ABSTRACT
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.
- Kathleen R. Merikangas, Jian-ping He, Marcy Burstein, Sonja A. Swanson, Shelli Avenevoli, Lihong Cui, Corina Benjet, Katholiki Georgiades, and Joel Swendsen. 2010. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication- Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry 49, 10: 980--989.Google ScholarCross Ref
- Lianne J. Woodward and David M. Fergusson. 2001. Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry 40, 9: 1086--1093.Google ScholarCross Ref
- Paul E. Greenberg, Tamar Sisitsky, Ronald C. Kessler, Stan N. Finkelstein, Ernst R. Berndt, Jonathan RT Davidson, James C. Ballenger, and Abby J. Fyer. 1999. The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry 60: 427-435.Google ScholarCross Ref
- Shirley Reynolds, Charlotte Wilson, Joanne Austin, and Lee Hooper. 2012. Effects of psychotherapy for anxiety in children and adolescents: A metaanalytic review. Clinical psychology review 32, 4: 251--262.Google Scholar
- Anthony C. James, Georgina James, Felicity A. Cowdrey, Angela Soler, and Aislinn Choke. 2013. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 6.Google Scholar
- Sam Cartwright-Hatton, Chris Roberts, Prathiba Chitsabesan, Claire Fothergill, and Richard Harrington. 2004. Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. British journal of clinical psychology 43, 4: 421--436.Google Scholar
- Marc S. Karver, Jessica B. Handelsman, Sherecce Fields, and Len Bickman. 2006. 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. Clinical psychology review 26, 1: 50--65.Google Scholar
- Aaron Antonovsky,. 1979. Health, stress, and coping.Google Scholar
- Paul Grossman. 1983. Respiration, stress, and cardiovascular function. Psychophysiology 20, 3: 284--300.Google ScholarCross Ref
- Carl F. Weems, Alan H. Zakem, Natalie M. Costa, Melinda F. Cannon, and Sarah E. Watts. 2005. Physiological response and childhood anxiety: Association with symptoms of anxiety disorders and cognitive bias. Journal of Clinical Child and Adolescent Psychology 34, 4: 712--723.Google ScholarCross Ref
- Tal Carthy, Netta Horesh, Alan Apter, and James J. Gross. 2010. Patterns of emotional reactivity and regulation in children with anxiety disorders. Journal of Psychopathology and Behavioral Assessment 32, 1: 23--36.Google ScholarCross Ref
- Barry R. Dworkin. 1993. Learning and physiological regulation. University of Chicago Press.Google Scholar
- A. D. Craig. 2008. Interoception and emotion: a neuroanatomical perspective. Handbook of emotions, 3: 272--88.Google Scholar
- Robert Fried and Joseph Grimaldi. 1993. The Psychology and Physiology of Breathing: In Behavioral Medicine, Clinical Psychology and Psychiatry. Springer Science & Business Media.Google Scholar
- Rolf Sovik. 2000. The science of breathing-the yogic view. Progress in brain research, 122: 491- 505.Google Scholar
- Philip C. Kendall. 1994. Treating anxiety disorders in children: results of a randomized clinical trial. Journal of consulting and clinical psychology, 62, 1: 100.Google ScholarCross Ref
- Philip C. Kendall, Ellen Flannery-Schroeder, Susan M. Panichelli-Mindel, Michael Southam-Gerow, Aude Henin, and Melissa Warman. 1997. Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of consulting and clinical psychology 65, 3: 366.Google ScholarCross Ref
- Wendy K. Silverman, Armando A. Pina, and Chockalingam Viswesvaran. 2008. Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology 37, 1: 105-Google ScholarCross Ref
- Owen L. L. Harris. 2015. owenllharris.com/deep. Retrieved from http://owenllharris.com/deepGoogle Scholar
- Niki Smit. 2015. DEEP. Retrieved from http://www.monobanda-play.com/project/deepGoogle Scholar
- Owen L. L. Harris. 2015. DEEP breathing in virtual reality, TEDxBratislava. Video. (4 July2015). Retrieved from https://www.youtube.com/watch?v=EYkWghdLNJMGoogle Scholar
- Susan Mineka and Cannon Thomas. 1999. Mechanisms of change in exposure therapy for anxiety disorders.Google Scholar
- Richard J. McNally. 2007. Mechanisms of exposure therapy: How neuroscience can improve psychological treatments for anxiety disorders. Clinical psychology review 27, 6: 750--759.Google Scholar
- Steven L. Berman, Carl F. Weems, Wendy K. Silverman, and William M. Kurtines. 2000. Predictors of outcome in exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in children. Behavior Therapy 31, 4: 713731.Google ScholarCross Ref
- Dan Opdyke, James S. Williford, and Max North. 1995. Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. American Journal of Psychiatry 1, 152: 626--28.Google Scholar
- P. M. G. Emmelkamp, M. Krijn, A. M. Hulsbosch, S. De Vries, M. J. Schuemie, and C. A. P. G. Van der Mast. 2002. Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behaviour research and therapy 40, 5: 509--516.Google Scholar
- Barbara O. Rothbaum, Larry Hodges, Benjamin A. Watson, G. Drew Kessler, and Dan Opdyke. 1996. Virtual reality exposure therapy in the treatment of fear of flying: A case report. Behaviour Research and Therapy 34, 5: 477--481.Google ScholarCross Ref
- Barbara O. Rothbaum, Larry Hodges, Samantha Smith, Jeong Hwan Lee, and Larry Price. 2000. A controlled study of virtual reality exposure therapy for the fear of flying. Journal of consulting and Clinical Psychology 68, 6: 1020.Google ScholarCross Ref
- Joann Difede and Hunter G. Hoffman. 2002. Virtual reality exposure therapy for World Trade Center post-traumatic stress disorder: A case report. Cyberpsychology & Behavior 5, 6: 529--535.Google ScholarCross Ref
- Barbara O. Rothbaum, Larry F. Hodges, David Ready, Ken Graap, and Renato D. Alarcon. 2001. Virtual reality exposure therapy for Vietnam veterans with post traumatic stress disorder. Journal of Clinical Psychiatry 62, 8: 617--622Google ScholarCross Ref
- Arthur M. Glenberg. 2008. Embodiment for education. In Handbook of cognitive science: An embodied approach, Paco Calvo and Toni Gomila (Eds.), Elsevier, Amsterdam, 355--372.Google Scholar
- J. A. Scott Kelso. 1997. Dynamic patterns: The self-organization of brain and behavior. MIT press.Google Scholar
- Esther Thelen, Linda B. Smith, Annette Karmiloff Smith, and Mark H. Johnson. 1994. A dynamic systems approach to the development of cognition and action. Nature 372, 6501: 53--53.Google Scholar
- Paul van Geert. 1994. Dynamic systems of development: Change between complexity and chaos. Harvester Wheatsheaf.Google Scholar
- Marc D. Lewis. 2000. The promise of dynamic systems approaches for an integrated account of human development. Child development: 36--43.Google Scholar
- C. A. Isnard and E. Christopher Zeeman. 1976. Some models from catastrophe theory in the social sciences. The Use of Models in the Social Sciences. Tavistock, London, UK.Google Scholar
- Paula Fitzpatrick, Claudia Carello, Richard C. Schmidt, and David Corey. 1994. Haptic and visual perception of an affordance for upright posture. Ecological Psychology 6, 4: 265--287.Google ScholarCross Ref
- Betty Tuller, Pamela Case, Mingzhou Ding, and J. A. Scott Kelso. 1994. The nonlinear dynamics of speech categorization. Journal of Experimental Psychology: Human perception and performance 20, 1: 3.Google ScholarCross Ref
- Damian G. Stephen, Rebecca A. Boncoddo, James S. Magnuson, and James A. Dixon. 2009. The dynamics of insight: Mathematical discovery as a phase transition. Memory & Cognition 37, 8: 11321149.Google ScholarCross Ref
- Marieke M. J. W. van Rooij. 2013. What Changes When We Change Our Decision Strategy? A Dynamical Account of Transitions between Riskaverse and Risk-seeking Choice Behavior. Ph.D. dissertation, University of Cincinnati, Cincinnati, OH.Google Scholar
- MEDIALAB. 2015. Retrieved from http://www.cinekid.nl/festival/medialab1Google Scholar
- Charles D. Spielberger. 1973. Manual for the StateTrait Anxiety Inventory for Children. Palo Alto, CA: Consulting Psychologist Press.Google Scholar
- David Watson, Lee A. Clark, and Auke Tellegen. 1988. Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of personality and social psychology 54, 6: 1063.Google ScholarCross Ref
- Edward L. Deci and Richard M. Ryan. 2003. Intrinsic motivation inventory. Self-Determination Theory.Google Scholar
- Albert Rizzo and Gerard Jounghyun Kim. 2005. A SWOT analysis of the field of virtual reality rehabilitation and therapy. Presence 14, 2: 119146. Google ScholarDigital Library
- Jeff Laurent, Salvatore J. Catanzaro, Thomas E. Joiner Jr., Karen D. Rudolph, Kirsten I. Potter, Sharon Lambert, Lori Osborne, and Tamara Gathright. 1999. A measure of positive and negative affect for children: scale development and preliminary validation. Psychological assessment 11 3: 326.Google Scholar
- J. Ridley Stroop. 1935. Studies of interference in serial verbal reactions. Journal of experimental psychology 18, 6: 643.Google ScholarCross Ref
- Alan Baddeley. 2003. Working memory: looking back and looking forward. Nature reviews neuroscience 4, 10: 829--839.Google Scholar
Index Terms
- DEEP: A Biofeedback Virtual Reality Game for Children At-risk for Anxiety
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