Improving Mood for People with Depressive Disorders: Designing
and Developing a VR Game
Alice J. Lin
1
, Charles B. Chen
2
and Fuhua (Frank) Cheng
3
1
Department of CSIT, Austin Peay State University, Clarksville, TN, U.S.A.
2
Department of Pediatrics, Cleveland Clinic, Cleveland, OH, U.S.A.
3
Department of Computer Science, University of Kentucky, Lexington, KY, U.S.A.
Keywords: Virtual Reality, Mood, Depression, Anxiety, Healthcare, Exercise.
Abstract: Mood disorders can have a significant psychological impact on many groups of people. It causes severe
disease burden and can lead to many effects that decrease the quality of life of an individual. Video games
are popular forms of entertainment which can help improve a person’s mood and decrease their depressive
symptoms. In the paper, we design and develop a prototype VR game to help people with depressive disorders
improve their mood. We have performed preliminary testing showing encouraging results in improving
peoples’ moods.
1 INTRODUCTION
Mood disorders occur frequently in many groups of
people throughout the world. An overwhelming
feeling of sadness and hopelessness is the main
symptom of mood disorders that can last for long time,
usually for months or years. Mood disorders can make
people feel that life is meaningless. Depression, which
is a mood disorder, is one of the major causes of global
disease burden (Vos T et al., 2012). In 2010, it was
listed as the second leading medical cause of disease
burden that is especially significant in high disability
in the working age people, which makes depression
particularly costly for society. Major depressive
disorder (clinical depression) was also a contributor of
burden allocated to suicide and ischemic heart disease.
These findings underscore the importance of including
depressive disorders as a public-health priority and
implementing cost-effective interventions to reduce
their burden (Ferrari et al., 2013).
Depressive symptoms and disorders account for
more than 40% of the burden of psychiatric disorders.
The levels of depressive symptoms increase markedly
in adolescence, and nearly 20% of those 12-18 year
of age suffer from a depressive disorder (Hankin,
2008). Depression causes a global economic burden
of more than USD $200 billion annually. However,
many individuals with depressive symptoms do not
receive appropriate services. Even among those who
do get treatment, up to two-thirds of those individuals
fail to respond and many drop out of these services
prematurely. This shows the need for more potent,
accessible interventions (Schleider, Mullarkey, &
Weisz, 2019). Depression (major depressive disorder
or clinical depression) is a common but serious mood
disorder which causes severe symptoms that affect
how you feel, think, and handle daily activities. To be
diagnosed with depression, the symptoms must be
present for at least two weeks (National Institute of
Mental Health, 2018).
Depression may come with serious illnesses.
Palliative care is often related to improving patients’
moods, which is an interdisciplinary person-centered
approach to treating patients with serious illnesses
through relieving symptoms and improving quality of
life for patients and their families (Personal Care
Medical Associates, 2019). Palliative care can be
incorporated successfully into the treatment regimen
for life-threatening diseases. Although palliative care
is sometimes used synonymously with end-of-life
care, it actually is a broader concept involving care
delivered at any stage of illness from diagnosis
through the terminal stages of the disease (Kelley &
Morrison, 2015).
There are valuable tools for fostering patient
participation in health-related activities, which
include digital games, such as 2D games, 3D games,
virtual realities, computer simulations, and online
play. Since regular fitness training is known to
improve depression (Kvam, Kleppe, Nordhus, &
406
Lin, A., Chen, C. and Cheng, F.
Improving Mood for People with Depressive Disorders: Designing and Developing a VR Game.
DOI: 10.5220/0009193104060411
In Proceedings of the 15th International Joint Conference on Computer Vision, Imaging and Computer Graphics Theory and Applications (VISIGRAPP 2020) - Volume 1: GRAPP, pages
406-411
ISBN: 978-989-758-402-2; ISSN: 2184-4321
Copyright
c
2022 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
Hovland, 2016), it may not be overly surprising that
these exergames likewise lead to an alleviation of
symptoms (Li, Theng, & Foo, 2016). However, the
compliance with physical exercise is generally lower
and more patients will enjoy a video game rather than
an exercise intervention. This is why gaming is the
latest tool in the arsenal to improve health outcomes
- gaming makes health-care fun (Hawn, 2009). A
survey conducted in the United States reported that
over 164 million adults in the United States play
video games and three-quarters of all Americans have
at least one gamer in their household. Video games
are the leading form of entertainment today, which is
an integral part of American culture (Entertainment
Software Association, 2019). Fast-paced action video
games can improve visual attention and task
switching. They have also been reported to reduce
rumination and enhance subjective cognitive ability.
Rumination is a good predictor of depression and may
contribute to triggering depression (Kühn, Berna,
Lüdtke, Gallinat, & Moritz, 2018).
More and more adolescents and adults around the
world are enjoying playing video games. Due to their
widespread use, scientists have researched how video
games can affect the brain as well as an individual’s
behavior (Nichols, 2017). Stress-related medical
disorders such as cardiovascular disease, diabetes and
depression are serious medical issues that can cause
disability and death. Strategies to prevent their
development are needed. Casual video games
(CVGs) are fun, easy to play, spontaneous, and
tremendously popular. Studies show that people play
CVGs for a multitude of reasons including cognitive
exercise, relaxation, and stress relief (Russoniello,
O’Brien, & Parks, 2009).
VR exercise can have a positive effect on anxiety
in addition to depression and other mental disorders
based on multiple studies. Anxiety is a disorder with
particular features including recurrent intrusive
thoughts, increased tension, and physical
manifestations such as tachycardia. It is the most
common mental health disorder in the US affecting
about 18% of the population. Unfortunately, only
about 40% of adults receive appropriate mental health
services. New and more enjoyable treatments for
mental disorders can be used along with more
traditional psychotherapy and medications (Kazdin,
2000).
A review article by Zeng et al. found four studies
that reported significant physical and psychological
improvements including reduced tiredness and
tension as well as increased energy and enjoyment as
a result of VR use (Zeng, Pope, Lee, & Gao, 2018).
The latest VR exercise systems have the capability to
allow for precise control of stimuli in a multi-sensory
three-dimensional computer-generated environment
while promoting a motivating exercise regimen. At
the same time, there is a lower risk of physical injuries
that may be associated with real-life exercise.
One of the fastest-growing industries is the video
game industry. About two thirds of American
households own at least one device which is capable
of playing video games. Similar usage data can also
be found in Europe, Asia and other parts of the world
(Roettl & Terlutter, 2018). Video game technology is
changing from 2D to 3D and virtual reality (VR)
graphics.
VR games are becoming increasingly more
prevalent in our daily lives due to its immersive and
interactive nature. They are a new milestone in the
way we interact with our environment, and even how
we conceive new approaches in our relationship with
reality (Kitson, Prpa, & Riecke, 2018). VR and other
immersive information and communication
technologies have a high potential for transforming
the real world and the way in which we interact with
it (Rubio-Tamayo, Barrio, & García, 2017). VR is a
computing technology that generates an artificially
simulated three dimensional (3D) environment that
imitates reality. VR presents a convincing interface
that allows the user to engage with the computer-
generated environment in a naturalistic way. Through
3D computer graphics via advanced input and output
devices, users believe they actually perceive sensory
information that is similar to that of the real world. In
very simple terms, virtual reality can be defined as a
synthetic or virtual environment which gives a person
a sense of reality (Ma & Zheng, 2011). There are
many kinds of VR devices available, including
Oculus Rift, PlayStation VR, and Samsung Gear VR.
Some VR Personality Projects were designed to
systematically target and increase adolescents’
perceived control by offering a more immersive,
engaging, user-directed intervention experience than
the Web-based intervention. By targeting an
identified predictor of intervention response, the VR
Personality Project may lead to larger reductions in
depressive symptoms than existing Web-based
mindset interventions (Schleider et al., 2019).
2 METHODS
People used to think that VR would damage our
brains. However, VR seems more likely to develop the
gray matter in the brain. A new wave of research is
pioneering VR to diagnose and treat medical
conditions from social anxiety to chronic pain to
Improving Mood for People with Depressive Disorders: Designing and Developing a VR Game
407
Alzheimer’s disease. Many of these solutions are still
undergoing testing, but some are already making their
way onto the market (Martin, 2019). With VR, players
will have an immersive experience, which is an
illusory environment that completely surrounds the
players such that the players feel that they are inside
it. Due to the immersive nature, VR games are more
powerful than regular video games in affecting
players’ feelings. Bad mood is so common for
everyone and video games are effective in improving
mood. It is necessary to design and develop VR games
to effectively improve mood for people with
depressive disorders. We use Unity as the game
engine for designing and developing the VR game.
Our VR game is a multiplayer game. The VR game
can be played by one or more persons in the same
game environment at the same time, either locally or
over the Internet. It allows players to have interactions
with other individuals in partnership, competition or
rivalry, providing them with social communication.
Players may compete against two (or more) human
contestants or work cooperatively with a human
partner to achieve a common goal. Players can choose
avatars or create their own avatars in the virtual world.
We use nature scenes as the background
environment in our VR game. With head tracking and
head mounted displays (HMD), players can reach out
and feel that they are really there. The built-in
microphone makes it easy to communicate with
teammates. Due to the lack of physical activity in
many individuals with depressive disorders, it is
necessary for us to integrate some exercise
components into our game. We can add bicycling,
canoeing, swimming, and skiing to our VR game to
make the game rich in choices (see Fig. 1.).
Figure 1: Components of the VR game.
We created four separate groups for the seasonal
scenes, with each group of scenes representing a
particular season. For each season, there will be
multiple themes and landscapes such as mountains,
islands, and bodies of water. The players can choose
which season they want and which themes they would
like. The VR game will have multiple difficulty levels
of exercise to suit different players. The players may
choose easy levels to start with, and then progressively
go to more difficult levels. They can also jump to
certain levels if they want. Additional challenges are
provided in each new level, and when a level is
successfully completed, the player will get a new score.
For the game to be attractive, we also need
computer-generated non-player characters (NPCs) to
be populated at a certain level. If the player chooses not
to play with other human players, NPCs will be the
main source of competition during gameplay based on
different levels that the players choose. NPCs are one
of the elements we will develop to craft the pacing,
challenge, and tension of a level. We can control not
only where the NPCs are placed, but also the NPCs’
scripted behavior, how they are equipped, and other
variables (Rivera, Hullett, & Whitehead, 2012).
The mood and depression assessment is a self-
reported measurement. It is similar to Klein et al.’s
work for evidence-based assessment of depression in
children and adolescents (Klein, Dougherty, & Olino,
2005). The measurement is most commonly used in
assessing depressive symptoms among adolescents,
but could also be used for other age groups.
3 RESULTS
Table 1: Volunteers’ mood net change.
Based on our purposes and the above design, we
developed a prototype of VR game to improve mood
for people with depressive disorders. The game theme
GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications
408
is a magical world where the inhabitants are falling ill
and being attacked by enemy characters. The only
way to save them is to find the Magical Healing
Potion. Fig. 2 - 4 show some scenes from the game.
The players are exposed to many natural scenes
throughout the course of the game. If the players
choose to exercise, he or she can also choose the kind
of exercise they prefer, such as walking, jogging,
biking, and canoeing. They can also choose the
difficulty level. For players who are physically
limited or less mobile, they can choose levels that
promote more walking. For players who are more
physically able, they may choose more strenuous
activities such as biking and canoeing.
Figure 2: Battling with enemies.
Figure 3: Battling with enemies.
Figure 4: The player is near a cabin in the hill.
Figure 5: Mood change for men.
Figure 6: Mood change for women.
Figure 7: Correlation between mood change and playing
time, combined for all male and female data.
For the current preliminary research, we recruited
a total of 20 healthy, young volunteers (10 males and
10 females, age range of 18 - 21) for testing our VR
Improving Mood for People with Depressive Disorders: Designing and Developing a VR Game
409
game on the effect of improving people’s mood. We
collected the volunteers’ mood change data (see table
1). Figure 5 and Figure 6 show that the VR game has
a positive effect for mood improving for all the men
and women tested.
It seems obvious that the longer the players played
the game, the more effective it would be on the
change of players’ mood. Figure 7 shows the
correlation between the time played and the net mood
change. The improvement seems universal. For males
and females, young or old, all of the players’
subjective reports showed that the game helped to
improve their mood after playing the game.
4 DISCUSSION
Exercising in VR games has multiple mental and
physical benefits. VR has been praised by people who
had trouble making other exercise habits last
(Brewster, 2019). CVGs have effects on improving
people’s moods (Russoniello et al., 2009). Nowadays,
VR and its related technology has been a research
focus with its applications in various fields, from
entertainment to education. Research has shown that
video games have numerous therapeutic benefits for
individuals living with chronic diseases (University
of Utah, 2012). As the players with depressive
disorders are often not motivated enough to perform
exercise activities, it is beneficial that exercise
components be integrated into the game. Based on
current research, it appears that VR games can help to
both increase physical activity and decrease
symptoms of anxiety and depression.
Because of its growing appeal amongst both
gamers and non-gamers alike, VR can be used to
promote a wide range of beneficial activities in
addition to physical activity. The wide capabilities of
VR systems indicate that they have the potential to
serve as an important adjunct therapy for depression
and anxiety in addition to mainstream treatments. As
technological improvements are made, one could
potentially see VR being incorporated into various
medical services.
VR allows the player to have complete control, as
the provider can control the exact aspects of the
exposure environment (Maples-Keller, Bunnell, Kim,
& Rothbaum, 2017). The method by which VR
promotes mental health and improves anxiety and
depression is multifactorial. There is evidence
suggesting that VR can help to create a virtual
environment that modulates the triggers that lead to
an individual’s anxiety or depression. VR also allows
individuals to manipulate exposures in ways that
might not be realistic, such as performing certain
physical feats that they may not be able to accomplish
in real life.
Among many advantages with the use of VR, it is
relatively safe and there are few negative effects from
using the technology. The main limitations including
physical effects such as eye strain, nausea, and
headache. Although many individuals are able to
tolerate these adverse effects, some people such as
those with epilepsy may be at higher risk of
developing symptoms from VR use. Finally, as with
other types of games, there may also be an element of
gaming addiction, especially in those who use VR
extensively.
Further research is needed to provide guidelines
and treatment techniques for video game players who
suffer depressive disorders. Our research is
preliminary. We need to do further to determine the
optimal intensity, duration, and frequency of VR
exercise and physical activity (Zeng et al., 2018). As
much of VR research is still in its infancy, further
research into the physical and mental benefits of VR
exercise is warranted. For the next step in our current
project, we plan to test the VR game on people with
clinically diagnosed depressive and anxiety disorders.
We aim to perform this next study in a hospital
environment, with the goal of comparing VR therapy
with more traditional methods of rehabilitation such
as physical and occupational therapy. We also seek to
qualitatively and quantitatively determine how much
improvement the game can achieve in improving
mood.
5 CONCLUSIONS
Playing VR games can help individuals with
depressive disorders to engage in a different
environment, which may offer numerous physical
and psychological benefits. The results suggest that
VR games can be an efficient strategy for reducing
depressive symptoms. VR equipment is relatively
affordable and its price is getting lower as the time
goes. VR is potentially engaging to adolescents
experiencing mood-related distress. This especially
helps the player to temporarily get rid of their
physical limitations. Therefore, playing VR games
can positively affect the mood of people with
depressive and anxiety disorders. The elements of the
game, such as natural scenes and music, also play an
important role. When these elements meet or exceed
the expectations of the player, this will provide a
boost to the player’s mood and help to provide the
intended therapeutic effect.
GRAPP 2020 - 15th International Conference on Computer Graphics Theory and Applications
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