NEW HAVEN, Conn. (AP) - In a novel approach to clinical study, a game developer and a Yale University psychologist developed a game for measuring avoidance in anxiety disorders.
Eli Lebowitz, assistant professor in the Child Study Center at Yale and associate director of the Anxiety and Mood Disorders Program, wanted a new way to study avoidance behaviors in people that was more reliable than traditional methods, so he took his concept of using motion tracking to PreviewLabs, a rapid game prototyping company, whose founder and CEO Bernard Francois turned concept into a working program.
Lebowitz studies anxiety-related disorders, primarily in children and adolescents, and central to that study is measuring avoidance because when anxiety or fear is triggered, it makes a person avoid doing what is safe (and even necessary).
“The real problem is not that I’m afraid of the thing; it’s that I start avoiding a variety of situations that make me fear,” Lebowitz said. “Avoidance is germane and central to anxiety disorders, but it’s also a challenge because it’s a non-behavior. It’s not like measuring a heartbeat. We’re talking about a behavior that (a person is) not doing.”
Lebowitz had the idea to use motion-tracking technology to study avoidance because there seemed no simpler way to see how people avoid what they’re afraid of than to see what they physically stay away from. He took the concept to rapid game prototyping company PreviewLabs, and Yale Interactive Kinect Environment Software (YIKES) was born.
“This game is really simple but it has a big impact,” Francois said. “It’s something we can be proud of because it has a big impact on researchers.”
In the game, participants see themselves as players on a screen and need to move back and forth between two images that stimulate feelings of fear or safety in the person in order to catch falling balls and earn points.
In Lebowitz’s study, he used traditional stimuli - spiders and angry faces of people - but any images relevant to what the person avoids can be used.
Historically, researchers use interviews and questionnaires to measure avoidance, but problems present themselves because that subjective measure tends to be inaccurate, Lebowitz said. Responses are biased by how participants understand the questions and what they consider normal. Their responses are only good for the day they’re taking the assessment because a person’s memory of how they felt isn’t reliable, he said.
“We developed it to be more game-like so we wouldn’t focus the participant on the study, but on the task,” Lebowitz said. “One of the best things about YIKES is it’s fun to do. That means they’re focused on the fun behavior rather than the question we’re asking. It’s a very immersive, natural intuitive experience.”
YIKES also opens up Lebowitz’s study to people where verbal communication is challenging, such as in children, people on the autism spectrum or those who aren’t fluent in the researcher’s language - doing away with interview-style limitations. With the program, Lebowitz could measure how fast people were walking, how close they went to the images, how soon they turned away from it, and use the data as a good predictor of other clinical characteristics, he said.
Through a recently published peer-reviewed paper, Lebowitz and Francois show YIKES measures avoidance behaviors accurately and effectively in a way traditional methods can’t. They were also able to measure progress of children in cognitive behavioral therapy and see whether their anxiety issues decreased after therapy. Now that Lebowitz and Francois have developed this program and tested its validity, YIKES can sit on a shelf for any researcher to take down and use, Lebowitz said.
PreviewLabs began in Francois’ living room in Belgium with his fascination for game creation and conceptualizing. Since 2010, lab projects have become wide-ranging - one was a forklift training game that uses virtual reality technology to take the player through a safety training for warehouse workers; another project called Buggy Blasters was the first multiplayer game available in the Microsoft store for HoloLens, a holographic computer that projects games and other software into physical space to create a “mixed reality.”
“We use the same tech used for games and make prototypes for other applications that use that technology,” Francois said. PreviewLabs clients come from 16 countries, including France, Israel, Belgium, the U.K. and the United States.
PreviewLabs rapidly prototypes games for clients working in medicine, education, research and technology. When Francois and his team finish, they’ve made a playable game concept with the help of the client’s input and feedback. They turn the client’s initial idea into a working prototype. Having a playable game to test lets clients see if their concept is good.
YIKES was the first project PreviewLabs collaboratioon with Yale, but they’ve worked several times over the years on other applications, such as developing an artillery-style game that teaches calculus by way of two people battling each other using function graphs.
Motion-tracking technology has recently developed, but its use in a research study is “not something I’ve heard before,” Francois said. “There’s definite interest in using this, especially in things that are hard to continue doing for a long time, like filling out a questionnaire of how you’re feeling every day… You’re playing a game but meanwhile you’re being measured.” The game measures avoidance so it can be very widely applied as a research tool. “It could become a standard of measuring avoidance,” he said. “It doesn’t need to be about games.”
“This has been a wonderful collaboration and a great experience for me because so much of research is done in silo ways; there’s not as much cross-pollination,” Lebowitz said. “It brought together a technology know-how in being able to rapidly and effectively do the programming to harness those tools and translate it with our understanding of the clinical problems and questions we’re trying to overcome.”
Lebowitz said the intersection of game technology and research is new but more and more, technology is finding applications in different areas that relate to health, such as wearing health trackers on your wrist.
“It’s very novel, but I hope it becomes less novel,” Lebowitz said. “We need to stop thinking of these things in the cubbyhole they were presented to us in.”
Information from: New Haven Register, http://www.nhregister.com
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