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Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
Boston gaming presentation
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Boston gaming presentation

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  • 1. Psychophysiology  Lab  and  Biofeedback  Clinic       Carmen  Russoniello,  Ph.D.,  LRT,  LPC,  BCB,  BCN   Matthew  Fish,  M.S.,  LRT,  BCB  
  • 2.      "There  aint  much  fun  in  medicine,  but  theres  a  heck  of  a  lot  of  medicine  in  fun"      Josh  Billings-­‐Humorist  and  Lecturer  (1808-­‐1885)  
  • 3. Casual Video Games Demonstrate Ability to Relieve Stress, ImproveMood: Potential Clinical Significance Highlighted “This Is Your Brain on a Videogame” “Medicinal use of video games growing” “Just Click the Mouse. Follow the Cursor. You Are Calm. You Feel Good.” “Medicinal use of video games growing After decades of research, medical communitys acceptance of video games for therapy growing” Game Industry: “Casual Games fight depression” Games for Health: “Casual Gaming’s Effects on Mood, Stress” WebMD Believe It or Not “Computer“How I Played Games for Science” Games Can Be Healthy”
  • 4. "There  ain’t  much  fun  in  medicine,  but  there’s  a  heck  of  a  lot  of  medicine  in  fun”      Josh  Billings-­‐Humorist  and  Lecturer  (1818-­‐1885)  
  • 5. Previous  Game  Research   Therapies  such  as  board  games,  card   games,  biofeedback,  meditation  and   massage  have  been  useful  in  helping   people  change  brain  and  autonomic   nervous  system  activity  from  areas   associated  with  depression  and  stress   to  areas  associated  with  relaxation  and   alertness  (Russoniello,  1991,  2008).    
  • 6. The  Ini(al  Scien(fic  Inves(ga(on  was  Designed  to  Determine  Whether  Casual  Video  Games  Could  Improve  Mood  and/or  Decrease  Stress  in  a  “Normal”  Popula(on      Results  from  surveys  indicated  that  people  played  PopCap  casual  video  games  because  the  games  reduced  their  stress  and  improved  their  mood.    
  • 7. Method  Data  from  134  participants  (Average  Age=26).    Participants  were  monitored  EEG  and  HRV  equipment  Subjects  played/surfed  the  web  for  20  minutes.  
  • 8. Psychological  Measurement   The  Profile  of  Mood  States  or  POMS  is  a   factor  analytically  derived  inventory  that   measures  six  subscales:  tension,   depression,  anger,  vigor,  fatigue,  and   confusion.  In  addition  it  calculates  a   “Total  Mood  Disturbance”  and  has   established  reliability  on  “Right  Now”   administration.      
  • 9. Total  Mood  Disorder  Changes          Overall  POMS  Changes                    md                  se            df              p      Control  Group(n=31)        2.6                2.4        30        .284          Bookworm  (n=29)                                7.9                  2.5        28          .002    Bejeweled  II  (n=38)                                -­‐11.3                  2.2        37          .000†    Peggle    (n=  36)                                              -­‐14.9              2.3            35          .000††      ††  Significantly  differs  from  control  p=.000.  †Significantly  differs  from  control  p=.009.      
  • 10. Physiological  Measure  of  Mood  Using  Brain  Wave  Measurement  It  is  has  been  shown  that  leC  hemisphere  frontal  alpha  brain  waves  can  be  correlated  with  mood  and  associated  behaviors.       • Increases  in  alpha  power  in  the  leC  hemisphere  is   associated  with  negaDve  affect,  depression  and   avoidance/withdrawal  behaviors.  Conversely,   decreases  in  leC  alpha  power  improves  mood  and   decreases  avoidance/withdrawal  behaviors.  
  • 11. Brain  Waves  and  Mood  (cont.)   • Decreases  in  right  hemisphere  alpha   power  has  been  also  been  associated  with   negative  mood.  Conversely  increases  in   right  alpha  power  improves  mood  and   increases  Approach/Engage  behaviors     • The  ratio  between  right  and  left  brain   alpha  has  been  used  to  measure  emotional   stability/mental  relaxation  (Davidson,1988   and  Marshall  &  Fox,  2000).    
  • 12. Bejeweled  2  Changes  Pre-­‐post      Left  Alpha  Changes      md          se        df      p  Control  Group  (n=22)                    .99          1.5        21          .50  Bejeweled  2  (n=28)                            -­‐3.3            1.3              27        .014†  †Significantly  differs  from  control  p=.032  
  • 13. Peggle  Changes  in  R-­‐Alpha  Pre-­‐post      Right  Alpha  Changes        md          se              df                p    Control  Group  (n=22)          .427        10                21          .996        Peggle  Group  (n=29)                          17.9          9                28          .048        
  • 14. Depression  —  Depression  is  a  serious  medical  illness;  it’s  not   something  that  you  have  made  up  in  your  head.  It’s   more  than  just  feeling  "down  in  the  dumps"  or  "blue"   for  a  few  days.  It’s  feeling  "down"  and  "low"  and   "hopeless"  for  weeks  at  a  time.  (National  Institute  of   Mental  Health,  2010)  
  • 15. Par(cipants  — Participants  were  Adults  (=>18)  that   signed  an  Institutional  Review  Board   approved  informed  consent  agreeing  to   participate  and  met  the  criteria  score   for  inclusion  (PHQ9  score=>5).  
  • 16. Par(cipants  Qualifying  participants  then  completed  the  POMS,  State/Trait  Anxiety  Inventory,  psychological  assessments,  demographic  profile  sheet,  and  the  remaining  components  of  the  Patient  Health  Questionnaire  (PHQ).    The  participants  also  gave  a  small  saliva  sample  for  biochemical  testing.  At  this  point  participants  opened  an  envelope  containing  a  random  assignment  to  the  control  or  experimental  groups.    
  • 17. Experimental  Group  If  the  participant  was  assigned  to  the  experimental  group  they  were  given  a  choice  of  three  popular  casual  video  games  to  play.  Research  has  demonstrated  that  freedom  to  choose  is  an  important  precursor  to  experiencing  the  full  benefits  of  recreation  participation.  The  participant  then  played  the  games  of  their  choice  for  30  minutes  while  being  recorded.  
  • 18. Experimental  Group  —  In  addition  to  the  two  lab  sessions  scheduled  one   month  apart,  the  experimental  group  was  instructed   to  play  the  casual  video  game  of  their  choice  at  home   for  at  least  30  minutes  3x  per  week    (At  least  24  hours   between  sessions)  for  one  month.  Participants  were   asked  to  keep  a  log  of  the  amount  of  time  spent   playing  the  game  during  the  month.  The  average   game  playing  time  for  the  experimental  group  was   minimum  30  max  68  minutes  and  the  mean  40.7   minutes.  
  • 19. Control  Group  —  If  the  person  was  assigned  to  the  control  group  biosensors   were  placed  by  the  researcher  and  baseline   psychophysiological  data  was  recorded  for  6  minutes.  —  The  control  participant  was  then  instructed  to  surf  the   National  Institutes  of  Mental  Health  consumer  web  site  on   depression  for  30  minutes  while  psychophysiology  data   was  being  recorded.     http://www.nimh.nih.gov/health/topics/ depressionindex.shtml    
  • 20. Methods  — All  sessions  were  conducted  in  a  room  with   minimal  distractions    (blank  walls,  no  outside   view,  minimal  noise).  The  researcher   administered  psychological  assessments  and   connected  the  participants  to  physiological   monitoring  equipment  following  the  same   procedure  for  both  groups.    All  participants   sat  in  the  same  chair  in  front  of  the  same   computer.    
  • 21.          RESULTS              PHQ9  Differences  between  Experimental  and  Control  Groups         Time      Mean    Diff                                Std.  Err      Sig       1          -­‐.345                            1.33    .797   2          3.13                            1.36    .024   3          2.85                              1.23    .024   4          3.13                            1.08    .005     PHQ  9  scores  did  not  differ  at  time  1  (the  initial  baseline)    but  did  so  after   time  2  or  post  session  one;  time  3  or  baseline  for  session  two  obtained  1   month  after  initial  data  collection  and  time  4  or  post  second  session.  
  • 22. Changes  in  Clinical  Depression    Pre-­‐Post  Study  (PHQ-­‐9)  Score                                                                          Minimal        Minor        Moderate            Severe        Total    Pre  Study  Control  Count                    12                              9                                  6                                  2                    29                                      Percent              41.4%            31.0%                20.7%              6.9%          100.0%  Post  Study  Control                          Count                    18                              9                                  1                          1                    29                                        Percent              62.1%              31.0%                    3.4%              3.4%          100.0%                                                                          Minimal            Minor        Moderate        Severe      Total  Pre  Study  Experimental        Count                      14                      9                      3                                    4                        30                                          Percent            46.7%              30.0%          10.0%                  13.3%        100.0%  Post  Study  Experimental      Count                    26                      4                      0                              0                      30                                            Percent              86.7%            13.3%              0%                            0%        100.0%            
  • 23. Changes  in  Clinical  Depression  within  CVG  Group   100   80  PERCENT     60   40   20   0   PHQ  post   Minimal   PHQ  pre   Mild   Moderate   Severe   Minimal   Mild   Moderate   Severe   PHQ  pre   42.9   50   7.1   0   PHQ  post   100   0   0   0  
  • 24. Profile  of  Mood  States  (POMS)  —  Overall  mood  during  game  play  was  also  measured.  The   POMS  measures  Psychological  Tension,  Anger,  Depression,   Vigor,  Fatigue  and  Confusion.  Cumulatively,  these  six   aspects  of  mood  are  combined  to  form  “Total  Mood   Disturbance,”  (TMD)   Time      Mean  Diff  Std.  Err    Sig      1              .252                          11.2    .982      2              24.4              7.4    .002      3              24.0            10    .020      4              29.6            7.7                        .000    A  decrease  in  TMD  indicates  a  positive  change  in  mood.  In  terms  of  TMD  during  game  play  the  experimental  group  experienced  a   65%  reduction  in  TMD  and  this  was  significant  from  control  after  each  measure  except  for  the  initial  baseline    
  • 25. Changes  in  POMS  Categories  —  The  following  slides  depict  the  differences  between  the   video  game  group  and  the  six  categories  of  the  POMS.    In  general  there  were  Decreases  in:   —   Tension:  49.6%     —  Anger:  55%   —   Depression:  50%   —   Fatigue:  58%   —   Confusion:  50%   —   and  a  33%  Increase  in  Vigor  
  • 26. Anxiety  — Anxiety  and  fear  are  two  different  emotions   but  are  commonly  regarded  as  the  same.     Fear  is  defined  by  an  obvious  source  of   danger.    However,  with  anxiety,  danger  is   not  typically  specified  clearly,  as  it  can   occur  in  situations  where  danger  is  not   observable  (Butcher,  et  al.,  2007).  
  • 27. Anxiety  Cont’d  —  Anxiety  disorders  develop  when  anxiety  becomes   excessive  or  uncontrollable  —  Common  symptoms   —  Negative  mood   —  Unnecessary  worry   —  Chronic  stress   —  Avoidance  of  specific  situation    
  • 28. Types  of  Anxiety  —   State  anxiety  refers  to  a  transitory  emotional  state   or  condition  that  can  be  characterized  by   subjective,  consciously  apparent  feelings  of   tension  and  apprehension,  and  an  amplified   autonomic  nervous  system.    —  Trait  anxiety  refers  to  an  individual’s  proneness   for  anxiety  and  a  common  tendency  to  respond   with  anxiety  when  confronted  with  a  perceived   threat.  
  • 29. STAI  —  To  determine  if  there  is  any  change  in  participants   anxiety  level  the  STAI  will  be  used  to  measure   changes  in  both  state  (S-­‐Anxiety)  and  trait  (T-­‐ Anxiety)  anxiety.      —  The  STAI  is  a  brief,  self-­‐report  inventory  that   consists  of  20  S-­‐Anxiety  questions  and  20  T-­‐ Anxiety  questions,  for  a  total  of  40  anxiety   questions.  
  • 30.          RESULTS     STAI-­‐S  Differences  between  Experimental  and  Control  Groups         Time    Mean    Diff    Std.  Err    Sig           1          3.28                              2.98    .275   2          8.48                          2.72    .003   3          8.34                            3.06    .009   4          11.64                          2.72    .000       STAI-­‐S  scores  did  not  differ  at  Time  1  (the  initial  baseline).    However,  at   Time  2,  pre  session  1,  and  Time  3,  baseline  for  session  two,  which  was     obtained  1  month  after  the  initial  baseline,  was  statically  significant  as   well  as  Time  4.  
  • 31. STAI-­‐S  Experimental  and  Control  Comparison     45   40   35  Axis  Title   30   25   20   Control  Group   Time  1   Time  2   Experimental  Group   Time  3   Time  4   Time  1   Time  2   Time  3   Time  4   Experimental  Group   38.04   31.59   30.37   28.15   Control  Group   41.32   40.07   38.71   39.79  
  • 32.          RESULTS   STAI-­‐T  Differences  between  Experimental  and  Control  Groups       Time            Mean    Diff            Std.  Err                    Sig     1    3.14      3.22    .333   2    7.86                                3.24      .019       STAI-­‐T  scores  did  not  differ  at  time  1  (the  initial  baseline)    but  did  so  at   time  2  or  baseline  for  session  two  obtained  1  month  after  data  collection.  
  • 33. STAI-­‐T  Experimental  and  Control  Comparison     50   45  Axis  Title   40   35   30   25   Control  Group   20   Experimental  Group   Time  1   Time  2   Time  1   Time  2  Experimental  Group   45.07   38.18  Control  Group   48.21   46.04  
  • 34. Changes  in  Anxiety   —  The  experimental  group  saw  significant   reductions  in  both  state  and  trait  anxiety.     Subjects  in  the  experimental  group  experienced  a   significant  decrease  in  their  state  anxiety  score   between  Time  1  (session  1  baseline)  and  Time  3   (session  2  baseline).    Likewise,  subjects  also   experienced  a  significant  decrease  in  their  trait   anxiety  score  from  Time  1  and  Time  3.  Subjects   within  the  control  group  did  not  experience  any   significant  change  in  their  anxiety  levels.  
  • 35. The  Effectiveness  of  Casual  Video  Games  in  Improving  Cognitive    Performance  in  People  Over  50:  A  Randomized  Controlled  Study    
  • 36. Why  is  it  important?  —  Most  adults  experience  a  decline  in  cognitive   functioning     —  When  this  loss  begins  and  its  intensity  varies  considerably  —  Cognitive  decline  can  also  impact:   —  Episodic  memory  (recall  info  in  linked  format)   —  Perceptual  reasoning  (identifying  objects)   —  Inductive  reasoning  (using  logic  for  decisions)  
  • 37. Speed  of  CogniDve  Processing  —  Area  of  cognition  receiving  most  of  attention  due  to   its  broad  influence  over  various  factors   —  Important  to  specific  operations:   —  Episodic  memory   —  Working  memory   —  Reasoning  abilities   —  Verbal  fluency     —  Also  linked  to:   —  New  learning   —  Everyday  task  performance    
  • 38. Trail  Making  Test  —  The  TMT  is  a  standardized  set  of  five  visual  search   and  sequencing  tasks  that  are  heavily  influenced  by   attention,  concentration,  resistance  to  distraction,   and  cognitive  flexibility  (or  set-­‐shifting).  —   It  is  highly  useful  in  the  evaluation  and  diagnosis  of   brain  injury;  frontal  lobe  deficits;  problems  with   psychomotor  speed,  visual  search  and  sequencing,   and  attention;  and  impairments  in  set-­‐shifting.  
  • 39. Improvement  in  CogniDve  FuncDoning   Trail  Making  Test  A   Control   Experimental   -­‐3.3   Preliminary  Results  indicate  that  playing    casual  video  games  decreases  response  time  to     cognitive  tests  by  12  %  indicating  improvement  in     cognitive  abilities   -­‐12  
  • 40. Improvement  in  CogniDve  FuncDoning   Trail  Making  Test  B   9   Experimental   Control   Playing  casual  video  games  increases  executive    cognitive  functioning    as  indicated  by  an  18%     decrease  in  response    time.    Whereas  the    control  group  increased  their  response  time    by  9%.   -­‐18  
  • 41. CogniDve  Improvement  Both  cogniDve  response  Dme  (the  speed  with  which  a  subject  completes  a  task)  and  execuDve  funcDon  (the  frequency  of  correctly  compleDng  parts  of  the  task)  were  tracked.  Those  parDcipants  that  played  Bejeweled  or  Peggle  for  short  (30  minute)  periods  showed  an  87%  improvement  in  cogniDve  response  Dme  and  a  2.15  Dmes  increase  in  execuDve  funcDoning  when  compared  to  a  control  group.    
  • 42. Improvement  in  CogniDon   These  improvements  in  overall   cognitive  acuity  are  comparable  to   changes  recorded  after  other   types  of  cognitive  interventions   such  as  mindfulness  based   cognitive  therapy  and  cognitive   remediation  therapy.    
  • 43. The  Efficacy  of  a  Biofeedback  Controlled  Video  Game  in  Preven(ng  and  Reducing  Symptoms  of  PTSD  
  • 44.  ANATOMY  of  a  GAMER  
  • 45. References  Schiesel,  S.  A  Graying  Audience  Discovers  Video  Games.  The  International  Herald  Tribune.  Retrieved  July  16,  2007from  the  Internet  www.iht.com  Anderson,  Craig  A.  and  Brad  J.  Bushman.    “Effects  of  Violent  Video  Games  On  Aggressive  Behavior,  Aggressive  Cognition,  Aggressive  Affect,  Physiological  Arousal,  and  Prosocial  Behavior:    A  Meta-­‐Analytic  Review  of  the  Scientific  Literature.”    American  Psychological  Society  12  (2001):  353-­‐359.  Lee,  Joanne  E.  and  Vessey,  Judith  A.    “Violent  Video  Games  Affecting  Our  Children.”    Pediatric  Nursing.    26.6    (November/December  2000)  607-­‐610.  Marjut  Wallenius,    Raija-­‐Leena  Punamäki,    Arja  Rimpelä.  Digital  Game  Playing  and  Direct  and  Indirect  Aggression  in  Early  Adolescence:  The  Roles  of  Age,  Social  Intelligence,  and  Parent-­‐Child  Communication.  Journal  of  Youth  and  Adolescence,  (2007):  36(3),  325-­‐336.  Retrieved  July  6,  2007,  from  Research  Library  Core  database.  Calvert,  Clay  and  Robert  D.  Richards.    “Violence  and  Video  Games  2006:    Legislation  and  Litigation.”  Texas  Dekanter,  Nike.    “Gaming  Redefines  Interactivity  for  Learning.”  TechTrends  49  (2005):  26-­‐31.  Funk,  J.  B.  Video  games.  Adolescent  Medicine  Clinics,  (2005):16(2),  395-­‐411.  Hutchison,  David.    “Video  Games  and  the  Pedagogy  of  Place.”    The  Social  Studies.    98.1  (January/February  2007)  35-­‐40.  Simpson,  E.  S.  Evolution  in  the  classroom:  What  teachers  need  to  know  about  the  video  game  generation.  Tech  Trends,  (2005):  49(5),  17-­‐22.  Agosto,  Denise  E.  “Girls  and  Gaming:  a  study  of  the  research  with  implications  for  practice.”  Teacher  Librarian  31.  (2004):  8-­‐15  Flores,  Alfredo.  “Using  Computer  Games  and  Other  Media  to  Decrease  Child  Obesity.”  Agricultural  Research  54.  (2006):  8-­‐10.  
  • 46. Monastra,  V.  Clinical  applications  of  electroencephalographic  biofeedback.  In  Biofeedback:  A  practitioner’s  guide.  Schwartz,  M.  A.  &  Andrasik,  F.  (Eds.).  2003;438-­‐470.  Hope  Lab.  Re-­‐Mission™  Outcomes  Study:  A  Research  Trial  of  a  Video  Game  Shows  Improvement  in  Health-­‐Related  Outcomes  for  Young  People  with  Cancer.  Retrieved  July  14,  2007  from  http://www.hopelab.org/docs/HopeLab%20-­‐%20Re-­‐Mission%20Outcomes%20Study.pdf    Axelrod,  S.  Gordon,  Ubel,  F.  A.  Shannon,  D.  C.,  Berger,  A.C.  Cohen,  R.  J.  Power  spectrum  analysis  of  heart  rate  fluctuation:  a  quantitative  probe  of  beat  to  beat  cardiovascular  control.  Science,  1981;  213:  220-­‐22.  Task  Force  of  the  European  Society  of  Cardiology  and  the  North  American  Society  of  Pacing  and  Electrophysiology.  Standards  of  measurement,  physiological  interpretation,  and  clinical  use.  Circulation  1996,  93(5):  1043-­‐1065.  Wilkinson,  D.  J.  C.,  Thompson,  J.  M.,  Lambert,  G.  W.,  Jennings,  G.  L.,  Schwarz,  R.  G.,  Jefferys,  D.,  Turner,  A.  G.,  and  Esler,  M.  D.  Sympathetic  activity  in  patients  with  panic  disorder  at  rest,  under  laboratory  mental  stress  and  during  panic  attacks.  Arch  Gen  Psychiatry  1998,    55:  511-­‐520  Mussleman,  D.  L.,  Evans,  D.  L.,  and  Nemeroff,  C.  B.  The  relationship  of  depression  to  cardiovascular  disease.  Arch  Gen  Psychiatry  1998,  55:  580-­‐592  Biocom  Technologies.  HRV  Live  Measuring  and  Monitoring  System.  Retrieved  from  www.biocomtech.com  July  14,  2007.    Nexus  32  Physiological  Measuring  System.  The  Stens  Corporation.  http://www.stens-­‐biofeedback.com/products/nexus32.htm  Davidson,  R.  J.  EEG  measures  of  cerebral  activation:  Conceptual  and  methodological  issues.  International  Journal  of  Neuroscience,  1988:  39,  71-­‐89.  
  • 47. Marshall  PJ,  Fox  NA:  Emotion  regulation,  depression,  and  hemispheric  asymmetry,  in  Stress,  Coping,  and  Depression.  Edited  by  Johnson  SL,  Hayes  AM.  Mahwah,  NJ,  Lawrence  Erlbaum  Associates,  2000,  pp  35-­‐50  Field,  T.,  Grizzle,  N.,  Scafidi,  F.,  Abrams,  S.,  Richardson,  S.,  Kuhn,  C.,  &  Schanberg,  S.  Massage  therapy  for  infants  of  depressed  mothers.  Infant  Behavior  and  Development,  1996:  19,  107-­‐112.  Field,  T.,  Grizzle,  N.,  Scafidi,  F.,  &  Schanberg,  S.  Massage  and  relaxation  therapies  effects  on  depressed  adolescent  mothers.  Adolescence,  1996:  31,  903-­‐911.  Field,  T.,  Ironson,  G.,  Scafidi,  F.,  Nawrocki,  T.,  Goncalves,  A.,  Pickens,  J.,  Fox,  N.  A.,  Schanberg,  S.,  &  Kuhn,  C.  Massage  therapy  reduces  anxiety  and  enhances  EEG  patterns  of  alertness  and  math  computations.  International  Journal  of  Neuroscience,  1996:  56,  197-­‐205.  Fox,  N.  A.  If  its  not  left,  its  right:  Electroencephalogram  asymmetry  and  the  development  of  emotion.  American  Psychologist,1991:    46,  863-­‐872.  McNair,  D.  M.,  Lorr,  M.  &  Droppleman,  L.  F.  Profile  of  mood  states.  San  Diego:  Educational  and  Testing  Industrial  Testing  Service,  1981.    Cohen,  S.,  Kamarck,  T.,  Mermelstein,  R.  A  global  measure  of  perceived  stress.  Journal  of  Health  and  Social  Behavior,  1983:  24,  385-­‐396.  Cohen,  S.,  &  Williamson,  G.  Perceived  stress  in  a  probability  sample  of  the  United  States.  In  S.  Spacapam  &  S.  Oskamp  (Eds.),  The  social  psychology  of  health:  Claremont  Symposium  on  applied  social  psychology.  Newbury  Park,  CA:  Sage,  1988.    
  • 48. References   Russoniello,  C.  V.,  Obrien,  K.,  &  Parks,  J.  M.  (2009).    EEG,  HRV  and  Psychological   Correlates  While  Playing  Bejeweled  II.  Annual  Review  of  CyberTherapy  and   Telemedicine.  Wiederhold,  B.K.  7  Riva,  G.  (Eds.)  The  Interactive  Media  Institute   and  IOS  Press.  Doi:10.3233/978-­‐1-­‐60750-­‐017-­‐9-­‐189  Russoniello,  C.  V.  O’  Brien,  K.  &  Parks,  J.  M.  (2009).  The  effectiveness  of  casual  video  games  in  improving  mood  and  decreasing  stress.  Journal  of  CyberTherapy  and  Rehabilitation,  2  (1),  53-­‐66.  Russoniello,  C.  V.  (2008).  The  effectiveness  of  prescribed  recreation  in  reducing  biochemical  stress  and  improving  mood  in  alcoholic  patients.    American  Journal  of  Recreation  Therapy,  7(3),  1-­‐11.  
  • 49. CONTACT  Carmen  V.  Russoniello,  Ph.D.,  Director    Psychophysiology  Lab  and  Biofeedback   Clinic   East  Carolina  University   Belk  Building  Suite  2501   Greenville,  NC  27858   russonielloc@ecu.edu   252-­‐328-­‐0024     www.ecu.edu/biofeedback    

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