This is a proposal for a VR headset game for Occulus Rift designed to help the player reduce their fear of spiders. Arachnophobia is among the most common of phobias, and is one of the most studied. The anxiety and avoidance behaviors that phobias can cause have large impacts on the life, work, and other daily activities of its sufferers (Miloff, 2016). While this proposed game is limited to addressing a fear of spiders, the principles behind its design could be extrapolated to addressing fears of other animals or insects that can be rendered virtually in a similar way. This game would be played in a therapist’s office over the course of approximately 2 or 3 hours as a replacement for the typical “One-Session Therapy” (OST) exposure.
Phobias are one of the most common mental health disorders in the United States, only slightly less prevalent than depression. (Milnoff, 2016) Most individuals with a phobia are hesitant to seek help, and anxiety and avoidance behaviors associated with phobias can be harmful to their daily lives. A fear of spiders is one of the most common phobias, and can cause debilitating behaviors like avoiding a garage, basement, or even nature in general.
“One Session Therapy” (OST) and Behaviorism.
One course of treatment for phobias to spiders, snakes, claustrophobia, or other stimuli that can be easily recreated or touched is “In Vivo Exposure Therapy,” also known as “One Session Therapy.” OST enjoys a high rate of success among patients who are motivated undertake it (Milnoff, 2016). OST seeks to isolate the patient’s “catastrophic thought,” and work to overcome their belief in it (Botella, 2011). An example of a catastrophic thought with a spider phobia would be that the spider will lethally bite. Drawing on the principles of Behaviorism, OST seeks to expose the patient to their phobia object in incremental intensity levels that do not result in the catastrophic thought or event (Popescue, 2013). The therapist models non-phobic behavior and encourages the patient throughout the process.
In-Vivo/OST Implications for a game
Limitations of OST
Therapists seeking to treat their patients with OST in-vivo exposure for animal-related phobias must maintain a veritable menagerie. It is not reasonable or feasible for a therapist to keep rodents, cockroaches, spiders, and snakes in their places of work (Milnoff, 2016). These animals are also somewhat unpredictable - even the most gentle snake may indeed bite a patient, making that therapy session extremely counterproductive.
While generally successful, OST is viewed by some therapists as cruel because it deliberately causes what some describe as suffering in an attempt to cure a patient. Many patients refuse OST once it is explained to them. Refusal rates have been shown to be as high as 45%. (Botella, 2011; Milnoff, 2016)
Solution - a Game as Therapy
Using VR and AR in OST exposure therapy has been somewhat successfully attempted (Botella, 2011; Milnoff, 2016). However, these sessions sought to simply use digital representations of phobia objects as substitutes for the actual stimuli. There were no game elements associated with the therapies. By using technology capabilities of the Occulus Rift headset and touch controllers, the principles of Behaviorism and OST can be embedded in a powerful narrative of trial and success that allows the player/patient to be the main character in a story of overcoming their fear.
A game that seeks to help a player overcome a specific fear must portray the object of that fear as realistically as possible. The game must also make the player feel as immersed in the game world as possible, in order for them to adequately identify with their character avatar, and to feel enough “presence” to feel the intended fear.
Immersion - Character Attachment
Avatar personalization increases character attachment. Players will feel more connected to a character that physically resembles them. (Williams, 2013) While this game will be VR, so the player will not spend most of the game seeing their character’s face, there will be a handful of cutscenes. Witnessing a character that looks like them experiencing these scenes will increase identification with that character, and the attachment to it the player feels.
Character Attachment implications for a game:
Immersion - Presence
One way to increase presence in a game is to draw attention to bodily sensations. (Heeter, 2015) Bodily sensations can also be simulated. Using audio of breath can heighten sensations of fear and immersion - particularly if the volume and intensity is matched to the game content. “Proprioception” is the phenomena of feeling ownership of body parts (even virtual ones) that match the owner’s perception of location. This means that visually rendering the positions of the player’s legs beneath them, and their arms in locations that match or resemble the locations and positions of their real arms, (based on input from the touch controllers) the player will mentally “take ownership” of those limbs. Artificial feeling in those limbs can even be induced if the proprioception is strong enough. (Botvinick, 1998) This can even be enhanced with haptic feedback from the touch controllers - quick and light vibrations for small spiders crawling on the player’s hands, to strong ones when they’re holding a large spider.
Presence - Bodily sensations implications for a game
Another way to increase presence is to use naturally-mapped controllers, as opposed to console thumb-stick controllers (Williams, 2013). Occulus Touch controllers, as previously mentioned, are ideal for this purpose. They allow for more nuanced control, and players will feel more immersed and present in a game if they use controls that use their body in a way that matches their character’s body (Bowman, 2012; Williams, 2013).
Presence - Controller implications for a game:
The narrative of a character completing a trial (in this case, overcoming a fear) fits beautifully into the “Hero’s Journey” story. The story outline of this game is based on it. It is mostly linear, but involves a flexible structure during the “ordeal” stage. This flexibility has been shown to have success for player immersion. (Göbel, 2009)
Call to Adventure
The game begins with a cutscene with the player experiencing a plane crash. They wake up on a beach to find they are the only survivor on a tropical island, and must navigate through the jungle in search of food and water. As the player moves through the jungle, they will begin to see strange shapes on the trees. Closer inspection of the shapes will show cave-painting like depictions of 7 concentric nesting spider shapes. The player will also come across increasingly large spider webs, holding the carcasses of increasingly large prey from insects up to mice, bats, and birds. The player will be free to explore at this stage, but will see no actual spiders in this initial period.
Meeting the Mentor/Helper
The player will soon encounter a man-made village of natives. They are sporting spider-themed jewelry and body art. They will beckon and gesture for the player to walk to a specific hut where he or she will meet an older western man in his 60’s who speaks english. Through a cutscene, we learn that his name is Winston, and he is a survivor of a shipwreck many years ago. He has survived on this island by learning the language and culture of the natives, and even chose to stay, rather than be rescued. He tells the player that the people on this island worship the “7 Spiders.” These are the 7 different species of spider native to the island. They range from the tiny (about as large as a housefly) to the huge. (as large as a cat) They are not poisonous or dangerous to people, he says, even the large ones. The natives will even harvest prey from the webs of the large ones - venom-injected birds are apparently a delicacy, and are extremely valuable on the island. The 6 smaller ones are seen as the “children” of the largest.
Winston asks us to join him on a walk to the chief’s hut. Gameplay resumes, and the player is able to now walk through the village. Winston leads toward the chief’s hut, but will stand and wait for the player if he or she walks off-course. This is another exploration period, but the story will not advance until the player arrives at the chief’s hut with Winston. As the player walks through the village, they will be approached by a native holding up her hand, palm face up. The player sees that the native woman is offering us a small spider. Winston tells us that this is a welcome gift, and that the player should take it. The player can choose to take it or not. If they do, it will stay in his or her hand unless shaken out.
The player will eventually arrive at the chief’s hut with Winston. With Winson acting as interpreter, the chief tells the player that they are welcome to become a member of the tribe if they can undergo the “initiation.” As a member of the tribe, the player would be given a boat and guidance to rescue by the outside world, if they wish. The initiation, however, is to find, capture, and return with one of each of the 7 spiders of the island. The first one (the smallest species) is already done if the player accepted and held onto the smallest one. The player is then turned loose, and is now free to explore the village and the island. They will find no more spiders in the village, and so will have to go into the jungle to collect them. To collect a spider, the player will have to reach out to one with their hand. The game will then show the player “grabbing” the spider, who will hold onto it as they walk back to the village.
While the exact order that the player collects the spiders is not completely predetermined, they will not see sizes 4-6 until 1-3 are collected and brought to the chief. They will also not encounter size 7 until all smaller sizes are collected and given. Multiple and redundant individuals of all species will be scattered throughout the island, either in their webs, or crawling around on the ground or the trees. The player may encounter already-collected species, and can collect them again if they wish, but will not advance the story if they do. The largest, size 7, must be collected with two hands, and will held in front of the player, moving and struggling (though not violently or threateningly) in great visual detail the entire walk back to the village.
Winston will remain with the player as guide and mentor until sizes 1-4 are collected. He will model non-phobic behavior as he touches and interacts with the various spiders on the island. He will leave the player to complete the remaining trials of 5-7 on their own.
The Road Back
Once all 7 species are collected, the final cutscene will show the chief and the natives holding a ceremony of acceptance for the player, followed by the player sailing away from the island on a small outrigger canoe. This scene will finish with a modern shipping vessel rescuing the player.
This game’s specific focus on the story allows the player to be an active agent in their effort to conquer, or at least reduce, their fear of spiders. Rather than the typical therapy sessions which simply involve exposure to the object, this game makes the player and various versions of the object characters in a story. Gradually increasing exposure to their phobia object in a story-driven session makes them a more active and willing participant in their own recovery.
The attention given to presence will heighten the player’s immersion in the game, and allow them to experience incremental exposure to their fear in a safe and predictable way.
Therapists can more easily implement virtual experiences as therapy, instead of maintaining their own menagerie of potentially uncooperative and unpredictable phobia subjects.
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