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Prevention of social fears
            A “gamificated” program for shy students

            Mario Lehenbauer & Birgit U. Stetina
               Clinical Psychologist & Health Psychologist
                                 mario.lehenbauer@univie.ac.at

                                  @mariolehenbauer

                                     Mario Lehenbauer




June 2012                     Games for Health Conference        www.gamesforhealth.org
Clinical Psychologist
Health Psychologist
Technology ”freak”
Passionate Gamer




Research topics:
•(“Serious”) Games for Health
•Innovative Technology in Psychology
• Compulsive Internet Use and “Online Gaming Addiction”
             differentiating between “high engagement” and “addiction”



June 2012                         Games for Health Conference    www.gamesforhealth.org
Games I am playing …
 June 2012             www.gamesforhealth.org
Social Anxiety Disorder and Shyness
• Social Anxiety Disorder (SAD)
       • DSM IV: 300.23
       • a persistent fear of negative evaluation in social
         situations
            • Cognitive symptoms
            • Behavioral symptoms
            • Physiological arousal / stress
       • Life-time prevalence 16-23 %
       • Shyness: 40-50%
       • Early age of onset! Between 15-25 years
June 2012                                           www.gamesforhealth.org
… some background facts
• Onlinestudy: 20% suffer from SAD
       – Compared to 6-16% offline   (Lehenbauer, 2009)



• Almost 100% of adolescents are online
• 72% of the American households play
  computer or video games            (ESA, 2011)


• Social phobia has an early age of onset
• Therefore:
• Go online and use “new” media!
June 2012                                                 www.gamesforhealth.org
Our „offline“ training
•    Funded by Austrian Ministry of Science
•    Novel aspect: development in cooperation with
     adolescents
•    Offline training: 14 lessons (á 50 min.) = 14 weeks
       – 1-7: Psychoeducation, cognitive restructuring (Joormann &
            Unnewehr, 2002; Margraf & Schneider, 1990; Stangier, Clark & Ehlers, 2006)

       – 8 – 12: Social Skills Training (eg, how to say „no“, get in
         contact with other people, solving conflicts, feedback, ..)
            (Hinsch & Pfingsten, 2007; Joormann & Unnewehr, 2002; Ullrich & de Muynck, 2001)

       – 13 – 14: Relapse prevention (Stangier, Clark & Ehlers, 2006)
       – 2-14: Body relaxation methods (Vaitl & Petermann, 2004)
       – Highly relevant effects                    (Lehenbauer & Stetina, 2011a; 2011b)


June 2012                                                                                      www.gamesforhealth.org
How can we do THIS online?!?!




June 2012                        www.gamesforhealth.org
Make it online!
• Big challenge
• Focus groups with young students
       • Text based informations and quizzes: BORING
       • How can we bring fun into a serious topic?
• One year of planning time and programming!

                  WE WANT FUN!!!



June 2012                                       www.gamesforhealth.org
June 2012   www.gamesforhealth.org
We need trainers!
            Development of six avatars with different background stories




June 2012                                                             www.gamesforhealth.org
WELL DONE! THAT WAS AWESOME




                We need feedback!
            Emotional reactions of avatars




                Hmmm... I think you can do better....




June 2012                                               www.gamesforhealth.org
Wow it is really hot in        Oh my god, how                     Well, i should go back to
here! I should open the          embarrassing.                       work. See ya later!
       windows...               She has noticed
                                  my sweat!




                              My first daywant roleplays online!
                                     We at
                              work, I literally create comics...
                                          Let‘s
                            know no one here.
                                This is so
                             embarrassing...

                                                              I could‘ve talked about
                                                                  so many things, I
                                                              failed. No one likes me
                                                              here, and all of this on
                    Why do I always turn                       my first day at work...
                     red and sweat so
                     much, no one will
                          like me!

June 2012                                                                            www.gamesforhealth.org
confident
                                                    shy

                       We want action for the comics!
                     Start a story with different endings




June 2012                                                   www.gamesforhealth.org
        aggressive
Scientific evaluation

               Was it successful?!




June 2012                            www.gamesforhealth.org
Design of our pilot study

                                  14 weeks
Voluntary
students
               t1                 Training           t2

               • Pretest          • Intervention     • Post test
                                  IG (n=61)
                                    group
               • Several                             • Several
                                  CG (n=47)
                 questionnaires   • Online group       questionnaires
                                  • Control group
                                  Dropout rates:
                                  IG: 50.4%
                                    (Waiting list)
                                  CG: 24.19%




  June 2012                                                    www.gamesforhealth.org
Sample
                    14%


                                     Male
                                     Female

              86%



                                               44%           Social Phobia
                                                             Non SP
                                       56%

Age: M = 24.75
No significant differences between IG and CG

  June 2012                                          www.gamesforhealth.org
Social fears I
                             19,78
            20

                                                            19,18


            18
                            18,44



                                                                             IG
                                                                             VG2
            16
                                                                             CG
                                                                             KG2




            14


                                                            12,91

            12
                            t1                         t2


            Social Phobia Inventory: F (1, 106) = 23.23, p < .001, d = .94

June 2012                                                              www.gamesforhealth.org
Social fears II

            38                   38,24



            36                   35,78


            34
                                                                          IG
                                                                       VG2
                                                                       IG
                                                                          CG
                                                           32,48       CG
                                                                       KG2
            32


            30


            28


            26                                             26,09
                            t1                        t2

      Liebowitz Social Anxiety Scale: F (1, 106) = 11.00, p = .001, d = .65

June 2012                                                             www.gamesforhealth.org
Summary of results
•    Significant decrease of social fears
       –    IG: from 44.26% to 28%
       –    CG: from 36% to 35%
•    Significant increase of social skills
       –    Better problem solving
       –    Better self-esteem and self-worth
       –    Appreciation from other people
       –    General achievement potential
       –    Emotion regulation



June 2012                                       www.gamesforhealth.org
Key take aways
•    Self-administered programs are effective!
•    Important: „Fun“
       •    Bring fun into a „serious“ training
•    Focus groups: effective instrument
•    Bugs bugs bugs  tests, tests, tests...
•    Weekly reminder!



June 2012                                         www.gamesforhealth.org
Future challenges and plans
•    Well evaluated training available
•    Ethical considerations necessary
•    Still too textbased:
       •    MAKE A GAME!
       •    „Cooperation with the Faculty of Computer
            Science, University of Vienna (Univ.-Prof. Helmut
            Hlavacs, Harald Judt, Leon Beutl)



June 2012                                            www.gamesforhealth.org
Thank you!



                     Mario Lehenbauer
            Clinical Psychologist & Health Psychologist
                               mario.lehenbauer@univie.ac.at
                               @mariolehenbauer
                               Mario Lehenbauer


  June 12-1, 2013
June 2012                                                      www.gamesforhealth.org
        Boston, MA
References
•    Electronic Entertainment Association (2011). Essential facts about the computer and video game
     industry Retrieved June 1st, 2012, from http://www.theesa.com/facts/pdfs/ESA_EF_2011.pdf
•    Erwina, B.A., Turk, C.L., Heimberg, R.G., Fresco, D.M., & Hantula, D.A. (2004). The Internet: home to
     a severe population of individuals with social anxiety disorder? Journal of Anxiety
     Disorders, 18, 629-646.
•    Hinsch, R. & Pfingsten, U. (2007). Gruppentraining sozialer Kompetenzen. Weinheim: Beltz.
•    Joormann, J. & Unnewehr, S. (2002). Behandlung der sozialen Phobie bei Kindern und Jugendlichen
     – ein kognitiv-verhaltenstherapeutisches Gruppenprogramm. Göttingen: Hogrefe.
•    Lehenbauer, M. (2009). Problematischer Internetgebrauch und Sozialphobie: Internetspezifische
     maladaptive Kognitionen. In B. U. Stetina & I. Kryspin-Exner (Eds.), Gesundheit und neue Medien.
     Psychologische Aspekte der Interaktion mit Informations- und Kommunikationstechnologien (pp.
     261–273). Wien: Springer-Verlag.
•    Margraf, J. & Schneider, S. (1990). Panik. Angstanfälle und ihre Behandlung. Berlin: Springer.
•    Stangier, U., Clark, D.M. & Ehlers, A. (2006). Soziale Phobie. Göttingen: Hogrefe.
•    Ullrich, R. & de Muynck, R. (2001). ATP 1: Einübung von Selbstvertrauen - Bedingungen und Formen
     sozialer Schwierigkeiten. Stuttgart: Klett-Cotta.
•    Vaitl, D. & Petermann, F. (2004). Handbuch der Entspannungsverfahren. Weinheim: Beltz Verlag




June 2012                                                                                www.gamesforhealth.org

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games for health 2012

  • 1. Prevention of social fears A “gamificated” program for shy students Mario Lehenbauer & Birgit U. Stetina Clinical Psychologist & Health Psychologist mario.lehenbauer@univie.ac.at @mariolehenbauer Mario Lehenbauer June 2012 Games for Health Conference www.gamesforhealth.org
  • 2. Clinical Psychologist Health Psychologist Technology ”freak” Passionate Gamer Research topics: •(“Serious”) Games for Health •Innovative Technology in Psychology • Compulsive Internet Use and “Online Gaming Addiction”  differentiating between “high engagement” and “addiction” June 2012 Games for Health Conference www.gamesforhealth.org
  • 3. Games I am playing … June 2012 www.gamesforhealth.org
  • 4. Social Anxiety Disorder and Shyness • Social Anxiety Disorder (SAD) • DSM IV: 300.23 • a persistent fear of negative evaluation in social situations • Cognitive symptoms • Behavioral symptoms • Physiological arousal / stress • Life-time prevalence 16-23 % • Shyness: 40-50% • Early age of onset! Between 15-25 years June 2012 www.gamesforhealth.org
  • 5. … some background facts • Onlinestudy: 20% suffer from SAD – Compared to 6-16% offline (Lehenbauer, 2009) • Almost 100% of adolescents are online • 72% of the American households play computer or video games (ESA, 2011) • Social phobia has an early age of onset • Therefore: • Go online and use “new” media! June 2012 www.gamesforhealth.org
  • 6. Our „offline“ training • Funded by Austrian Ministry of Science • Novel aspect: development in cooperation with adolescents • Offline training: 14 lessons (á 50 min.) = 14 weeks – 1-7: Psychoeducation, cognitive restructuring (Joormann & Unnewehr, 2002; Margraf & Schneider, 1990; Stangier, Clark & Ehlers, 2006) – 8 – 12: Social Skills Training (eg, how to say „no“, get in contact with other people, solving conflicts, feedback, ..) (Hinsch & Pfingsten, 2007; Joormann & Unnewehr, 2002; Ullrich & de Muynck, 2001) – 13 – 14: Relapse prevention (Stangier, Clark & Ehlers, 2006) – 2-14: Body relaxation methods (Vaitl & Petermann, 2004) – Highly relevant effects (Lehenbauer & Stetina, 2011a; 2011b) June 2012 www.gamesforhealth.org
  • 7. How can we do THIS online?!?! June 2012 www.gamesforhealth.org
  • 8. Make it online! • Big challenge • Focus groups with young students • Text based informations and quizzes: BORING • How can we bring fun into a serious topic? • One year of planning time and programming! WE WANT FUN!!! June 2012 www.gamesforhealth.org
  • 9. June 2012 www.gamesforhealth.org
  • 10. We need trainers! Development of six avatars with different background stories June 2012 www.gamesforhealth.org
  • 11. WELL DONE! THAT WAS AWESOME We need feedback! Emotional reactions of avatars Hmmm... I think you can do better.... June 2012 www.gamesforhealth.org
  • 12. Wow it is really hot in Oh my god, how Well, i should go back to here! I should open the embarrassing. work. See ya later! windows... She has noticed my sweat! My first daywant roleplays online! We at work, I literally create comics... Let‘s know no one here. This is so embarrassing... I could‘ve talked about so many things, I failed. No one likes me here, and all of this on Why do I always turn my first day at work... red and sweat so much, no one will like me! June 2012 www.gamesforhealth.org
  • 13. confident shy We want action for the comics! Start a story with different endings June 2012 www.gamesforhealth.org aggressive
  • 14. Scientific evaluation Was it successful?! June 2012 www.gamesforhealth.org
  • 15. Design of our pilot study 14 weeks Voluntary students t1 Training t2 • Pretest • Intervention • Post test IG (n=61) group • Several • Several CG (n=47) questionnaires • Online group questionnaires • Control group Dropout rates: IG: 50.4% (Waiting list) CG: 24.19% June 2012 www.gamesforhealth.org
  • 16. Sample 14% Male Female 86% 44% Social Phobia Non SP 56% Age: M = 24.75 No significant differences between IG and CG June 2012 www.gamesforhealth.org
  • 17. Social fears I 19,78 20 19,18 18 18,44 IG VG2 16 CG KG2 14 12,91 12 t1 t2 Social Phobia Inventory: F (1, 106) = 23.23, p < .001, d = .94 June 2012 www.gamesforhealth.org
  • 18. Social fears II 38 38,24 36 35,78 34 IG VG2 IG CG 32,48 CG KG2 32 30 28 26 26,09 t1 t2 Liebowitz Social Anxiety Scale: F (1, 106) = 11.00, p = .001, d = .65 June 2012 www.gamesforhealth.org
  • 19. Summary of results • Significant decrease of social fears – IG: from 44.26% to 28% – CG: from 36% to 35% • Significant increase of social skills – Better problem solving – Better self-esteem and self-worth – Appreciation from other people – General achievement potential – Emotion regulation June 2012 www.gamesforhealth.org
  • 20. Key take aways • Self-administered programs are effective! • Important: „Fun“ • Bring fun into a „serious“ training • Focus groups: effective instrument • Bugs bugs bugs  tests, tests, tests... • Weekly reminder! June 2012 www.gamesforhealth.org
  • 21. Future challenges and plans • Well evaluated training available • Ethical considerations necessary • Still too textbased: • MAKE A GAME! • „Cooperation with the Faculty of Computer Science, University of Vienna (Univ.-Prof. Helmut Hlavacs, Harald Judt, Leon Beutl) June 2012 www.gamesforhealth.org
  • 22. Thank you! Mario Lehenbauer Clinical Psychologist & Health Psychologist mario.lehenbauer@univie.ac.at @mariolehenbauer Mario Lehenbauer June 12-1, 2013 June 2012 www.gamesforhealth.org Boston, MA
  • 23. References • Electronic Entertainment Association (2011). Essential facts about the computer and video game industry Retrieved June 1st, 2012, from http://www.theesa.com/facts/pdfs/ESA_EF_2011.pdf • Erwina, B.A., Turk, C.L., Heimberg, R.G., Fresco, D.M., & Hantula, D.A. (2004). The Internet: home to a severe population of individuals with social anxiety disorder? Journal of Anxiety Disorders, 18, 629-646. • Hinsch, R. & Pfingsten, U. (2007). Gruppentraining sozialer Kompetenzen. Weinheim: Beltz. • Joormann, J. & Unnewehr, S. (2002). Behandlung der sozialen Phobie bei Kindern und Jugendlichen – ein kognitiv-verhaltenstherapeutisches Gruppenprogramm. Göttingen: Hogrefe. • Lehenbauer, M. (2009). Problematischer Internetgebrauch und Sozialphobie: Internetspezifische maladaptive Kognitionen. In B. U. Stetina & I. Kryspin-Exner (Eds.), Gesundheit und neue Medien. Psychologische Aspekte der Interaktion mit Informations- und Kommunikationstechnologien (pp. 261–273). Wien: Springer-Verlag. • Margraf, J. & Schneider, S. (1990). Panik. Angstanfälle und ihre Behandlung. Berlin: Springer. • Stangier, U., Clark, D.M. & Ehlers, A. (2006). Soziale Phobie. Göttingen: Hogrefe. • Ullrich, R. & de Muynck, R. (2001). ATP 1: Einübung von Selbstvertrauen - Bedingungen und Formen sozialer Schwierigkeiten. Stuttgart: Klett-Cotta. • Vaitl, D. & Petermann, F. (2004). Handbuch der Entspannungsverfahren. Weinheim: Beltz Verlag June 2012 www.gamesforhealth.org