Games[4Therapy]: Designing and developing a serious game for adolescents with externalizing problems, using the ‘5G-method’

Games[4Therapy]

Marille RosendaalApplied Psychologist User Researcher

Games[4Therapy] presents:Thought-O-Gram & Helpagons

Designing and developing a serious game for adolescents with externalizing problems, using the 5G-method

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Before we start the presentation:

Does everyone have a QR-code scanner installed on their phones (Android only)?

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Consortium partners

The games4therapy consortium has quite a few big players. Fontys, ZUYD and Hogeschool van Amsterdam are educational institutions here in the Netherlands. Both students and professors in different areas work together. Then we have GGzE and Mondriaan, which are mental healthcare institutions. Kenniscentrum is a centre of and for expertise in childrens- and youth psychiatry.

Every partner delivers in this consortium; students and professors work together to create games and applications, supported by the knowledge and expertise of the mental healthcare professionals.

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Cocreators: Studio GDT and many more

These are our heroes that designed and created the game(s), graduate students and their project managers/professors4

GoalsDeveloping, implementing serious games & applications to increase adherence to CBT in youths (age 12-18) with externalizing problems

Fit perception/world of youths Increase motivation for therapyLower drop-out rates

Dropout rates are high: several studies report 6 up to 52 percent. This means that in some cases, over half of these young clients prematurely end their therapy.In designing, developing and implementing serious games and or applications, the games4therapy consortium hopes to bring some change. To do so, we must make sure that the games we develop fit the perception of the youths. These youngsters will have to want to play the games. When the youths want to play the game, we believe motivation for therapy will increase. This is currently being tests. Finally, when the game increases motivation and adherence, drop-out rates could lower, which is our ultimate goal.

Externalizing problems are quite common in adolescents with autism, adhd, oppositional defiant disorder and conduct disorder. Typical problems would be arriving late or not at all at a meeting, insulting or swearing, generally not listening, talking when its inappropriate (at school for instance), bullying, but also more serious offences like stealing, fighting, arson, animal cruelty. 5

CBT: Cognitive Behavioral Therapy5G-method: analyzing and learning from difficult situations, by thinking of and practicing with other possibilitiesGebeurtenis SituationGedachte ThoughtGevoel FeelingGedrag BehaviorGevolg Result

(Translated it would be the STFBR method, not as catchy, so ill keep refering to it as the 5G method)

In this method, the client analyses a situation in which his or her externalizing problems clearly showed. The analyzing is done using the 5 gs, translated to be the event: what happened? Where? Who else was there? When?, the thoughts: What was client thinking when it happened? Feelings: How did the client feel at that moment? Behavior: How did the client act/react in this situation? And finally the result; what did this behavior in this situation lead to?For instance, john is playing call of duty online, when all of a sudden, some other player starts insulting him. Johns first thought is what an asshole! What the hell is wrong with him?, which leads to john feeling very angry. John starts swearing online, which leads to a ban on the server. Result: john cant game on.

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Thought-O-Gram & HelpagonsThought-O-Gram: Helps client communicate 5 Gs to therapistMakes 5Gs insightful by entering text, audio and imagesHelpagons:Helps client search for better ways to deal with own difficult situations in playful manner (puzzle)

We created two steps in this whole process. The first step is describing and analyzing the sitation, using the 5Gs. Using Thought-O-Gram, the client can enter text, audio (recording spoken words) and choose images from our library. In a few moments, I will show you exactly how this is done. By using different methods to enter the 5Gs, we make sure every client can use his or her prefered method of interaction. When the situation has been entered and analyzed, together with their therapist, the client can save the situation and use it in Helpagons. Helpagons is a puzzlegame, in which the client has to find a path to a certain goal, based on a certain situation (their own situations). To get to the end, the client has to use the right tiles in the right order (based on the 5Gs). By thinking of different possibilities, the client can learn that there are other ways to respond to a situation.For instance, lets go back to john. John was playing call of duty, when someone starts insulting him. John has been practicing how to handle himself; this time he thinks well, i wonder why this other player is insulting me. He still feels a little hurt; who wouldnt be when someone insults you? John decides to ask the other player whats going on and learns that he was in fact walking around in the line of sight the other player had on an enemy. John quickly moves position, the other player thanks him and both can happily continue on gaming.7

Testing Research during design processCo-creation focusgroups with clients (Pizza-parties)Expert-panels including therapists and serious game designersUsability tests with clients and their therapists in 1 on 1 sessionsCurrent ResearchTechnology acceptance in therapists using TARSRole of games in therapy complementary or replacing?Future ResearchExperience of clients and therapists in therapy

Since I only have 10 minutes, I will quickly explain what we are doing now, research wise, and what our plans for the future are. Then, if there is time, ill do a quick playthrough of our games!

To figure out what these adolescents want, we organised a few focusgroups with clients. During these pizza-parties, we showed clients the ideas we were working on and asked them to give feedback and come up with ideas to improve the ideas. We brought paper-models of our concepts, making it possible for the clients to actually try out some of the elements irl.

During the creation of the game, we used several ways to include our users in the design process. First of all, we used a panel of experts in different fields to reflect on our progress. Every two weeks (at the end of a sprint) the panel would give feedback using an online questionaire. Members of the panel also had the opportunity to elaborate on their feedback in skype or telephone calls.

As soon as there were playable versions of our games, we tested them in a realistic fashion; by asking therapists to plan a session with their client and using the games in this session. We observed these testsessions closely, using observation schemes. This way, we could not only see how the games are used and if the interactions were working, but also see how the clients responded to the games in general. We used the information gathered here to improve our games even further.

Weve just started our research into technology acceptance in therapists. We are going to use the TARS, the technology acceptance readiness scale, to measure the acceptance of our games in the therapists. Frame of reference for therapists is the analog way, which is the use of a diary. This led to the initial reaction of therapists to the games as being not very positive. Once these therapists were guided through the games and the use of those games, they were much more positive and more enthused about them. Using the TARS, we want to research the means to get these therapists to accept and use the games.

Then finally we will do a longitudinal study of motivation for therapy in the clients. We are currently working hard to get this research up and running. Wat voor rol zou deze game in therapie kunnen hebben? Alleen een dagboek, begin van therapievervangende onderdelen? Niet meer dan alleen aanvulling op therapie? Doel niet perse behaald, ambitie is om op zijn minst de analoge formulieren te kunnen vervangen met de app. Op termijn zouden we ook de therapie vorm willen verdiepen door gebruik te maken van de directe beschikbaarheid van de informatie (in vergelijking met analoog formulier dat pas in de volgende sessie beschikbaar is) en verlaging van therapiesessies terwijl de intensiteit verhoogd wordt door korte online contactmomenten (feedback op logs).

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Results so farClients expressed pleasant surprise with concrete examples of games, available in near futureGames: step in right direction, compared to analogue material More helpful (automation, visual clues) More structured Provide direct insights for both client and therapistPriorities for further developmentOptions / placement elements (obviously)Connection with puzzleMultiplayer functionality

Making therapy fun: expectations for adherence are positive!

Improvements made were usually more on the usability-side; buttons that didnt work properly, bigger library, placement of elements in screen

Best feedback for the helpagon-game: make it multiplayer clients loved the idea of working together with other clients and helping and learning from eachother. The social aspect also seemed useful to the therapists (gaat er nog iets mee gebeuren?)

Compared to analogue therapy materials, discussed only in a therapy session, the games are more helpful (automation, visual clues), structured and provide direct insights for both client and therapist

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Thought-O-Gram

Scenario ik in trein aan telefoon daardoor mis ik overstap, ik ga schelden aan telefoon met als gevolg dat conducteur naar me toe komt, ik ruzie maak en een boete krijg daardoor.10

Thought-O-Gram

scenario: gamen/uitschelden/..11

Thought-O-Gram


Thought-O-Gram


Thought-O-Gram


Thought-O-Gram


Helpagons

Scenario: serveerster gooit drinken over je wat doe jeLet 16

QR-Scanners ready?

Misschien even benoemen dat de games niet altijd meteen geinstalleerd kunnen worden - heeft te maken met instellingen op android phone (niet in playstore, staat automatisch uit) - find me after this session if you need any help installing the games!17

Try our games for yourself!

Thought-O-Gram

Helpagons

QR codes maken en zorgen dat ze maar een paar dagen beschikbaar zijn!!

eventueel aanbieden hulp met installeren 18

Games[4Therapy]: Designing and developing a serious game for adolescents with externalizing problems, using the ‘5G-method’

Healthcare