A game that teaches you to breathe in fear

You are not playing VR Deep for fun. It was created as an anxiety intervention. Whether you have a fear of flying, submission, crowds, or spiders, the fear usually expresses itself in the same way. You begin to worry, avoid confrontational situations and there is a physical reaction: a general feeling of jitters, increased heart rate, rapid and high breathing in the chest, and sometimes abdominal pain or sweating.

Deep abdominal breathing helps calm the body. Deep is about breathing. You can play it with VR glasses and an elastic belly band. You don’t move forward in the game unless your stomach goes up and down. A larger and smaller ring in the middle of your field of vision shows if you’re doing it right. Seaweeds and other parts of the underwater world also react to the movement of the abdomen.

“Fear is a normal response to threats in the environment. But if it persists for a long time, it can develop into a borderline anxiety disorder,” says Guanke Werdmeister. At the end of last year, Weerdmeester received his Ph.D. from Radboud University on game-based biofeedback interventions in anxiety disorders. Contributed to the development of Depp, and researched its effects on young people.

Anxiety disorders are usually treated with cognitive behavioral therapy, and sometimes with medication. “It focuses, as the name suggests, a lot on perception. It’s about your thoughts about something and the behavior you exhibit,” Weerdmeester says. “This is also very important, but it is very difficult for children and young adults. You have to be able to think about your own thoughts on a meta-level, just that. While children are often very good at pointing out what is going on in their bodies. They do not always associate the fact that they are suffering. from stomach pain or feel tense with their fear.”

Biofeedback arose in the 1970s, when the realization grew that the body, emotions, and behavior were linked, Werdmeister explains. Biofeedback gives you control of your body and the rest gets better in its wake, the idea is. “The deeper and calmer you breathe, the better, science agrees a lot. But it’s hard to master. If you’re training on your own, you have less idea if you’re doing it right or not, you can’t adapt either.”

positive whistle

That’s why comments are important. “In the early days it seemed simple. A heart rate sensor was attached to your body, and you would hear a positive beep if things were going well, and a negative beep if things were going less,” says Weerdmeester. “Later on, it became a lot more interesting, for example, to let people watch a TV that showed sharp images when things were going well, and made noise when things were going less well.” Measuring has become much easier in recent decades. Most smartphones and smartwatches have heart rate monitors. Virtual reality has also become more accessible in recent years.

Virtual reality isn’t just a tool to make therapy fun so that people last longer. “In virtual reality, you can simulate an environment in which feelings and the physical reactions that accompany them are evoked. We know that this works better than if someone was only thinking about the moment they felt fear,” says Werdmeister. So virtual worlds are also used as openTherapy, where people face their fears. Then someone has to walk in a virtual plane, for example. “Such a treat works, and it’s much easier to do than walking in a plane with someone. But these worlds often look very fake. My teacher calls it “chocolate covered broccoli.” You see right away that it’s supposed to teach you something, which makes it hard to try Real feelings for him.”

It takes me a while to get off the bottom. Breathe calmly, look in the direction of freedom. My patience is running out. This is counterproductive, I’m slower instead of faster.

Deep didn’t have to be chocolate-covered broccoli, but it’s a real science-backed gaming experience for you to use as a serious treat. “Design and science come together here,” says Niki Smit, Deep developer and designer at Monobanda, where Deep started. “Many of the treatments dealing with game elements are all about scoring. But that’s not what makes playing fun. Learn the rules, get better at something, that’s why people like to play. It gives confidence. Deep doesn’t punish you if you do it wrong, you are less Effectiveness. This way you can master belly breathing with relative ease while playing.”

A rough version of Deep existed before Weerdmeester got involved in development. A festival programmer who saw the first edition at a festival linked the festival makers with the Weerdmeester promoter. “They were really working on things we know from science,” Weerdmeester says. “There is still a lot that needs to be finely milled. For example, feedback can be better visualized.”

scary shark

Once engaged, they wondered if they could offer some form of confrontation therapy as well. Named: “We thought we could make a scary shark or a threatening whale instead of a spider that someone would be afraid of. But a person who’s afraid of spiders doesn’t feel the same way when he sees a shark.” Wedmeister: „We’ve been thinking too, for whom are we doing this? Not just for people who are afraid of spiders. We wanted to make something generic, teach us to breathe.” They got to the general feeling of tension that anxious people have. Named: „The worst thing you can do in the game is to lose control. As Joann saw something in it, if you take away someone’s control, It can generate fear.”

How does that look? Named: “Lack of control and uncertainty about what’s going on, and then you end up in the dark as a game designer. You’re in a tunnel and don’t know what’s around the corner. Music can support effect.” They decided to associate light with breathing, the second level of the Deep only lights up on exhalation.

The underwater world is beautiful. Two trials had to show if it also had an effect. First, Werdmeister divided 112 anxious youths (17-25 years old) into two groups. Half of them practiced deep breathing, and the other half had to do it using a smartphone app with breathing exercises without feedback.

Breathing exercises helped, in both groups, feelings of anxiety were reduced, for up to three months after treatment. But Depp hasn’t drastically outperformed his naked breathing exercises. However, Deep players more than App players reported that they felt more in control, and had more confidence in their abilities to do something about fear. “This is also a great result. Because we know from other research that these variables have an enhanced effect on the final effect of the treatment,” says Werdmeister.

The dark level did not generate the sense of increased tension expected. Werdmeister concludes in his dissertation that “this may indicate that the level is not yet severe enough, or that the participants have already mastered breathing to the point that it has less impact on them.”

Quieter in class

Another smaller experiment with eight children (ages 12-17) in a special education school showed that Depp’s players felt less anxious after 15 minutes of play and were calmer in class for up to two hours afterward. “The latter suggests that this approach can also influence other areas of emotion and behavior,” Werdmeister says.

Weerdmeester received his Ph.D. at the end of 2021, but the research is far from over. “Now we want to bring translation into the real world,” says Weerdmeester. “For use in a clinical setting, we need to know how many VR sessions are useful. And also how you can combine it with other forms of therapy, and how to make it technically available to therapists.”

Smit also sees many other opportunities for his game. “In America, research is now being done to see if it can help young people with post-traumatic stress, at Twente we are looking at a forensic youth care clinic if it can help regulate aggression. We are also in talks to check whether It could have helped with Covid lung disease. This may sound crazy because it is so different from anxiety or stress, but some lung patients have trouble breathing and have lost confidence in their bodies.” Who knows, Deep can be released as a general meditation game, he dreams out loud. “Being able to breathe properly is actually good for everything.”

The loop cycle takes me to the end of the level. Just for fun, I swim through jellyfish. Abdominal breathing is self-explanatory, but I sit abnormally erect and am more excited by the VR experience than relaxing. When I take off the glasses, I still go back and carry on.