Think+: Using Virtual Reality Therapy Game Mobile

Application for Treating Phobia

Clark Tame Tyler H. Go Edvard G. Leis Mark Jonelle D. Quiambao
Mapua University Mapua University Mapua University
Makati City, Philippines Makati City, Philippines Makati City, Philippines
+63282475000 +63282475000 +63282475000
clarkgo@[Link] edvardleis@[Link] [Link]@[Link]

Mary Jane C. Samonte Gloren S. Fuentes Cristina A. Pascua

Mapua University Mapua University Mapua University
Makati City, Philippines Makati City, Philippines Makati City, Philippines
+63282475000 +63282475000 +63282475000
mjcsamonte@[Link] gsfuentes@[Link] capascua@[Link]

ABSTRACT 1. INTRODUCTION
The main purpose of Think+ is to provide both psychiatrists and The word ‘phobia’ refers to a fear of one particular trigger. A
common people alike to help treat phobias without the need of phobia is considered a type of anxiety disorder that causes a person
complex treatment procedures. Using a virtual environment, the to experience extreme irrational fear and exaggerated. A person
app intends to help provide an experience for a user to give the with a phobia tries to avoid coming into contact with the things or
players a chance to get over their fears without having to go through situations that can cause them anxiety or irrational fear. It can also
the burden of multiple therapies. Given that people with phobias do limit their daily activities when anxiety or depression is triggered
not see a doctor or psychiatrist as often as they should, people are [1][2].
always feeling threatened whenever they come in contact with what
caused their fear in the first place, which is sometimes inevitable. Usually a person with phobias can often have panic attacks, as well
The study focus on most common phobias with the use of Virtual as, overwhelming feelings of anxiety; this can occur without a
Reality Technology that will assist psychologists and psychiatrists warning. Two types of symptoms of panic attacks can be classified
in treating phobias. The developed virtual reality system is fully as physical and psychological symptoms. Some condition of
functional and technically assessed to meet the requirements of its physical symptoms can occur such as rapid heartbeat, shortness of
intended use. Based from the Psychologists, Psychiatrist and breath or difficulty breathing, feeling faint, digestion problem,
experts’ user acceptance testing done, the developed system is sweating and trembling. While psychological conditions may also
equipped with requirements intended for patients with phobia. The experience like fear of losing control, fear of fainting, feelings of
application is working properly according to its purpose and is dread and fear of dying [1][3][4].
suited to be used for patients’ for phobia exposure and interaction Various multimedia applications have proven effective in different
in a virtual reality environment. aspects of life of human beings. Virtual reality is a
multidimensional simulated environment used to mimic a scenario
CCS Concepts to serve as a stimulus to peoples’ behavior like excitement, fear,
• Information systems➝ Information retrieval → Users and happiness. It is used in games and entertainment, and continuous to
interactive retrieval → Personalization evolve its purpose in other areas like e-health, education, and
advertising and in other business areas [5][6][7].
Keywords
Virtual Reality; e-Health; Mental Health; Psychiatry; Phobia Medical studies shows that while avoidance is the most common
treatment. workaround to phobias, facing fears gradually is the best solution
to treating phobias. Psychologist described virtual reality exposure
therapy (VRET) as the main form of effective phobia treatment
Permission to make digital or hard copies of all or part of this work for [7][8][9].
personal or classroom use is granted without fee provided that copies are
not made or distributed for profit or commercial advantage and that copies This study applies a game in virtual reality where it will use for
bear this notice and the full citation on the first page. Copyrights for patients gradually by exposing their phobias at a distance while
components of this work owned by others than ACM must be honored. completing tasks as an exposure therapy. Phobic people are
Abstracting with credit is permitted. To copy otherwise, or republish, to
post on servers or to redistribute to lists, requires prior specific permission
gradually exposed to their fears at a distance and going closer as
and/or a fee. they progress [8][9].
Request permissions from Permissions@[Link].
The study named the virtual reality, “Think+”. The study covers
ICFET 2020, June 5–8, 2020, Tokyo, Japan
© 2020 Association for Computing Machinery.
five common phobias as suggested by experts or medical
ACM ISBN 978-1-4503-7533-7/20/06…$15.00 practitioners in this study. These are Agoraphobia (Fear of Public
[Link] place), Acrophobia (Fear of Heights), Arachnophobia (Fear of
Spiders), Claustrophobia (Fear of Enclosed Place) and
Ophidiophobia (Fear of Snakes) [10][11][12]. The scope is limited are fear and loss of focus from reality. Until proper treatment can
only to certain types of phobia, usually the more common ones, and be started, typically people have their own way to manage their
does not include treatment for anxiety, depression, a broken heart, specific phobia. Either by avoiding it, not thinking about it, or
social awkwardness or any extreme emotional distress, nor is it purposely planning their day to work around the phobia among
intended to replace the treatment styles done by a professional other things. Exposing the Phobic to their Phobia is one of the best
medical expert. ways to make the more comfortable being around their fear
[12][13][14].
1.1 Objective and Scope of the Study
The study aims to develop a web application that will assist a 2.2 Technology Assisted Therapy
psychiatrist in diagnosing, profiling and consultation of a patient. The term coined as Technology assisted therapy is basically any
form of therapy that uses technology as a medium. This is an
The developers will also implement the use of Virtual reality as the important study, because of the existence of both medical and
environment while 3D models of items, animals and places come psychological experts and the ever-advancing use of technology.
into view. Think+ will require users to wear a VR headset of their One study indicates that phobias are disorders that have a negative
choosing to fully immerse themselves in the virtual experience. To impact on work, life, and leisure activities but is largely untreated.
assess a person based on exposure therapy, players will be exposed Gamification of Virtual Reality Exposure Therapy may possibly
to their said phobias while distance will be what separates the provide improvements in efficacy, access, and cost effectiveness.
Phobic to their phobia, in order to provide an appropriate difficulty Virtual Reality Exposure Therapy is indeed effective in reducing
setting. The game will set a distance the player will have to the item, fear and anxiety associated with phobias. Recent technologies such
animal or place they are afraid of. As the player progresses, this as Oculus Rift and Samsung Gear now makes extensive use of
distance will be reduced. Depending on the phobia the developers Virtual Reality Exposure Therapy in some clinical setting [7][8][9].
will also feature generated environments and the use of 360 degree
images and videos to simulate environments and videos to simulate 2.3 Virtual Reality
environments such as tall buildings or enclosed spaces. Virtual reality gives a perspective to games and videos or point of
Game objectives will be based on the specific phobia with tasks view (POV). This gives a great opportunity for Phobia treatment.
such as reaching destinations, collecting items and navigating Virtual reality (VR) is the use of technology to create computer
through different environments. The user then has to experience an generated experience that users can experience a certain
environment, in three (3) mini-games, that is catered to their own environment, mimic to a real world scenario. Gradual exposure is
phobia, which could either be filled with spiders (if the user is done as a way to treat phobia, which is difficult to do in a practice
According to the Psychologist’s Information, there would be that is why virtual reality is the best suited simulated environment
several questions asked related to their fear and history of the to apply safely [5]][10][14].
person in relation to their fear. This can indicate whether they are Virtual reality exposure therapy (VRET) is where a device is a head
genuinely phobic or if it is only a fear. The source of this phobia is mounted display (HMD) connected to a computer system that
primarily what is sought after. Also, their behavior while being generates real-time 3D images. Computer-animated virtual
asked is also being taken into account. Whether they are confident environment (CAVE), a projection-based virtual reality system
or afraid when answering, or if their body language is consistent [15][16].
with what they are saying. In order to implement this in the game,
the game will conduct a short interview with the player when they 3. GAME DESIGN
choose their phobia. These questions will attempt to gauge the The study applied Virtual Reality program, called Think+ in phobia
intensity of their fear. This will tell the game which level and therapy with psychoanalysis sessions that includes exposure
difficulty will be most appropriate for the player to begin. The VR therapy. Each session or level will have the player reach
Core architecture of the study is shown in Figure 1. destinations and collect stars while creatures or places they are
afraid of around them. This will be developed using Java
programming language, Unity game engine and the Android
Software Development Kit.
Based on an interview with psychiatrist, the diagnosis of phobia is
manifested within the fear if their goal is to overcome. Step-by-step,
a phobia can determine by a psychiatrist if the person is having an
anxiety, having a depression, border lining into paranoia and into
bad schizophrenia according to Sigmund Freud, Father of
Psychoanalysis, he creates the levels of human mind [17][18].
Figure 1. VR Core Architecture of the Study.
3.1 Conditioning Principle
2. LITERATURE REVIEW Principle of Conditioning - exposing a person to stimulating
Phobias affect virtually everyone, and have many effects socially, experiences to produce a new response to a certain situation, object
emotionally and physically. All of which can prove to be a handicap or creature. In treating phobia, the goal is for the phobic person to
for people. get used to being exposed to the object of their fear. This is done
through by stimulating their fear in different levels. Starting with
2.1 Phobia Symptoms Management and low exposure levels followed by medium and high exposures. Each
Treatment level represents three (3) levels of fear stimulation from low
Studies identify a variety of symptoms from light headedness, stimulation to high stimulation [18][19][20]. The following are the
shortness of breath, sweating, nausea among others are the clear different conditioning levels.
physical effects of a phobia. While common emotional symptoms
Low Exposure - The phobic person is introduced to a low level of
fear stimulation giving them a lower but still uncomfortable feeling with collecting 3 stars inside
while around the object of their fear. an aeroplane.
Level 3- The player is tasked
Medium Exposure - The phobic person is introduced to a medium with collecting 4 stars inside
level of fear stimulation giving them a higher degree of uncomfort a lift.
and greater room for improvement.
High Exposure - The phobic person is introduced to a high level of
fear stimulation giving them a higher level of fear and uncomfort Level 1 -The player is tasked
to acclimate to. Agoraphobia
with collecting 3 stars on an
All the levels correspond with the psychologist’s conditioning expansive street.
principle of subjecting a user to gradually increasing intensity until Level 2 - The player is tasked
the psychologist deems the user to have adjusted enough. with collecting 4 stars inside
a cinema.
3.2 Principle of Rewards
The completion of tasks or goals can cause a person to be rewarded Level 3 - The player is tasked
or gain the feeling of accomplishment and motivation. In treating with collecting 5 stars inside
phobia as the patient gains more confidence and motivation as their a disco.
fears are lessened. Greater tasks can yield greater rewards [19][20].
In this study, the collection of stars in the game were used as the Ophidiophobia Level 1 - The player is tasked
reward of the game. with collecting 1 star in a
room filled with snakes.
The Star Collection Reward System collecting stars represents a
task the player must perform while their fear is being stimulated. Level 2 - The player is tasked
More stars give the player a greater task to perform. with collecting 2 stars in
another room filled with
All the levels contain different amounts of stars depending on the snakes.
phobia; this corresponds with the psychologist’s rewards principle
of subjecting a user to varying degrees of stars to collect, less stars Level 3 - The player is tasked
is a smaller task which increases in higher levels. The Think+ game with collecting 3 stars inside
levels developed in the study is shown in Table 1. a room littered with snakes.

Table 1. Think+ Game Levels.

3.3 Game Flow
The main purpose of Think+ is to provide both psychiatrists and
Phobia Level/Objective common people alike to help treat phobias without the need of
complex treatment procedures. Using a Virtual environment, the
Level 1- The player is tasked app intends to help provide an experience for a user to give the
Arachnophobia players a chance to get over their fears without having to go through
with collecting 2 stars
containing 6 spiders. the burden of multiple therapies.
Level 2 - The player is tasked This game will simulate the Exposure Therapy with elements of the
with collecting 3 stars Rewarding and Conditioning Principle, where the player will
containing 6 spiders. collect stars while being exposed to their fears in varying degrees.
Level 3 - The player is tasked This is to be an alternative therapy to be given by a psychologist to
with collecting 3 containing 9 their patients.
spiders.
The Home Screen is divided into three: Start Game, Scoreboard and
Settings as shown in Figures 2. The Start Game will present the list
Acrophobia Level 1 - The player is tasked of five 5 phobias as shown in Figure 3. Selecting any of the listed
with collecting 3 stars on a phobia will immediately start level 1. Each phobia game module
lower level floor. can be accessed by the patient, guided by the psychiatrist, and can
Level 2 - The player is tasked view the time completion of each category as displayed in Figure 4.
with collecting 4 stars on a Think + provides a toggle or setting the music and volume on and
higher-level floor. off by tapping as displayed in Figure 5. Sample game play where
the objective is to walk towards the stars is shown in Figure 6. Once
Level 3 - The player is tasked every star is collected tap to go to the next level or tap to return to
with collecting 5 stars on a phobia selection.
building’s rooftop.

Claustrophobia Level 1 - The player is tasked

with collecting 2 stars inside
a train with a narrow passage
Level 2 - The player is tasked
 Figure 2. Think+ Sample Report Screen. Figure 6. Think+ Sample Report

4. TESTING RESULTS
Think+ is deemed accepted by its intended users, both psychiatrist
and patients. Using a Software Evaluation Criteria as basis,
evaluation was made.
Test cases for the project return a ninety percent (90%) success rate
for the second iteration and seventy-five percent (75%) for the first
iteration. For the first iteration, about ⅕ of the Phobia selection
screen test cases failed the test and ⅙ of the Unit Test Cases failed,
while all other test cases resulted in a success.
All issues, errors or bugs unearthed during the deployment phase
Figure 3. Think+ Start Game Screen. were corrected in this phase. It was a continuous process of
enhancements, corrections, and changes will be made to make sure
the system continues to work and stay updated to meet the business
goals. It was necessary to maintain and upgrade the system from
time to time so it can adapt to future needs.

5. CONCLUSION
Think+ is a mobile gaming application functional on smartphones
and designed specifically for the Android OS and platform. It will
support android versions 4.4 KitKat and newer. Saved Data,
Evaluation results and progress is stored locally in the application.
Gameplay elements are generated in 2 dimensional and 3-
dimensional graphics run on the Unity game engine.
Upon submitting the game to the psychologist, he noted that the
Figure 4. Think+Time Completion Screen. game can assist patients in treating their phobia due to its situation
conditioning which exposes a patient in a progressively increasing
fear factor which conditions them to their fears. The levels of the
game, according to him, are adequate since it digitally exposes a
patient to their fear, and that the UI is easy to work on, but he noted
that users must first familiarize themselves in using the device.
However, he reported a difficulty in using the device’s joystick and
the program itself. He believed that the game’s design is very
similar to other games in the market. One recommendation of his is
to visually enhance the collection of stars. At the moment there is
little indication of a star being collected and he felt it necessary to
include a visual signal to enhance user experience.
Based on the psychologist’s remarks and the test cases, the game
has successfully applied the psychological basis and helps in the
Figure 5. Think+ Setting for Music and Volume. reduction of phobia. The game’s easy to use UI and the
effectiveness of the conditioning principle helped patients in
dealing with their phobias while following the principles correctly.
To this end, the users have witnessed a fun and reliable way of
helping treat their phobias and to assuage fears about the treatment
process.
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