will be mentioned here. The exercises selected for moni-
toring through image processing techniques, the game concept and design and its
logical scheme, as well as the development of the first level will also be discussed.
2 Literature Review
There are many individuals whose physical disabilities oblige them to practice physi-
cal therapy programs based on repetitive exercises, which discourage them and make
them to feel isolated, especially if they do not see immediate improvements [1, 5].
However, as such exercises, though tedious, are essential to improve the quality of
life of these patients, it is necessary to develop strategies to motivate and prevent
them from prematurely abandoning their treatment. Serious games seem to be the
appropriate tool to trigger motivation [2].
Among the many advantages we can withdraw from the use of serious games in
physical therapy of patients with limited mobility, we can highlight the control and
consistency of the stimuli, the feedback performance in real time, the change of stim-
uli and responses that depend on the physical abilities of the user, the opportunity for
exposure to stimuli in a graduated way, the independent practice, which culminates in
patient's motivation [6]. At the same time they entertain the players, reward their vic-
tories and reinforce the healthy movements [1].
The pleasant atmosphere created by a serious game and feedback forms such as
numerical scores, progress bars, character dialogue, controller vibration/force and
sound constitute an incentive and can provide the increase of the patients motivation
to complete their programs of physiotherapy [4]. In general, they encourage the user
to understand the more difficult exercises as challenges, performing them gradually.
Furthermore, the possibility of repetition of an exercise, if it fails, seems to be a moti-
vating factor. There is also the attraction that games usually promote. After starting a
game, people are interested in keeping on playing it to improve results [2].
Previous studies show that the use of serious games in physical therapy lead to a
longer playing time, a higher interest/enjoyment and an increased effort to complete
the game [7].
Fig. 1. Set of exercises chosen for the PhysioVinci Game. 1 – Glenohumeral joint abduction;
2 – Radiohumeral joint flexion; 3 – Pulleys; 4 – Coxofemoral joint abduction;
5 – Glenohumeral joint flexion; 6 – Crossed arms movement
4 T. Martins et al.
The glenohumeral joint abduction can be defined as the movement that occurs in
the frontal plane around a horizontal axis directed dorsoventrally, pulls the arm from
the midline of the body [13].
The radiohumeral joint flexion also occurs in the frontal plane, consisting of the
movement of the forearm towards the shoulder [13].
The pulley consists of a combined movement of glenohumeral abduction and flex-
ion radiohumeral and so it is performed in the frontal plane.
Such as the three aforementioned movements, the coxofemoral abduction joint is
performed once more in the frontal plane, around a horizontal axis in anteroposterior
direction, and consists of the lateral lifting of the leg [13].
Regarding the glenohumeral joint flexion, it occurs in the sagittal plane, being car-
ried forward and upward, suffering a change from 0° to 180° [14].
The crossed arms movement is a diagonal movement, in which each arm alter-
nately moves forward and upward or downward, trying to reach a target that appears
on the opposite side, placed randomly by the physiotherapist.
After the definition of the exercises, it was necessary to idealize the games situations
that motivate the performance of those exercises.
In the first place, it is necessary to define the target public for the game. This will
be useful, as reported earlier, as an adjunct to physiotherapy of individuals with neu-
rological diseases, in a mild or moderate state. The use of the game may not be indi-
cated for individuals with advanced disease states, since they would not be able to
minimally perform the proposed tasks, thus leading them to demotivation, as checked
in a previous study [2].
As PsysioVinci is a 3D environment game, the 'Unity 3D' engine was employed in
the development. Beyond the acceptability and exponential expansion that it is taking
on the market, Unity 3D allows programming in JavaScript and C#, which facilitates
the integration of Microsoft Kinect SDK (the Kinect sensor is used to monitor the
movements of patients). Another asset of using this software is the compatibility of
importing objects from Blender software. Blender was used to build 3D characters,
among other game elements.
As it can be observed in Fig. 2, at a logic level, the game is divided into three main
areas: Game (for the player), Backoffice (for physiatrist) and Data Storage serving as
an intermediary between both.
PhysioVinci – A First Approach on a Physical Rehabilitation Game 5
The "Backoffice" section is divided into 3 parts: player profiles, statistics and rank-
ings. This area is exclusive to the physiatrist. Here, he/she fills the patient data –
player (name, age, weight, type of pathology, degree of pathology, among other rele-
vant personal information). He/she also defines a set of exercises that a particular
patient has to perform (eg: Glenohumeral abduction – left arm, bending radiohumeral
– left arm, among others.). When the profile is completed, the information is recorded
in a centralized server. In this backoffice, the physiatrist may analyze the evolution of
a particular patient, compare with other patients, and check the ranking of the best
ratings.
The "game" section is divided into three parts: selection of player, game levels and
ranking. It is worth noting that the game activity needs a monitor who is responsible
for the proper handling of the application and accompanies the player. Thus, before a
patient begins to play, the technician must select the correct player.
After selecting the player, there will be a calibration system (Fig. 4.4), to make
sure that the patient is prepared to be monitored using the Microsoft Kinect sensor.
After calibration, the player will perform levels (exercises) defined by the physiat-
rist. At the end of each level the ranking of the ten top-ranked players is presented.
These ten players match those that have the same degree of disease that the current
player.
Since all the information is centrally stored, in a remote server, research-
ers/therapists can access the data at any time. The database stores the patient’s
characterization, such as name, age, gender, pathology, disease status, medical
history. Other relevant parameters related to physical therapy he/she is performing, as
movements to carry out, responsible physiotherapist, and the patient's progress in the
therapy sessions are also registered.
6 T. Martins et al.
Currently, the game has one level that corresponds to the exercise of glenohumeral
joint abduction. The StoryBoard of this level is briefly represented in Fig. 3, which is
described next.
This level is based on the Delta Wing invention glide of Leonardo Da Vinci. The
reason why it was chosen is related with the similarity between the beating of the
Delta Wing of Leonardo da Vinci and the proposed exercise. Theoretically, the player
should use both arms to hit the two wings, but since the exercise is performed with
only one, the movement of the second wing is replicated (in mirror).
At the beginning of the level the main character follows a stabilized flight with the
Delta Wing (Fig. 4.5) until the player takes control of the game (start level). From that
moment, the player has to perform correctly the proposed exercise so that the flight
continues stabilized and he can catch objects to get points (Fig. 4.6). If the player does
not perform the proposed exercise correctly, the flight is destabilized and the glider
starts to fall until it touches the ground (Fig. 4.7, Fig. 4.8, Fig. 4.9). If the player is
able to correct the exercise before the glider touches the ground, it goes back up to its
normal position, accessible to the objects that give score.
This level contains a graph in the upper right corner informing the player if he is
properly performing the exercise, indicating the direction of the movement and its
percentage of conclusion. Furthermore, it indicates the errors in case that the player is
performing wrongly the exercise.
PhysioVinci – A First Approach on a Physical Rehabilitation Game 7
The Kinect Sensor continuously monitors the player position and it is through it
that it is possible to check if the user is performing the exercise correctly.
In the specific case of this level the player must perform the exercise correctly ac-
cording to the descriptions mentioned in the section of the exercises. Theoretically,
the player is penalized in the following cases (see Fig. 3): arm-forearm angle lower
than 180°; incorrect alignment in the frontal plane or in the sagittal plane; acceleration
of execution different from zero.
In fact, due to the anatomy of the human body, we cannot guarantee the values de-
scribed above, and therefore it is necessary to set some thresholds to ensure that the
game has gameplay and does not have an exaggerated precision, which would lead to
the disinterest of the player and a consequent demotivation because he was unable to
minimally perform the proposed exercise.
There are many people with problems associated with neurological diseases, requiring
appropriate physical therapy programs. Sometimes these programs become monoto-
nous, leading to the disinterest of patients who eventually abandon them prematurely
for lack of motivation. We consider the use of electronic games as a support to
physiotherapy as they can trigger the motivation, leading the individuals to comply
fully with the respective programs in order to use their quality of life.
Therefore, our research has grown towards realizing, which exercises are most
used in physiotherapy for patients with these conditions, in order to adapt them to
game situations. For this purpose, we created a story that is based on some Leonard
8 T. Martins et al.
Da Vinci inventions, which, beyond giving the game a play context, at the same time
adds to it a cultural nature.
Presently, the first level of the game is finished. The preliminary tests were per-
formed in laboratory environment with healthy people, to validate the game activity
and check for errors. This first tests reveal that players do not show any kind of diffi-
culty either in understanding the performance of the game, either in the effectiveness
of the results.
The next step will be to test this game level in the clinics, with patients and physi-
cal therapists. When this level is validated, we will proceed to the development of the
other levels. We believe that the game offers some advantages regarding other exist-
ing games, namely the widest spectrum of diseases to which it can be applied.
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%20alguns%20apontamentos.pdf (accessed on April 2014)
A Pilot Evaluation of a Therapeutic Game Applied
to Small Animal Phobia Treatment
Abstract. This study presents Catch Me game, a therapeutic game for teaching
patients how to confront to their feared animals during spider and cockroach
phobia treatment, and evaluates whether inclusion of gaming elements into
therapeutic protocol does have an added value for the treatment. The Catch Me
game was designed in order to help patients learn about their feared animals and
to learn how to apply adapted confrontation strategies and techniques with the
lowest possible anxiety level. In this study, Catch Me game was evaluated in
terms of knowledge acquisition, anxiety level, self-efficacy belief acquisition,
and appeal to both participants and therapists. Data collection consisted of
quantitative measures on a sample of 14 non-clinical population. The results
showed that the game significantly improved knowledge and self-efficacy belief
regarding the feared animal, and significantly decreased the anxiety level of
participants. Moreover, both participants and the therapists were highly satisfied
with the game.
1 Introduction
Although new technologies have been identified as a potential tool for increasing
patient engagement in the therapy and accessibility of the treatment [1], the main
reason for treatment failure is lack of patient motivation [2]. Thus, new channels that
offer the ability to increase motivation and engagement in the therapeutic process are
needed in order to be able to reach a larger clinical population. One possible channel
corresponds to the introduction of computer games in the therapeutic environment.
Indeed, successful computer games all have one important characteristic in common:
the capacity to draw people in [3]. This ability to engage people as well as the wide
range of possibilities that new technologies offer can create new, motivating, and
engaging therapeutic environments: therapeutic games.
Despite a growing number of recent studies regarding the use of computer games
as a form of therapy, therapeutic games are still under investigation. The aim of this
paper is to evaluate the influence of therapeutic game on participants’ appeal,
knowledge acquisition, anxiety level, and self-efficacy belief for treatment of small
animal phobia (i.e., spiders and cockroaches). The paper is organized as follows.
Section 2 presents some of the main issues related to new technologies in specific
phobia treatment. Section 3 presents issues related to computer games in the
therapeutic field. Section 4 presents the methodology undertaken in this evaluation.
Finally, Section 5 presents our results, and the remainder of the sections presents the
discussion and conclusions that we have drawn from the study.
Some new therapeutic tools have recently been developed to improve the appeal to
phobia sufferers and to cover some drawbacks (i.e., time consuming and logistics
problems; a lack of full control of the animal or situation; a low level of acceptance
and a high dropout rate) related to the standard therapy for treating specific phobia
[4], namely in vivo exposure therapy. Virtual Reality (VR) and Augmented Reality
(AR) technology offer potentially efficient solutions to the treatment of specific
phobias, proposing full control of the phobic object or situation, as well as the
immediacy and safety of the environment in which therapists and patients can work.
VR has demonstrated to have great potential in different MH applications and has
been effectively used in different MH disorders (see [5] for review). Also, AR
technology, which has recently been introduced, has become a potential treatment tool
for specific phobias such as small animal phobias (e.g. [6]) or acrophobia [7].
However, since some authors [8] demonstrated that these technologies do not
necessarily have a direct impact on patient motivation, new channels to motivate and
engage patients in the therapy should be addressed. In our opinion, the introduction of
serious games in the therapeutic context might be promising. The following section
presents the concept of therapeutic games.
3 Therapeutic Games
It has been recognized that computer games are enjoyed by millions of people around
the world and that they have come to be an integral part of our cultural and social
environment [9]. Even though computer games are known in the MH field for their
negative impact on their users (e.g. game addiction, aggressive behavior) [10];
computer games have demonstrated that they can make learning effective, engaging,
and inspiring both in the educational field (e.g. [11]), and in the health care field (e.g.
[12]). Consequently, in recent years, the use of computer games as a form of therapy
has captured the attention of MH professionals (e.g. [13]). The combination of
therapeutic content and computer games can be defined as Therapeutic Games (TGs).
Specifically, TGs are games that integrate gaming elements with therapeutic
objectives. In the MH field, TGs have been applied to autistic spectrum disorder (e.g.
12 M. Wrzesien et al.
[14]), anxiety disorders (e.g. [15]), language learning impairments (e.g. [16]),
cognitive behavioral therapy [17], and solution focused therapy [1].Although TGs
have just begun to emerge, and the majority of applications have not yet empirically
demonstrated their efficacy and utility, TGs can easily respond to therapeutic
requirements. In the case of specific phobia, in order for the exposure to be
effective, factors such as repetition [18], the patient’s perception of his/her self-
efficacy belief [19], and humor [20] all need to be integrated. In our opinion, the
introduction of TGs to the therapeutic session with respect to these factors can be
beneficial for both the patient and the therapist. A pilot study of a mobile therapeutic
game for cockroach phobia treatment has demonstrated this possibility [21]. Botella
and her colleagues [21] showed that the mobile TG reduced the patient’s anxiety and
avoidance (from 10/10 to 7/10) before the therapeutic session started. Moreover, the
patient found the use of TG to be very helpful and was willing to use it after the
therapeutic session as a homework assignment.
As the above literature review indicates, the enjoyment factor included in TGs
seems to be beneficial for patients and can open up a new range of related research.
With appropriate design, TGs can be an effective tool in complementing other
therapeutic techniques or as a therapeutic tool itself [22]. The aim of this study is to
evaluate a therapeutic game, namely Catch Me game that aims to be applied in the
context of small animal phobia treatment.
4 Methodology
The study evaluates the impact of a therapeutic game on the participants’ and
therapists’ appeal, participants’ knowledge acquisition, anxiety level, and their self-
efficacy belief that was measures before and after the sessions.
4.2 Participants
9 man and 5 women (M=26.71; SD=6.15 years old) participated in the study. Since
the game have not been tested before, due to the ethical issues the pilot evaluation
was decided to be performed with non-clinical population. However, the measures
and selection criteria of the participants were applied based on the clinical protocol
for specific phobia treatment. The participants were selected based on the following
inclusion criteria: no prescribed medication use, no current alcohol or drug
dependency, no diagnosis of psychological disorder, and no serious medical problems
(e.g. heart disease or epilepsy). All of the participants responded to both the spider
and cockroach anxiety and avoidance questionnaire. The animal with the highest
score determined which animal they were exposed to. The participants that obtained a
score greater than 92 out of 126 (N=0) were considered to be potentially phobic
subjects and were disqualified from participating in the study due to ethical issues. 6
participants were exposed in the Catch Me game to the cockroaches with the higher
anxiety and avoidance scores for this animal (M=35.83; SD=24.61), and 8
participants were exposed to the spiders (M=36.13, 22.30).
A Pilot Evaluation of a Therapeutic Game Applied to Small Animal Phobia Treatment 13
4.3 Measures
Spider and cockroach anxiety and avoidance questionnaire
The measure of anxiety and avoidance level was performed by applying the spider
and cockroaches fear questionnaire (adapted from [23]). This questionnaire
corresponds to 18 questions (on a 7-point Likert scale) that reflect fear and avoidance
of a specific animal.
Anxiety assessment
The subjective Unit of Discomfort scale [24] was used to evaluate the level of anxiety
during the therapeutic session. Participants were asked at the beginning and at the end
of each exposure exercise to indicate their level of anxiety regarding the feared animal
(on a 11-point Likert scale).
Knowledge Assessment regarding the feared animal
A knowledge questionnaire was used to evaluate the level of knowledge that the
participants had about their feared animal. The participants filled out the knowledge
questionnaire at the beginning and at the end of the session; responding to six
questions related to the animal, its functions, and its characteristics. 12 questions of
equal difficulty (evaluated by one of the researchers) were randomly distributed
between pre- and post-knowledge questionnaire.
b) Therapeutic game
The Catch Me game described below is an augmented reality therapeutic game tthat
conform to cognitive behavvioral therapy protocols. The goal of the Catch Me gam me is
to allow small animal pho obia sufferers to confront and interact with their phoobic
animals with the lowest poossible level of anxiety in a fun environment. Spiders and
cockroaches were chosen ass the animals for the project because of the high prevaleence
of spider and cockroach pho
obias in the world population.
The purpose and the deesign motivation of the Catch Me game correspondss to
active psycho-education. The game aims to encourage active learning of self-
efficacy belief and adapteed strategies of interaction with feared animals withiin a
highly innovative, fun, and
a easily accessible, controlled environment. Whhile
participating in the games, patients have the opportunity to discover informattion
A Pilot Evaluation of a Therapeutic Game Applied to Small Animal Phobia Treatment 15
about the feared animals, to engage themselves in confrontation with the animals, and
to test their capacities regarding the animals.
The games correspond to learning adaptive strategies and psycho-educative
objectives. The games allow participants to learn information about the animal (e.g.
its characteristics such as physical appearance, movement), and how to behave when
they are surprised by an animal found in a familiar environment). Specifically, in
Catch Me game the participant has to catch walking animals with a mug and drag
them to the zone where they will stay captured (see Figure 1). Every four animals
captured, information about the specific animal appears (e.g. the potential danger of
the animal; the particular function of its anatomical characteristics; its function in the
ecosystem). More specifically, there are 10 different levels of play (0-9). The highest
level corresponds to the highest velocity of animals moving around the virtual
kitchen. The velocity increments gradually according to each level. Every 12 seconds
8 new bugs appear. Each game lasts 60 seconds, after which a message appears with a
number of captured animals. Also, every 4 bugs a psycho-educative messages are
displayed such as "You just feed a tarantula!" or "99% of cockroaches are harmless to
man".
The therapist’s function is to model the adapted behavior by first demonstrating
the interaction with the animal and then guiding the participant through the different
parts of the games. The therapist can also change the velocity in which the animals
appear so that the exposure to the animals can be gradual.
4.5 Procedure
When the participants arrived to the laboratory, they responded to both a demographic
questionnaire and a diagnostic questionnaire (i.e., spider and cockroach fear and
avoidance questionnaires). Once the level of anxiety and avoidance of each
participant was established, the participants were informed about the objectives of the
study, and they completed a consent form, a pre-test self-efficacy belief questionnaire,
and a pre-test knowledge questionnaire. Afterwards, they played the game for
approximately 2 minutes. The game was played first by the researcher, and then the
participant was invited to repeat the exercise. Throughout the game, each participant
was asked twice (i.e., at the beginning and at the end of the game) about his/her
anxiety regarding the feared animal. At the end of the session, the participants filled
out the post-test knowledge questionnaire, the appeal questionnaire, the post-test self-
efficacy belief questionnaire. The session lasted approximately 15 minutes.
5 Results
As Figure 2 shows, both self-efficacy belief regarding the capacity of the participants
to confront themselves to the phobic stimuli, and knowledge regarding information
about the phobic stimuli increased significantly after playing the Catch Me game (Z=-
2.810; p=.005; and Z=-3.238; p<.001, respectively). Moreover, although the anxiety
level of participants in the beginning of the game (M=1.77; SD=1.83) was not very
high due to characteristics of the population (i.e., a non-clinical population). Still the
anxiety level decreased significantly after the game (Z=-2.414; p=.016) which might
show the efficacy of the game as an exposure exercise.
(a) (b)
Fig. 2. (a) Self-efficacy score (out of 42) and (b) knowledge questionnaire score (out of 6)
before and after playing Catch Me game
In order to study the impact of the game on the appeal to participants, six scores for each
dimension and a global score were calculated for each participant (see Table 1). The
results show that, on the general level, participants were highly satisfied with the game.
Regarding the therapists appeal, both the system and the Catch Me game received
very good comments. The therapists strongly agreed (M=6.09 out of 7, SD=1.41) that
the system brings some additional value to existent technology-mediated therapies
(i.e., VR or AR) or traditional therapy (i.e., in vivo exposure therapy). Moreover, the
therapists consider that the system will provide similar clinical efficacy as other
therapies (i.e., VR, AR, in vivo exposure therapies), and that it will facilitate their
work as therapists (M=6.25 out of 7, SD=0.96; M=6.25 out of 7, SD=0.96,
respectively). Regarding the game, the therapists agreed that the game was fun
(M=5.50 out of 7, SD=1.23), useful for patients (M=6.00 out of 7, SD=1.16), and that
the game brought something new and positive to the therapeutic session (M=6.00 out
of 7, SD=1.41) and could motivate patients to participate in the therapy (M=6.25 out
of 7, SD=0.96).
This study presents a therapeutic game and evaluates its influence on appeal, anxiety
level, self-efficacy belief, and knowledge acquisition as a part of small animal phobia
treatment. The main conclusions and their implications for Mental Health care are
discussed below.
First, the evaluation showed a significant influence of the therapeutic game on self-
efficacy belief. This allows us to assume that the game migh bring a significant
contribution to the therapeutic sessions. Self-efficacy belief is defined by Bandura
(1994) as determinant of how people think, behave, and feel. Specifically, one’s belief
in one's ability to succeed in specific situations such as confrontation with a feared
cockroach or spider can play a major role and influence the way in which the person
approaches goals, tasks, and challenges [27].
Also, participants’ appeal scores were very high (i.e., global satisfaction was
around 6 out of 7). The participants strongly agreed that the game was useful, had a
therapeutic value for the phobic sufferers, and was fun. Furthermore, in the
participants’ opinion, the game was motivating, and they were willing to participate
more frequently in this type of session if they could. Although the results were
obtained only with a non-clinical population we still managed to obtain some
interesting results. First, the game significantly increased knowledge about the feared
animal, which allows us to conclude that the game is effective in transmitting
important information about feared animal characteristics and functions to
participants, which responds to the psycho-educative objective of the therapeutic
session. Second, the game significantly reduced the feeling of anxiety between the
beginning and the end of the game. Although the anxiety scores were not high as in
other studies with clinical population (e.g. 9 out of 10 at the beginning of the session;
[21]), our results demonstrate a similar tendency to decrease anxiety. Therefore, these
results together with the self-efficacy belief results lead us to assume that the game
has a potential to be clinically valid and provide an interesting tool to complement the
therapeutic session before the exposure or as a homework assignment after the
exposure.
18 M. Wrzesien et al.
This study has certain limitations. First of all, this pilot study should be confirmed
with a larger sample. Also, the evaluation of the therapeutic game was performed with
a non-clinical population due to ethical issues; thus, before drawing the final
conclusions an evaluation with a clinical population must be done. Other issues
related to the evaluation of the learning effectiveness should be studied further. In our
study, only a declarative type of knowledge (facts) was tested in the knowledge
questionnaire. However, the learning process also involves procedures of how to
perform the described action, namely procedural knowledge (e.g. how to catch the
feared animal) as well as attitudes that correspond to the transfer of learned
information to other situations, namely strategic knowledge (e.g. emotional regulation
strategies such as respiration exercises during the stressful situation). Thus, learning
about the feared animals is not only learning about their characteristics and functions,
it is also learning about how to manage the situation when one is confronted with the
animal, and how to apply this knowledge to other stressful situations. Finally, a
comparative study with a control group would be suitable.
This study shows that Catch Me game is a potentially effective tool for helping in
the treatment of small animal phobias as well as satisfying, and engaging patients in
the therapeutic process. This result is one of the crucial aspects in the learning process
of adaptive strategies during the therapeutic process. New technologies used in the
Mental Health field must be carefully chosen and applied not only to help the patient
to enjoy an emotionally difficult situation a little bit more but also to assist the
therapist in supporting and guiding the patient in this task. This pilot study shows that
the Catch Me game satisfy both potential patients and therapists needs.
Therapeutic games bring new possibilities to the daily practice of therapists and
their patients. However, only a few authors have begun to address these issues in
empirical studies. Therefore, a deeper understanding of therapeutic games in the
mental health field is needed. We believe that this study is a first step in
understanding therapeutic game issues in the context of mental disorders.
References
1. Coyle, D., Doherty, G.: Clinical evaluations and collaborative design: developing new
technologies for mental healthcare interventions. In: Proceedings of CHI, pp. 2051–2060
(2009)
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beschermen en van welke wij in hunne mythen en legenden nu en dan
voorbeelden leeren kennen (zie No. 39). Zij mogen bijv. niet te veel van
een zelfde diersoort schieten, uit vrees dat haar bijzondere boschgeest
hen kwaad zou kunnen doen. Daarom ook dragen de Indianen het wild
en de visch, waarmeê zij terugkeeren, niet zelf in de hut, doch leggen
het buiten neêr, het aan de vrouwen overlatende, den buit te halen.
(Zie No. 1 en No. 36). Ook hierdoor meenen zij zich tegen den geest te
kunnen beschermen, die in het dier huist, dat zij hebben bemachtigd;
vast zijn zij overtuigd dat, als zij zich hieraan niet houden, de jacht den
volgenden dag niets zal opleveren. Overal, waar men in Guyana, op de
eilanden en in het Orinocogebied zijn onderzoekingen instelt, zal men
dit gebruik aantreffen.
Aan de vrees voor gevaren van den kant der geesten ligt nog een
ander gebruik, waaraan de Indiaan zich in bepaalde omstandigheden
steeds zal houden, ten grondslag, nl. de gewoonte om even de oogen
te sluiten. De Arowakken en Caraïben zullen b.v. de oogen even
sluiten, wanneer zij voor het eerst een landschap zien, dat hun
aandacht trekt, of wanneer zij ergens voor de eerste maal komen. Zij
meenen dan te kunnen voorkomen, dat de Geest zich tot hen zou
voelen aangetrokken. Dikwijls heeft deze gewoonte ook ten doel, een
gevaar te kunnen vermijden. Veelal is het voor hen een teeken van
wangunst, haat of kwaadaardigheid. Bij Warraus en Arowakken zal,
wanneer twee mannen of twee vrouwen hevige oneenigheid hebben,
de vertoornde de andere partij aanzien en daarna plotseling de oogen
sluiten, om na het weder openen, zich zonder iets te zeggen te
verwijderen. Het sluiten der oogen en het daarna uitspreken van een
wensch (zie No. 25) zal wel met het geloof aan geestenbeïnvloeding in
verband staan.
Kenaima, den geest der wrake, zien wij vooral aan het werk in No. 29,
maar ook in No. 47, waar hij in de gedaante van den zoon van
Mapajawari optreedt.
Doorgaans bedient een Kenaima zich van onzichtbare pijlen (No. 44) of
van gebroken pijlen (No. 24 en No. 37).
Wie aan het einde van een verblijf van eenige dagen in een
Indianenkamp, waarin hij het doen en laten van dit sympathieke volk
aandachtig heeft gadegeslagen, de piaiman bezig heeft gehoord, heeft
reeds van het zieleleven van den Indiaan een diepen indruk kunnen
medenemen (C. a.). Geen ander verhaal in dezen bundel geeft een
zóó helder beeld van hetgeen er in de Indianenziel omgaat en van het
leven van de Indianen, dan „de Geschiedenis van Maconaura en
Anoeannaïtoe” (No. 29). Vooral het opwekken van den Kenaima-geest
en het werk van den piaiman is er op boeiende wijze in geschetst. In dit
verhaal worden wij tevens herinnerd aan de wijze, hoe het eertijds in de
groote hutten of vergaderplaatsen der Indianen moet zijn toegegaan,
alvorens tot een vijandelijke aanval werd overgegaan. De Gebroeders
Penard hebben van hetgeen op een besluit daartoe placht te volgen
een belangwekkende schets gegeven, die wij hier woordelijk
overnemen, en die in het bijzonder betrekking heeft op de vroegere
oorlogen tusschen de strijdlustige Caraïben en de meer zachtaardige
Arowakken:
„De Indiaan immers redeneert als volgt: In koelen bloede stuit het mij
tegen den borst, is het mij onmogelijk een man te vermoorden, laat
staan een onschuldig wicht den schedel te verpletteren. Handel ik
alzoo, dan geschiedt zulks niet uit eigen aandrift, doch word ik
voortgedreven door een gevoel van woede en moordlust, dat niets
anders kan zijn dan de geest van den Jagoear. Om dien geest in mij op
te wekken, dans ik den Jagoeardans; ik volg alle bewegingen van den
Tijger na. Ik brul, ik his, ik zwaai den knots, gelijk het vreeselijke
roofdier, dat zijn prooi met één slag der geduchte klauwen verplettert.
En heb ik eenmaal mijn vijand gedood, dan moet ik ook zijn bloed
drinken en proeven van zijn vleesch, 15 ten einde te voldoen aan den
geest, die mij voortdrijft. [44]
Ieder mensch en dier kan, hoe goedaardig ook, getergd zijnde, den
tijgergeest in zich opwekken, die hem handelingen doet begaan,
waarover hij later berouw gevoelt. Hij vraagt zich af: hoe is het
mogelijk, dat ik zoo te keer kan gaan? En het antwoord luidt: Is de
Tijger in den mensch, dan wordt ook de mensch gelijk den Tijger”.
Het „Een man een man, een woord een woord”, een der eerste regels
eener goede moraal, en dat in de hedendaagsche, zoogenaamde
beschaafde maatschappij, waarin wij moeten verkeeren, steeds minder
wordt toegepast, wordt bij den Indiaan nog altijd in hooge eere
gehouden, [50]hoewel eerlijkheid en woordtrouw bij den
„geciviliseerden” Indiaan wel even groot gevaar zal loopen, belangrijk
achteruit te gaan, als dit met alle primitieve volken, die met het blanke
ras in aanraking zijn gekomen, het geval is geweest.
De Indiaan zal een eenmaal gegeven woord niet gauw verbreken en
doet hij dit, bijv. wanneer hij zich bedronken heeft, dan zal, volgens
hem, vroeg of laat de gerechte straf niet uitblijven. (Zie No. 37 en 43).
In het algemeen kan kwaad, meent hij, nimmer ongestraft blijven 19 (No.
16, 27 en 39) en typeerend voor de Indiaansche moraliteit kan gelden,
dat in vele zijner verhalen de veranderingen, die in den
oorspronkelijken Indiaanschen gelukstaat hebben plaats gegrepen,
hieraan worden toegeschreven, dat de ongehoorzaamheid in de wereld
haar intrede heeft gedaan. Volgens de Indianen waren het de blanken,
die de laatste sporen van dezen gelukstaat verloren deden gaan.
Dit geldt bijv. voor de groote groep der Maskoki-stammen, waartoe ook
de z.g. Creek-Indianen behooren, en wier migratie-legenden leeren,
dat zij in oude tijden van het Westen naar het Oosten en het Zuid-
Oosten zijn getrokken, waar zij nu ten Oosten van den Mississippi-
stroom in Alabama, Georgia en op het schiereiland Florida in
verschillende stammen hunne woonplaatsen hebben. Daar deze
stammen evenals vele anderen, als de Chirokezen, Choctaws,
Chickasaws enz., die landbouw en veeteelt drijven, en reeds lang in
dorpen samenwonen—als „geciviliseerde” Indianen het eigenlijke
Indianen-territorium vormen, staan de Sioux, die echte jagerstammen
zijn en de Nomaden en Bedouïnen der Nieuwe Wereld kunnen
genoemd worden, nog in den aanvang der „beschaving”; hun bestaan
hing bijna uitsluitend van den Bison af, die nu zoo goed als geheel
uitgeroeid is.
Een vertaling in het Duitsch van de Legende was echter onder een
aantal verhandelingen over koloniale aangelegenheden tusschen 1735
en 1741 opgenomen, en onder den titel „Ausfuerliche Nachricht von
den Saltzburgischen Emigranten, die sich in America niedergelassen
haben enz.” Halle 1735, blz. 869–876, gepubliceerd. De legende vindt
men in het eerste deel in Hernn Philipp Georg Friedrichs von Reck’s
„Diarium von Seiner Reise nach Georgien im Jahr 1735.” Deze von
Reck was de leider van een aantal protestantsche emigranten, die
wegens godsdienstvervolging uit Salzburg uitgeweken waren. Wij
geven deze bijzonderheden, teneinde sommige der hiaten te verklaren,
die den lezer wellicht in de [56]legende zullen opvallen, en ongetwijfeld
te wijten zijn aan de vertaling van het Engelsch in het Duitsch, en
daarna weder van het Duitsch in het Engelsch. Ik volgde streng den
Engelschen tekst in het werk van Gatschet.
Aan den arbeid der Penards hebben wij de kennis van een aantal
historische legenden te danken, die, hoewel zij wegens de invloeden
der blanke overheerschers, [57]die er zoo duidelijk in naar voren komen,
uit een wetenschappelijk oogpunt van minder belang zijn, toch in dezen
bundel niet mogen ontbreken.
Verwonderen kan het ons niet, dat van de eerste aanraking der
Indianen af aan met menschen van zóó geheel ander voorkomen, van
zóó geheel verschillenden aard en levensbeschouwing als zij, allerlei
zonderlinge verhalen aangaande de vreemde indringers onder hen de
ronde gingen doen, noch minder, dat ook deze verhalen van geslacht
op geslacht werden overgeleverd en tot op den huidigen dag bewaard
zijn gebleven.
Voor hem, die zich eenig denkbeeld wil vormen van het psychologisch
proces, dat bij dit dichterlijk en wijsgeerig aangelegd, moreel
hoogstaand volk zich door deze aanraking ging voltrekken, mogen
bedoelde legenden zeker van niet minder belang geacht worden, dan
het [58]grootste deel van dezen bundel mythen, sagen en legenden, die
ons in de oorspronkelijke denkwijzen van het zoo lang buiten iedere
vreemde aanraking gebleven Roode ras een blik kan leeren slaan.
De Legende van Armoribo en Jorobodie (No. 39), waarin van den strijd
der Arowakken met de eerste blanken verteld wordt 23, is niet alleen in
verband met de voorafgaande regels onze aandacht waard, doch ook
wegens eenige gewoonten en opvattingen, die wij er in aantreffen en
die tot illustratie kunnen dienen van de voorgaande beschouwingen.
Na deze legende, die wij aan den katholieken missionaris, Pater C. van
Coll te danken hebben, nemen wij uit den arbeid der gebroeders
Penard een tweetal legenden over, omdat deze verhalen, naar onze
meening, de uiting zijn van het besef der diepe klove, die de Indianen
ten opzichte hunner levensbeschouwingen en denkbeelden met die der
van verre komende blanken steeds meer moesten gaan gevoelen.
Zulks moet vooral het geval geweest zijn bij hunne aanraking met
zendelingen, die hun een geloof trachtten op te dringen, dat zóó ver
buiten hun gedachtensfeer ligt en dat deze zoo streng aan hun
overtuiging en aan de met hun geloof in verband staande voorschriften
zich houdende menschen in hooge mate moest krenken.