The Efficacy of a Novel Video Game Intervention (MindLight) in Reducing Children's Anxiety

Anxiety disorders are the most prevalent form of psychopathology among children and adolescents. Because demand for treatment far exceeds availability, there is a need for alternative approaches that are engaging, accessible, cost-effective, and incorporate practice to reach as many youth as possible. One novel approach is a video game intervention called MindLight that uses two evidence-based strategies to target childhood anxiety problems. Using neurofeedback mechanics to train players to: (1) attend to positive rather than threatening stimuli and (2) down-regulate arousal during stressful situations, MindLight teaches children how to practice overcoming anxious thoughts and arousal in a fun and engaging context. The present study examined the effectiveness of MindLight versus online cognitive-behavioural therapy (CBT) based psychoeducation sessions as a comparison in reducing anxiety in a sample of 144 anxious children, which was measured in three ways: (1) anxiety symptoms, (2) state anxiety in response to stress, and (3) psychophysiological arousal in response to stress. Children between the ages of 8.05–17.78 years (M=13.61, SD=1.79) were randomly assigned to play MindLight or complete psychoeducation for five hours over three weeks. State anxiety and psychophysiological arousal were assessed in response to two stress tasks before and after exposure to MindLight or psychoeducation. Anxiety symptoms were also measured via a questionnaire. Overall, participants showed significant reductions in anxiety symptoms and state anxiety in response to stress, but not psychophysiological arousal in response to stress. Moreover, the magnitude of reductions in anxiety did not differ between interventions but by age and sex. Specifically, older participants showed a greater decrease in severity of state anxiety in response to a social stressor than younger participants and girls showed a greater decrease in severity of state anxiety in response to a cognitive stressor than boys. The present study suggests that playing MindLight results in similar reductions in anxiety as one of the more common means of delivering CBT principles to youth.

A Virtual Joystick as a Novel Interaction Modality for Surgeon-Computer Interaction During Computer-Assisted Surgical Procedures

Interacting with a computer system in the operating room (OR) can be a frustrating experience for a surgeon, who currently has to verbally delegate to an assistant every computer interaction task. This indirect mode of interaction is time consuming, error prone and can lead to poor usability of OR computer systems. This thesis describes the design and evaluation of a joystick-like device that allows direct surgeon control of the computer in the OR. The device was tested extensively in comparison to a mouse and delegated dictation with seven surgeons, eleven residents, and five graduate students. The device contains no electronic parts, is easy to use, is unobtrusive, has no physical connection to the computer and makes use of an existing tool in the OR. We performed a user study to determine its effectiveness in allowing a user to perform all the tasks they would be expected to perform on an OR computer system during a computer-assisted surgery. Dictation was found to be superior to the joystick in qualitative measures, but the joystick was preferred over dictation in user satisfaction responses. The mouse outperformed both joystick and dictation, but it is not a readily accepted modality in the OR.

HELPING YOUTH WITH AUTISM SPECTRUM DISORDER DEVELOP SOCIAL COMPETENCE IN COMMUNITY-BASED SETTINGS

The purpose of the current dissertation is to identify the features of effective interventions by exploring the experiences of youth with ASD who participate in such interventions, through two intervention studies (Studies 1 and 2) and one interview study (Study 3). Studies 1 and 2 were designed to support the development of social competence of youth with ASD through Structured Play with LEGO TM (Study 1, 12 youths with ASD, ages 7–12) and Minecraft TM (Study 2, 4 youths with ASD, ages 11–13). Over the course of the sessions, the play of the youth developed from parallel play (children playing alone, without interacting) to co-operative play (playing together with shared objectives). The results of Study 2 showed that rates of initiations and levels of engagement increased from the first session to the final session. In Study 3, 12 youths with ASD (ages 10–14) and at least one of their parents were interviewed to explore what children and their parents want from programs designed to improve social competence, which activities and practices were perceived to promote social competence by the participants, and which factors affected their decisions regarding these programs. The adolescents and parents looked for programs that supported social development and emotional wellbeing, but did not always have access to the programs they would have preferred, with factors such as cost and location reducing their options. Three overarching themes emerged through analysis of the three studies: (a) interests of the youth; (b) structure, both through interactions and instruction; and (c) naturalistic settings. Adolescents generally engage more willingly in interventions that incorporate their interests, such as play with Minecraft TM in Study 2. Additionally, Structured Play and structured instruction were crucial components of providing safe and supportive contexts for the development of social competence. Finally, skills learned in naturalistic settings tend to be applied more successfully in everyday situations. The themes are analysed through the lens of Vygotsky’s (1978) perspectives on learning, play, and development. Implications of the results for practitioners and researchers are discussed.

The Use of Nudges in Exergames to Moderate Player Exertion

Exergames are digital games with a physical exertion component. Exergames can help motivate fitness in people not inclined toward exercise. However, players of exergames sometimes over-exert, risking adverse health effects. These players must be told to slow down, but doing so may distract them from gameplay and diminish their desire to keep exercising. In this thesis we apply the concept of nudges—indirect suggestions that gently push people toward a desired behaviour—to keeping exergame players from over-exerting. We describe the effective use of nudges through a set of four design principles: natural integration, comprehension, progression, and multiple channels. We describe two exergames modified to use nudges to persuade players to slow down, and describe the studies evaluating the use of nudges in these games. PlaneGame shows that nudges can be as effective as an explicit textual display to control player over-exertion. Gekku Race demonstrates that nudges are not necessarily effective when players have a strong incentive to over-exert. However, Gekku Race also shows that, even in high-energy games, the power of nudges can be maintained by adding negative consequences to the nudges. We use the term "shove" to describe a nudge using negative consequences to increase its pressure. We were concerned that making players slow down would damage their immersion—the feeling of being engaged with a game. However, testing showed no loss of immersion through the use of nudges to reduce exertion. Players reported that the nudges and shoves motivated them to slow down when they were over-exerting, and fit naturally into the games.