GASICAGeneric Automated Stress Induction

and Control Application

Benny van der Vijgh, Robbert-Jan BeunMaarten van Rood, Peter Werkhoven

Stress induction & manipulation

Stress dependent/confounding variable

Currently no application available

GASICA

Stressor component

Multidimensionality

Adjustability

Real-time

Continuity

Digital game stressor

Requirements

Stressor component

Meta-analysis

83 studies (1978 – 2012)

Coded 19 game and study characteristics & 29 physiological signals

Analyzed 10 characteristics & 3 physiological signals (HR, SBP, DBP)

High mean weighted effect sizes (0.76 – 0.97 g*)

Metaregression: 4 game characteristics & 2 study characteristics

Digital game stressor characteristics

Stressor componentDigital game stressor characteristics

Game type

Realism

Aversive stimuli

Game music

Time pressureFrustration I/O

Measurement componentRequirements

Responsitivity

Response consistency

Measurement continuity

Measurement inertion

Low response latency

Measurement componentCharacteristics

Heart rate (HR)

Blood pressure (BP)

Electrodermal response (EDA)

Feedback model

Stress state

Rules Selection

GASICA revisited

Implementation

Game type

Narrative

Stressor

ImplementationStressor characteristics instantiations

ImplementationStressor engine requirements

Data exchange

Characteristic implementation

High-level programming language

Real-time adjustment

Virtual BattleSpace 2 (Bohemia Interactive)

ImplementationStressor

ImplementationMeasurement equipment requirements

fMRI compatible

Continuous

Broad spectrum

MP150 System (Biopac Systems Inc.)

ImplementationFeedback model requirements

High-level Biopac compatible classes

Python

Implementation

Open source Ease of use

Gasica.com

General requirements

Implementation

Testing

Debugging

S/N ratio

EEG timing

Pilot 1

N = 27

Usability & perceived stress

Questionnaire

Sufficient quality & slightly stressed

Pilot 2

Proof of concept

N = 6 (3M, age = 33.7Y)

10m fitting, 30m manipulation

2x5m baseline

High & low stress

HR, SBP, DBP, EDA

Pilot 2

Summary

Automated

Open source Induction

Manipulation

Standardized

Ease of use

Generic

Multi-dimensional

Conclusion

Currently larger validation studyN= 42, HR, BP, EDA, Cortisol, subjective stress

GASICA potential for easy to use tool, allowing for standardized stress induction and manipulation.

Remind cognitive training for (brain) tumor patients

life in years opportunities for families affected by cancerGames for Health Europe

Petra Hoogendoorn

Utrecht, October 2014

name, e-mail address, country code

‘on top of your mind’

‘mind blowing or mindful’ afterburners:petrahgndrn@gmail.com

thank you!

name, e-mail address, country code

‘on top of your mind’:

what other cancer apps / games are you aware of?

WHO (1948): a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Huber et al. (2011): the ability to adapt and to self manage, in the face of social, physical and emotional challenges

tumortumor

change of focus

tumor tumor

treatments

treatments

what can you do yourself

functioning with tumor

personalized functioning with a tumor

the other 99,95% of timecoping, self management, life

Sara Riggare (Sweden) researcher and Parkinson (im)patient(with permission)

lots (family) functioning with cancer issues waiting to be attended to

name, e-mail address, country code

‘on top of your mind’:

what apps / games for other diseases could be interesting for cancer patients and/or their loved ones?

significant numbers and financial opportunities

and probably lots more award winning research currently not available to

patients and families

Dutch government e-health agenda

name, e-mail address, country code

‘on top of your mind’:

how would you rate opportunities and support for e-health / health games in your country?

a number of obstacles encountered

upfront:• researchers are rewarded for (funding and) articles not apps• rather an investment with unsure benefits, pricing, numbers reached, knowledge who to target

(physician, insurance, ‘publishers?’) and procedures and rules to follow, perhaps reputation risks• and what is a reasonable division of benefits for accomplishments in research on the one hand and

business on the other? (in publishing books standards already in existence)funding:• funding is project and time bound, app development not necessarily easy to predict upfront plus

ongoing development is a necessity from technical - , physician - and patient perspective• funding channels traditionally familiar for researchers are not necessarily keen to support

‘commercial’ activities, yet would like a sustainable productdevelopment:• building apps and doing medical research are two entirely different worlds with different notions of

time, approach, budget flexibility, finished products, etc. etc.implementation:• no such thing as a sales, support or ongoing development organization (like book publishers)• researchers and physicians tend to be rather focused, specializing in a certain area / domain,

opportunities outside it are not necessarily seen, (considered) easy to enter and used• not invented here syndrome• how are patients and physicians supposed to know what is available where and how and good

value for money and time / energy?• availability devices and skills within certain groups of patients or clinical practices• proof to be used in practice / reimbursed requires (preferably less throughput time consuming)

research, yet much more expensive face to face treatments without real evidence are reimbursed• …

name, e-mail address, country code

‘on top of your mind’:

what could / should we do ourselves / together to enhance uptake and use of e-health / health games?

what can governments or other organizations contribute?

Thank you!

petra.hoogendoorn@your-years.nl