Presented by Prof Dr. Sajjad Mohsin Dean Faculty of Information Sciences and Technology COMSATS Institute of Information Technology Islamabad, Pakistan.

Presented byProf Dr. Sajjad Mohsin

DeanFaculty of Information Sciences and TechnologyCOMSATS Institute of Information Technology

Islamabad, Pakistan

PSYCHOTHERAPY THROUGH DIGITIZATION

PSYCHOTHERAPY BASED GAME FOR HEALING BRAIN TUMOR IN CHILDREN

Outline

1. Overview2. Problem Background3. Research Question & Objectives4. Methodology and Design 5. Evaluation and Results6. Conclusion7. Contribution and Future Work

1. Overview

Psychotherapy

Brain TumorIn children

Game Design

• Game design documents the creative, conceptual, technical and functional aspects of game.

• Every game has to be custom design depending on its intended usage.

• There are no specific set of rules for serious game design but can use common principles that apply to these games.

• The important aspects for designing a game is on its mechanics, Dynamics and Aesthetics.

• One of the second largest deadly diseases in children and it is the abnormal growth of tissues in the brain.

• Its diagnosis may originate many psychological problems among children like anger, depression, low self esteem and anxiety.

• These problems can be dealt successfully if some form of psychotherapy is applied on such patients.

• Term used by Psychotherapists/Psychologists for treating or healing mental disturbances such as anxieties and depressions etc.

• There are many types of Psychotherapies widely used all over the world by the Psychotherapists such as behavioral therapies, Psychoanalytical therapies or Cognitive therapies etc.

• Guided Imagery Psychotherapy is a technique in which patient is guided in imagining a relaxing scene or series of experiences and Play therapy is developed by David Levy in 1938 is a kind of therapy with children going through specific kind of stress. The play situation and material is introduced for a child.

Psychotherapy

Brain TumorIn children

Game Design

Therapeutic Game

(digitization) Applied on

2. Problem Background

Salient Features of Literature Review

Game Design

Effect of Computer Games

Psychotherapy

Brain Tumor & Psychological

Effects

Psychotherapy

• Its been used since the Greek era to solve mental & behavioral problems• At present many forms of Psychotherapies exist, such as Imagery & Play therapy widely used for children•Number of studies and researches has proved the effectiveness of play therapy on children suffering from cancer• Study in the Scandinavian Journal shows a positive correlation between imagery therapies and positive Psychological changes in cancer patients. (Gruber et al., 1988).

Psychotherapy

• The experiment conducted by Troesch et al. (1993) and Arthur in Cancer Hospital (2001) found that individuals who took part in imagery sessions got good scores on better mood and, even after sessions were complete, giving clear indication that guided imagery is effective in improving mood and quality of life in cancer patients.

• Constantinou (2009), has proved that the play therapy is effective with a child diagnosed as cancer

• Play therapy can helps children deal psychologically as well as physically with cancer.

Positive Effect of Computer Games

• Flew and Humphreys (2005) suggested in their researches that, games are helpful to get away from individual’s everyday life and to break routine. They also help to relieve stress, allow individual to cool off in the stressful state because they are fun and an interesting way to spend time.

• Betker et al. (2006) used video game based system for selected patients having tumor and brain injury. After the experiments, the authors came to the conclusion that the exercise based games urged the patients towards regular exercise.

• Lehmann (1997) explained that through the use of educational video games, the awareness about illnesses like diabetes can be raised. The author urged that diabetic patients can be attracted by using powerful interfaces and interesting scripts in the games.

Health Games

• ‘Treasure Hunt’ is the first psychotherapeutic computer game being made on the rules of behavior enhancement (Brezinka, 2008).

• This game which is for 8 to 12 year old children is not developed for replacing the therapist but to advise engaging electronic homework assignments and practice the main educational concepts that have been adopted during therapy.

Health Games

• Re-mission -- developed by Hope lab for cancer patients (Tate et al., 2009).• It was the first game made for cancer patients

and proved effective with regard to decrease in anxiety and depression but for teens.

• Third person shooter game does not provide the explanation of self-empowerment and cannot fulfill the therapeutic requirements.

• Personal Investigator (Coyle et al., 2005). • It is designed to engage adolescents in

psychotherapy .

Computer Game Design

• Hunicke (2004) has proposed a MDA Framework for game design. i.e also Mechanics, Dynamics and Aesthetics. This approach supports a formal, iterative approach to design and tuning.

• Mechanics illustrates the game at algorithms level. • Dynamics shows the run-time behavior of the game as

system.• Aesthetics demonstrates the emotional reactions induced

in the player. • Pulsipher (2012) describes MDI approach for game design. MDI

represents Mechanics, Dynamics and Impression. • Impression is basically what a designer wants to produce in

the mind and heart of the player.

Computer Game Design

•Game design for therapy purpose is important where challenge is not winning the game in itself, but rather an approach for treating mental health problems games.

•Psychotherapeutic games are reality oriented for the treatment of patients so they are developed accordingly keeping in view the real world problems.

•Game play and rules are developed after complete research on the desired health problem (Goh et al., 2008).

Computer Games

• New computer games are launched on daily basis with variety of purpose

• Serious Games are made for the purpose of training, education or improving health.

2008 2009 2010 2011 2012 2013 2014

Psychotherapeutic Game Design

• Game design for psychotherapeutic games is meant to have simple rules that are fair enough for the player to play, rather than spending all the time in understanding the rules of the game and the game play.

• Game design of this type is more important in psychotherapeutic games where challenge is not winning the game in itself, but rather an approach for treating mental health problems games. The games developed for entertainment are more into giving players a fake view of the world. But psychotherapeutic games are reality oriented for the treatment of patients so they are developed accordingly keeping in view the real world problems. Game play and rules are developed after complete research on the desired health problem (Goh et al., 2008).

Psychological Effects of Brain Tumor

Anger : is a response to an apparent thereatDepression: low mood condition after bad life situationAnxiety : Anticipating the upcoming event. Diagnosis will make a person feel disturbed of what will happen next.Disruptive behavior: disturbed patterns of overall all behaviors. Can not utilize any of his/her strength and potentials.Self Concept: mental expression of a self. It includes past present and future of a self. Diagnosis lead to a distorted self concept.

Literature Review Cont..

Brain Tumor

Treated by: Conventional methods• Radiation• Chemotherapy• Medical treatments

Psychological Illness

Needs to be treated

Literature Review cont…

Computer Games Health Games

Treating Psychological Illness

Types

Literature Review cont…

Remission

Personal Investigator & Treasure Hunt

No therapy embedded

Therapy embedded to some extent but therapist required

Closing the Gap

• Psychotherapy Based Game Design for Healing Brain Tumor in Children

4. Methodology and Design

Design Phase: Therapy Game story plotting

• In the therapy game design the therapeutic protocols has to be followed. • The empowerment concept of Imagery therapy is emphasized and existing

protocols of therapy have been enhanced by introducing the strong suggestions and implementing in game scenario.

• Three Level Game story

Methodology

Game Scene

Engine

Executable

Animation of Character

Survey- Selection of music

for game

3D Character Modeling

2D Enemy Sketch

Survey- Selection

of weapon for game

Computational Results

Heads Hands Legs

Enemy Sketch

selection of enemy character

•Visit: different schools of Islamabad and Rawalpindi•Target Audience: Children of age raging 8-12 years•Samples of drawings collected: 100•Collected drawings were categorized and grouped on the basis of similarities of concepts of enemy features and structures.

Unique Avatar Creation

•Based on a survey a software “unique avatar creation” is developed•Development environment: Matlab

Survey- Selection of enemy character

Survey on the selection of weapon

• Visit: PIMS Hospital• Target Audience: Children of age raging 8-

12 years• Purpose: what kind of unique weapons,

children having brain tumor like to play within game

Computational Results

• Visit: different schools of Islamabad• Target Audience: Brain tumor patient, 8-12

age• Samples of music: 5 (soothing and healing)• Result: Music that is liked by children was

selected for game.

Computational Results

• Children choice weapon is modeled• Unique weapon- syringe. • Weapons are morphed from White Blood

Cell

Implementation of the therapy Game Design

Progression in Mechanics, Dynamics and Aesthetics Framework to MDAT• MDA framework: The Mechanic, Dynamics and Aesthetics has

to be defined as per the usage of any game and MDA has given a general outline for game design.

• In our game the Mechanics are defined that the player has to kill NPC in a particular time. It also involves the path leading player towards destination where throughout some pickups are present in forms of medicines and fruits. These are in accordance with the therapeutic requirement in the form of strong suggestions.

Implementation of the therapy Game Design. Continued

Progression in MDA Framework to MDAT• The dynamics include the less challenging game requiring

auto aiming or auto targeting.

• It involves stage containing story and tasks confronted by the player.

• The aesthetics are the overall environment selected which involves therapy steps in our case.

MDAT• The therapy target is achieved here through giving the sense

of empowerment within the self. • The promising line of research: as this concept is therapeutic

but not used before in other similar games. • Remission game for cancer patients: The concept in that was

some angel character will come from outside and will destroy the cancer cell unlike our proposed therapy game.

• The concept is inline with the existing therapies applied on the patients with illness related psychological problems.

Therapy Based Game Design

Therapeutic Computer Game• This insertion of Psycho-Therapy in Aesthetic portion of the

game is in-line with the recommendation made by Hocine and Gouaïch (2011) where they emphasize that effect of therapy in the game depends on how carefully it is implemented in Aesthetics portion of the game. The Aesthetics of the game influence the mechanics and dynamics.

• In our proposed game the tumor patients (children) are exposed to the brain environment so that they are able to fight with the tumor and its powers to make them brave enough to fight with their own disease in the real world as well. The therapy step is based on concept of empowerment through Imagery and Play Therapy. The digitization has made it possible to play without physical presence of Psychotherapist.

7. Results and Evaluation

Results• Successful fusion of two therapies in a computer game (PGIT).• Enhancement in game design to implement PGIT in it.• The therapy based game was tested on 76 children with brain

tumor Play TherapyImagery TherapyPlay Therapy

& Imagery Therapy

Computer Technology

Play Graphical Imagery Therapy

(PGIT)

Mechanic, Dynamics and Aesthetics

(MDA)

Mechanic, Dynamics Aesthetics and Therapy

(MDA-T)

Therapy 38 played this game (experimental group) 38 didn’t played this game (controlled group) The experiment showed exciting results The 38 children who played this game have shown

improvement over the children who didn’t played this game.

Results

Results

Results

AngerAnxietyDepressionDisruptive BehaviorLack of Self ConceptPositive response towards treatmentWilling to play gameSelf ConfidenceTaking medicineTaking FruitsRelaxed

Oncologist Reviews

8. Conclusion and Future work

Conclusions• In this research an attempt is made to computerize the

psychotherapy

• The case study for this research is done on the children with brain tumor

• Enhancement in the MDA game designed was proposed into a new game design MDAT

• Two psychotherapies was fused together in MDAT

Conclusions• The psychotherapy is implemented in a computer game

design.• The effectiveness of Psychotherapy based game design is

tested by using standardized psychological testing tool.

• The test results have shown marked improvements in the overall behavior of the children before and after using the designed game.

• The results also proved that the designed game could be used without the presence of a Psychotherapist

9. Contribution and Future work

Contributions to Knowledge• The Game design frame work was enhanced and Psychotherapy is induced

into it.• The two independent psychotherapies, Imagery Therapy and Play Therapy

are fused together in Play Guided Imagery Therapy (PGIT). The other contribution to knowledge PGIT has made is by eliminating Therapist presence that is a must in both the therapies. So the game could be played independently, without therapist.

• The proactive approach of designing the game environment by surveying/involving children has contributed to knowledge that Imagery therapy and Play therapy could be digitized. This is achieved by capturing their imagination for the choice weapon, creation of avatar, selection of color and therapeutic music. This imagination is the core basis of Imagery Therapy. Therefore by converting sketches made by children into enemy/avatar and use of their choice of weapon, color and music made it possible to computerize the Imagery Therapy. Thus it opens the new avenues for digitization of other psychotherapies in future.

Contributions6 Research Papers Published from thesis

1. Psychotherapy Through Video Game to Target Illness related Problematic Behaviors of Children with Brain Tumor. Medical Imaging Reviews 10(1) 2014: 62-72 (ISI Impact 1.059)

2. Digitizing 2D sketched Animated Character for Graphical Imagery Therapy (GIT) Game. International Journal of Information and Education Technology Singapore (2012)

3. Enemy Character design for Graphical Imagery Therapy (GIT) Game. International Journal of Information and Education Technology Singapore (2012)

4. Involving enemy avatar through categorization technique in computer game for healing. International Journal of Information and Education Technology Singapore (2012),

5. Background Music Generation for Health using Children preferred Music. ARCHIVES DES SCIENCES-Archive of Sciences Journal Switzerland, Geneva (2012).

6. Unique Avatar Creation using Computation. ARCHIVES DES SCIENCES-Archive of Sciences Journal Switzerland, Geneva (2012)

Cited In: Curr Psychiatry Rep 2014, DOI 10.1007/s11920-014-0520-6Title: The Use of Electronic Games in Therapy : a Review with Clinical ImplicationsAuthor: Lynn Hornc et al.

“Papers of particular interest of major importance”

Invited Talks on Use of Health Games

1. Commission for Thematic research in ICT, Turkey (May 2012)

2. Department of Computer Science, Germany Paderborn University (November

2012)

3. Frontier of Information Technology, Pakistan (December 2012)

4. Commission for Thematic Research in ICT, Ghana (May 2013)

5. Invited talk on making business Plan for 3D GIT game (1 -15 June –2013)

-MIT Boston, USA

-Silicon Valley, USA

-Washington DC (embassy of Pakistan), USA

-US State department, USA

-US Commerce Department , USA

Contributions Contd…

Future Work

• There are a number of areas of future research that have been identified during this study.

• Longitudinal studies for the long term evaluation of the progress in the health of children with brain Tumor.

• Evaluation or psychological testing is done by the therapist. Since the therapy is computerized in this research so psychological testing could also be performed automatically.

• The work on digitizing other psychological therapies is also possible.