Empowering novices through playful self-expression - the role of creativity and video games in the context of virtual reality exposure therapy

Video games elicit emotions of various kinds. From the simple joy of completing a level
or the sense of achievement by overcoming a tough challenge to the emotional bonds
players form to virtual characters when being enthralled in a captivating narrative, the
spectrum of emotional responses stemming from playing games is wide. In addition to
linear games, that focus on progression systems such as completing levels, advancing
a story, or upgrading a virtual character, open-ended games offer emergent gameplay.
These games define specific rules and mechanics but do not restrict the player to reach
a distinct end goal in a certain way. They allow players to explore the game’s content in
a curious and free way. Game genres associated with such openness are sandbox games
and city-builders that give players the means for playful creative self-expression. Using
the toolsets the games provide, players create and shape worlds, they form the very
terrain of these worlds by creating hills, valleys, rivers, and canyons. Moreover, players
can embellish these worlds with urban structures like roads or buildings. These games
stimulate creativity and create a sense of playfulness that lets players approach in-game
challenges in curious and novel ways.
Besides the entertainment industry, the benefits of playing games for serious purposes
have been recognized and examined by human-computer interaction (HCI) research for
decades. Since games have the capability to satisfy emotional needs, they have been
investigated regarding their potential to support learning, behavior change, motivation
to exercise, and many other applications beyond entertainment. One such domain is
psychotherapy. Specifically for the treatment of phobias, studies suggest that the in-
clusion of video games can be beneficial to the course of therapy. These games usually
incorporate concepts from the domains of cognitive-behavioral therapy (CBT) and ex-
posure therapy (ET), the most common treatment technique for simple phobias. By
gamification of these techniques or the implementation of serious games, motivation to
seek therapy can be increased, giving more people access to professional mental health
interventions.
In this thesis, I examine the interplay of games that allow creative self-expression and
psychotherapy for the treatment of phobias. The work reported here is composed of
three distinct domains of examination that illuminate different aspects of this approach.
First, based on requirement analysis and in-the-field evaluations with industry experts
from the domains of animation, film, and theater, the thesis investigates the use of
natural user interfaces (NUIs) to support professionals with low technical expertise but
highly technical tasks in their everyday lives. Thus, I demonstrate how NUIs may sup-
port therapists in the configuration, maintenance, and usage of virtual reality exposure
therapy (VRET) systems. The second domain is concerned with the definition of a game
design strategy suitable for the treatment of phobias. In the course of this thesis, I argue that game design for the treatment of phobias needs to consider specific requirements
that have not been covered by previous research in this field. Based on these require-
ments that have been identified with therapy practitioners, this thesis introduces a novel
concept - playful user-generated treatment (PUT), that incorporates these requirements
for an applicable addition to therapy. An evaluation in the form of a user study and an
expert survey demonstrate opportunities and challenges that PUT involves. The third
and last research topic is concerned with the inclusion of procedural content genera-
tion (PCG) into the PUT concept as a way to alleviate technical complexity and foster
human-computer co-creation. This segment covers the impact of PCG on self-reported
creativity support and user engagement in a playful city-building task as defined in the
PUT concept.
Based on the work reported in this thesis, these key insights have been found. For
the design of systems that are to be used by users with high technical demands and low
technical expertise such as therapists and patients in a VRET context, NUIs can serve as
tools to alleviate technical complexity whilst providing the benefits of novel technology.
Furthermore, when implementing playful VRET systems, specific requirements need to
be considered in the design process so as to not interfere with therapeutic success. The
proposed PUT game design strategy fulfills these requirements and can be used to harness
the positive effects of playful creative self-expression in a VRET scenario. Lastly, results
from this thesis demonstrate that the inclusion of PCG into a PUT-based system does
not interfere with self-reported creativity support.
By investigating these research topics, this thesis contributes to the domains of nat-
ural interaction as facilitated through NUIs, motivational aspects of games user re-
search (GUR), PCG in video games, creativity and self-expression through playfulness,
and the inclusion of playful elements into the VRET procedure.

Dissertation online