Just Add Monsters: Stressful Biofeedback Games for Improved Physiological Control

Abstract

Anxiety is often experienced as an explicitly physiological sensation: an increased breathing rate, sweaty palms, and a racing heart which can precede, co-occur with, and follow stressful experiences. The bi-directional relationship between these physiological responses and their subjective experiences suggests that physiology itself could be a useful therapeutic target. Many established therapies incorporate elements of physiological control (e.g., breathing techniques are often included in cognitive behavioural therapy), and other therapeutic techniques (such as biofeedback) rely entirely on physiological regulation as the mechanism of action for improving mental health. During the current global mental health crisis, many people face a lack of immediate access to appropriate care, meaning that more readily and rapidly available therapeutic methods are required. Here, physiological regulation training could act as a stopgap measure for people on waiting lists to receive standard treatment (such as medication or talking therapies) or may be appropriate as a standalone therapy if shown to be sufficiently efficacious. This thesis describes the process of creating and testing a series of virtual reality (VR) experiences and games, which have the potential to be developed into clinically relevant tools in the future. Such VR games, through their technology and the inherently motivating and enjoyable aspects of gameplay, can offer unique benefits for both psychological testing and therapeutics by providing an ideal medium for people to develop and practise new skills – including physiological regulation. The aims of the project were twofold: firstly, to produce a battery of virtual reality experiences that could be used as experimental stressors in psychological studies. Secondly, to create short VR games that can teach people physiological regulation techniques and then encourage them to apply these techniques in a stressful game setting. The VR experiences created were shown to elicit both physiological and subjective stress responses in healthy control participants (Study 1). Building on the results of this study, two games were developed: a breathing training game and a stressful biofeedback game. The breathing training game was subsequently shown to reduce respiration rate and increase heart rate variability in a proof-of-concept study (Study 2). This was then developed into a controlled study, which demonstrated that the breathing training game increased heart rate variability and reduced breathing rate more in the training group than in the control group (Study 3). In summary, this thesis demonstrates that games and virtual reality can be used both as stress induction experiences and to teach people physiological regulation skills. Future work can expand this research into using game-based physiological regulation in a therapeutic context for people suffering from mental health conditions.