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 natural interaction as facilitated through NUIs, motivational aspects of games user research (GUR), PCG in video games, creativity and self-expression through playfulness, and the inclusion of playful elements into the VRET procedure.

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