1. Psychophysiology
Lab
and
Biofeedback
Clinic
Carmen
Russoniello,
Ph.D.,
LRT,
LPC,
BCB,
BCN
Matthew
Fish,
M.S.,
LRT,
BCB

2.
"There
ain't
much
fun
in
medicine,
but
there's
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, Improve
Mood: 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 community's
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.

9. Method
Data
from
134
participants
(Average
Age=26).
Participants
were
monitored
EEG
and
HRV
equipment
Subjects
played/surfed
the
web
for
20
minutes.

10. 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.

11. 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.

12. 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.

13. 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).

14. 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

15. 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

16. 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)

17. 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).

18. 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.

19. 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.

20. 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.

21. 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

22. 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.

23.
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.

24. 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%

25. 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

26. 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

27. 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

28. 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).

29. Anxiety
Cont’d
— Anxiety
disorders
develop
when
anxiety
becomes
excessive
or
uncontrollable
— Common
symptoms
— Negative
mood
— Unnecessary
worry
— Chronic
stress
— Avoidance
of
specific
situation

30. 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.

31. 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.

32.
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.

33. 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

34.
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.

35. 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

36. 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.

37. The
Effectiveness
of
Casual
Video
Games
in
Improving
Cognitive
Performance
in
People
Over
50:
A
Randomized
Controlled
Study

38. 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)

39. 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

40. 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.

41. 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

42. 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

43. 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.

44. 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.

45. The
Efficacy
of
a
Biofeedback
Controlled
Video
Game
in
Preven(ng
and
Reducing
Symptoms
of
PTSD

46. ANATOMY
of
a
GAMER

47. 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
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for
Learning.”
TechTrends
49
(2005):
26-­‐31.
Funk,
J.
B.
Video
games.
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51. 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