DEEP: A Biofeedback Virtual Reality Game for Children At-risk for Anxiety

Anxiety disorders are among the most frequently diagnosed mental health problems in children, leading to potentially devastating outcomes on a personal level and high costs for society. Although evidence-based interventions are readily available, their outcomes are often disappointing and variable. In particular, existing interventions are not effective long-term nor tailored to differences in individual responsiveness. We therefore need a new approach to the prevention and treatment of anxiety in children and a commensurate scientific methodology to uncover individual profiles of change. We argue that applied games have a great deal of potential for both. The current paper presents results from a recent pilot study using a biofeedback virtual reality game (DEEP). DEEP integrates established therapeutic principles with an embodied and intuitive learning process towards improved anxiety regulation skills.

[1]  Damian G. Stephen,et al.  The dynamics of insight: Mathematical discovery as a phase transition , 2009, Memory & cognition.

[2]  S. Mineka,et al.  Mechanisms of Change in Exposure Therapy for Anxiety Disorders , 2005 .

[3]  Thomas C. Meyer,et al.  Presence as the Defining Factor in a VR Application , 1994 .

[4]  Hunter G. Hoffman,et al.  Virtual Reality Exposure Therapy for World Trade Center Post-traumatic Stress Disorder: A Case Report , 2002, Cyberpsychology Behav. Soc. Netw..

[5]  B. Rothbaum,et al.  Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. , 2001, The Journal of clinical psychiatry.

[6]  B. Rothbaum,et al.  A controlled study of virtual reality exposure therapy for the fear of flying. , 2000, Journal of consulting and clinical psychology.

[7]  Marc D. Lewis,et al.  The promise of dynamic systems approaches for an integrated account of human development. , 2000, Child development.

[8]  R Sovik,et al.  The science of breathing--the yogic view. , 2000, Progress in brain research.

[9]  A. Opstal.  Dynamic Patterns: The Self-Organization of Brain and Behavior , 1995 .

[10]  R. McNally.  Mechanisms of exposure therapy: how neuroscience can improve psychological treatments for anxiety disorders. , 2007, Clinical psychology review.

[11]  Gavan Lintern,et al.  Dynamic patterns: The self-organization of brain and behavior , 1997, Complex.

[12]  A. Antonovsky.  Health, stress, and coping , 1979 .

[13]  Thomas E. Joiner,et al.  A measure of positive and negative affect for children: Scale development and preliminary validation. , 1999 .

[14]  Sherecce Fields,et al.  Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature. , 2006, Clinical psychology review.

[15]  James J. Gross,et al.  Patterns of Emotional Reactivity and Regulation in Children with Anxiety Disorders , 2010 .

[16]  D. Watson,et al.  Development and validation of brief measures of positive and negative affect: the PANAS scales. , 1988, Journal of personality and social psychology.

[17]  J. Stockman.  Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A) , 2012 .

[18]  K. Merikangas,et al.  Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). , 2010, Journal of the American Academy of Child and Adolescent Psychiatry.

[19]  Charlotte Wilson,et al.  Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. , 2012, Clinical psychology review.

[20]  Georgina James,et al.  Cognitive behavioural therapy for anxiety disorders in children and adolescents. , 2015, The Cochrane database of systematic reviews.

[21]  D. Fergusson,et al.  Life course outcomes of young people with anxiety disorders in adolescence. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  C. Roberts,et al.  Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. , 2004, The British journal of clinical psychology.

[23]  R. Fried,et al.  The psychology and physiology of breathing : in behavioral medicine, clinical psychology, and psychiatry , 1993 .

[24]  A. Craig,et al.  Interoception and Emotion : a Neuroanatomical Perspective , 2007 .

[25]  Barry R. Dworkin.  Learning and Physiological Regulation , 1993 .

[26]  P. Kendall,et al.  Therapy for youths with anxiety disorders: a second randomized clinical trial. , 1997, Journal of consulting and clinical psychology.

[27]  P. Grossman.  Respiration, stress, and cardiovascular function. , 1983, Psychophysiology.

[28]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[29]  Lyndhurst Collins.  The Use of Models in the Social Sciences , 1976 .

[30]  S. Watts,et al.  Physiological Response and Childhood Anxiety: Association With Symptoms of Anxiety Disorders and Cognitive Bias , 2005, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[31]  Ronald Ley,et al.  The psychology and physiology of breathing: In behavioral medicine, clinical psychology, and psychiatry: By Robert Fried with Joseph Grimaldi New York, Plenum Publishing Corporation, 1993 , 1994 .

[32]  C. Viswesvaran,et al.  Evidence-Based Psychosocial Treatments for Phobic and Anxiety Disorders in Children and Adolescents , 2008, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[33]  P. V. Geert,et al.  Dynamic systems of development: Change between complexity and chaos , 1994 .

[34]  P. Kendall.  Treating anxiety disorders in children: results of a randomized clinical trial. , 1994, Journal of consulting and clinical psychology.

[35]  B. Rothbaum,et al.  Virtual reality exposure therapy in the treatment of fear of flying: a case report. , 1996, Behaviour research and therapy.

[36]  D. Lewkowicz,et al.  A dynamic systems approach to the development of cognition and action. , 2007, Journal of cognitive neuroscience.

[37]  R. Kessler,et al.  The economic burden of anxiety disorders in the 1990s. , 1999, The Journal of clinical psychiatry.

[38]  A. Glenberg.  Embodiment for Education , 2008 .

[39]  P. Calvo,et al.  Handbook of cognitive science : an embodied approach , 2008 .

[40]  J A Kelso,et al.  The nonlinear dynamics of speech categorization. , 1994, Journal of experimental psychology. Human perception and performance.

[41]  A. Baddeley.  Working memory: looking back and looking forward , 2003, Nature Reviews Neuroscience.

[42]  J. Ridley.  Studies of Interference in Serial Verbal Reactions , 2001 .

[43]  H. Eysenck,et al.  THE EFFECTS OF PSYCHOTHERAPY. , 1965, International journal of psychiatry.

[44]  Claudia Carello,et al.  Haptic and Visual Perception of an Affordance for Upright Posture , 1994 .

[45]  William M. Kurtines,et al.  Predictors of outcome in exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in children* , 2000 .

[46]  R. Fried,et al.  The psychology and physiology of breathing , 1993 .

[47]  Gerard Jounghyun Kim,et al.  A SWOT Analysis of the Field of Virtual Reality Rehabilitation and Therapy , 2005, Presence: Teleoperators & Virtual Environments.

[48]  M. Krijn,et al.  Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. , 2002, Behaviour research and therapy.