Dan Hoch Massachusetts General Hospital Boston

Deborah Linton Center for Connected Health

Partners HealthCare

Group Training Sessions for Relaxation Response Techniques

in Virtual World

Virtual Worlds Day Games For Health June 10th, 2009

Group Training Sessions for Relaxation Response Techniques in Virtual World

Dan Hoch, Massachusetts General Hospital, Boston

Deb Linton, Partners Healthcare Center for Connected Health

Virtual Worlds DayGames for Health, 2009

Games

GTA IV

Dead Space

Halo 1-3

What is Second Life?

Second Life is persistent online world with: a multiuser, international community completely built and owned by the residents who keep all IPOpen source scripting language

Fictional analogs are Stephenson’s Metaverse from “Snow Crash” or Vinge’s Otherverse from “True Names”

property rights

In Second Life, residents own their creationsWhat does this mean? Residents retain their Intellectual Property rights to their creations Residents may buy and sell L$ for real world $ Residents may license their creations back into the real world

Emotional Connections

Increase emotional bandwidth

Use real-world social cues and proxemics

Create (not merely customize) your visual identity

Animations and sounds add more depth

Mainstream Health Activities

• Health Info Island• Ann Myers Medical

Center• The CDC• Second Health• Virtual Hallucinations• Play2Train• Palomar West/Cisco

• Immersive Learning• Simulation• First responder

exercises• Demonstrations

►Therapeutic Intervention

Communities of support

-Asperger’s Syndrome

-Stroke Survivors

-Healing depression

-Cerebral Palsy

-Children with cancer

Cognitive Stimulation Programs may improve function in: MCI and Alzheimer’s Stroke Psychiatric disorders (Schizophrenia)

User-generated Interventions

Stroke survivors on Dreams Island Emotional support “equality”, physical disabilities minimized Physical and cognitive challenges to

improve recovery

Speed Builds

Relaxation Response Coined by Herbert Benson Actual physiological state, with changes

in biochemistry and even gene regulation

Best thought of as opposite of “flight or fight” response

Induced by MANY kinds of techniques

Collaboration: Center for Connected Health Benson Henry Institute for Mind Body Medicine MGH Department of Neurology

Design

Pilot study of 2-3 groups of healthy volunteers talked to elicit the relaxation response in SL

Target N=20-40 Recruitment from the greater Boston area Exclusion criteria:

Unable to travel to attend 2 face-to-face meetings at MGH

Unfamiliar with SL “serious” psychopathology

Methods-enrollment and assessment

Face-to-face visit before and after 8-week “virtual” program Eliminated the problem of virtual consent

and virtual survey instruments Basic demographic questionnaires,

Perceived Stress Scale, SCL-90 R, QOL-10, SF-12

Weekly, adherence questionnaires

Method- Virtual Consent

Recruitment of present users of SL via in world and real world ads, as well as word of mouth

Face to face consent had to be obtained Validated measures had to be filled out

in face to face meetings before and after the 8 week program

Expedited IRB

Method- Team Coordination

Bi-Weekly meetings Share our domains of knowledge Greater usability Authenticity of clinical practice Explore the capability of the technology Maintained end-user perspective Acclimated team to virtual environment Feedback on the real-world program

translation

Method- Application of Tech

Providing a preconceived notion of a self-initiated practice

The imagination stays switched on

Only material that would have played a role during the face-to-face session

We did not want to overly develop the environment with the technology

Method- Encouraging exchangeUsing the Environment as a tool

Participants were granted creation privileges 24/7 access promoted the idea that the virtual space

was a resource itself Group text-chat acknowledged as form of legitimate

communication

Open Source - Animation Avimator .bvh Animation Editor

QAvimator (early alpha stage)

Avimator (originally by Vinay Pulim / Vince

Invincible)

Open Source - Scripting

Tour of the space:

HUD

Imbedded information

• Gong survey

• Listening stations

• Group Chat

• Psychoacoustics

Labyrinth

Conference Center

Yoga

Crown

Results-1 28 subjects took part in 3 separate

groups Attendance was good, but not perfect Some parts of the program/build

“worked” better than others Users returned to the space on their

own time

Results-2 Before and after assessment showed a

trend toward reduced stress, fewer medical symptoms, better quality of life and health status

Goal of estimating “effect size” of teaching RR in this environment was achieved

Conclusions A face to face health intervention can be

adapted to a virtual world, with input from team on both sides of the looking glass.

Effect may be close to that of face to face

Experimental design and statistics need attention in this field, as in every other

Acknowledgements

Funding was granted by the Partners Information Services Research Council

Special thanks for support and sage advice from: Dr. Joe Kvedar Dr. Herb Benson Dr. Greg Fricchione

Our Team

The Center for Connected Health Heather Bello Deb Linton Marco Senelly Alice Watson

The Benson Henry Center for Mind-Body Medicine Peg Baim Mariola Milik Megan Floret Albert Yeung

Example of poor avatar construction

@dbhoch @ozone24

Thanks