A fully customizable truck-driving simulator for the care of people suffering from Post-Traumatic Stress Disorder

Considering that multiple issues impact the psychological health of truckers and that about 80% of truckers survived at fatal car accidents, it seems that truckers are likely to suffer from Post Traumatic Stress Disorder. In addition, little research deals with the use of Virtual Reality technologies as a therapy for truckers suffering from this illness. This paper concerns the creation of a fully customizable virtual environment to help truckers at facing their fears through an Exposure Therapy. Proposed customization aims at targeting the factors that do affect the mental health of a trucker. For this, we designed a truck-driving simulator that can easily and rapidly replicate multiple real life environments (different weather conditions, several types of neighborhoods, various traffic conditions, etc.). Doing so, we propose a simulator that may fit the needs of several profils of truckers suffering from PTSD

Developing and evaluating MindMax: promoting mental wellbeing through an Australian Football League-themed app incorporating applied games (including gamification), psychoeducation, and social connectedness

Gamification is increasingly being used as a behavioural change strategy to increase engagement with apps and technologies for mental health and wellbeing. While there is promising evidence supporting the effectiveness of individual gamification elements, there remains little evidence for its overall effectiveness. Furthermore, a lack of consistency in how ‘gamification’ and related terms (such as ‘applied games’, an umbrella term of which gamification is one type) are used has been observed within and across multiple academic fields. This contributes to the difficulty of studying gamification and decreases its accessibility to people unfamiliar with applied games. Finally, gamification has also been critiqued by both game developers and by academics for its reliance on extrinsic motivators and for the messages that gamified systems may unintentionally convey. In this context, the aims of this thesis were fourfold: 1) to iteratively co-design and develop a gamified app for mental health and wellbeing, 2) to evaluate the eventuating app, 3) to consolidate literature on gamification for mental health and wellbeing, and 4) to synthesise findings into practical guidelines for implementing gamification for mental health and wellbeing. Chapter 2 reports the first study which addresses the first aim of this thesis. Six participatory design workshops were conducted to support the development of MindMax, an Australian Football League (AFL)-themed mobile phone app aimed at AFL fans (particularly male ones) that incorporates applied games, psychoeducation, and social connectedness. Findings from these workshops were independently knowledge translated and fed back to the software development team, resulting in a MindMax prototype. This prototype was further tested with 15 one-on-one user experience testing interviews at three separate time points to iteratively refine MindMax’s design and delivery of its content. The findings of this study suggest that broadly, participants endorsed a customisable user experience with activities requiring active user participation. These specifications were reflected in the continual software updates made to MindMax. Chapters 3 and 4 report the second and third studies which address the second aim of this thesis. As regular content, performance, and aesthetic updates were applied to MindMax (following the model of the wider tech industry), a naturalistic longitudinal trial, described in Chapter 3, was deemed to be the most appropriate systematic evaluation method. In this study, participants (n=313) were given access to MindMax and asked to use it at their leisure, and surveys were sent out at multiple time points to assess their wellbeing, resilience, and help-seeking intentions. Increases in flourishing (60-day only), sense of connection to MindMax, and impersonal help-seeking intentions were observed over 30 and 60 days, suggesting that Internet-based interventions like MindMax can contribute to their users’ social connectedness and encourage their help-seeking. The third study, described in Chapter 4, reports a secondary analysis of data collected for Chapter 3, and further explores participants’ help-seeking intentions and their links to wellbeing, resilience, gender, and age. An explanatory factor analysis was conducted on Day 1 General Help-Seeking Questionnaire (GHSQ) data (n=530), with the best fitting solution resulting in three factors: personal sources, health professionals, and distal sources. In addition to providing more evidence that younger people aged 16–35 categorise apps and technologies for mental health and wellbeing like MindMax alongside other distal social sources such as phone helplines and work or school, our findings also suggest that the best way to target individuals who are least likely to seek help, particularly men, may be through these distal sources as well. Chapter 5 reports the fourth study, which addresses the third aim. In order to consolidate literature on gamification for mental health and wellbeing, this systematic review identified 70 papers that collectively reported on 50 apps and technologies for improving mental health and wellbeing. These papers were coded for gamification element, mental health and wellbeing domain, and researchers’ justification for applying gamification to improving mental health and wellbeing. This study resulted in two major findings: first, that the current application of gamification for mental health and wellbeing does not resemble the heavily critiqued mainstream application that relies on extrinsic motivators; and second, that many authors of the reviewed papers provided little or no justification for why they applied gamification to their mental health and wellbeing interventions. While the former finding is encouraging, the latter suggests that the gamification of mental health and wellbeing is not theory-driven, and is a cause for concern. Finally, to address the final aim of this thesis, all study learnings were synthesised into practical guidelines for implementing gamification for mental health and wellbeing. First, it is important to assess the suitability of implementing gamification into the intervention. Second, this implementation should ideally be integrated at a deeper, systemic level, with the explicitly qualified intention to support users, evidence-based processes, and user engagement with these processes. Third, it is important to assess the acceptability of this gamified intervention throughout its development, involving all relevant stakeholders (particularly representative end user populations). Fourth, it is important to evaluate the impact of this gamified intervention. Fifth, and finally, comprehensive and detailed documentation of this process should be provided at all stages of this process. This thesis contributes to a growing literature on the increasing importance and relevance of Internet-based resources and apps and technologies for mental health and wellbeing, particularly for young people. Given the dominance of games in society and culture across history, and the increasing contemporary prominence of digital games (also known as video games) in particular, gamification is uniquely positioned to have the potential to make large contributions to mental health and wellbeing research. In this context, this thesis contributes a systematically derived operationalisation of gamification, an evaluation of a gamified app for mental health and wellbeing, and best practice guidelines for implementing gamification for mental health and wellbeing, thereby providing frameworks that future implementations of gamified mental health and wellbeing interventions and initiatives may find useful

Nouvelles approches pour une exploitation efficace des comportements et interactions de l'humain dans l'environnement virtuel

La création des moyens permettant à l’humain de se retrouver dans un endroit différent du monde réel n’est pas une nouveauté. Les outils comme les peintures ou les livres permettent tout autant de transporter l’humain par imagination dans un monde fictif afin de lui permettre de s’évader de la vie réelle. C’est également ce que permettent les technologies de la réalité virtuelle. Cependant, les environnements de la réalité virtuelle sont des représentations 3D numériques exploitables à l’échelle humaine. Ils peuvent stimuler au maximum les habiletés perceptives de l’humain à travers ses canaux sensoriels, tout en lui permettant d’influencer activement le déroulement des évènements qui y ont lieu. De ce fait, ils représentent un atout majeur pour la représentation de l’information à des fins diverses. Dans cette thèse, nous nous sommes intéressés à l’exploitation de la réalité virtuelle dans le cadre de la thérapie par exposition pour le traitement du trouble de stress post-traumatique. En faisant une revue de littérature dans ce domaine, nous avons constaté le rôle essentiellement passif qui est attribué au patient. En effet, les études antérieures se sont focalisées sur la composante « modélisation 3D » de la réalité virtuelle ainsi que sur la stimulation sensorielle, avec pour but principal d’aider le patient à narrer son trauma. Cela est fait au détriment d’une des caractéristiques principales de la réalité virtuelle qu’est l’interaction du sujet avec l’environnement virtuel. Ainsi, au vu des avantages qu’elles offrent, nous pensons que les technologies de la réalité virtuelle devraient être utilisées pour permettre au patient de revivre son trauma différemment au moyen de l’interaction. Alors, nous avons proposé des approches basées sur le modèle de référence de la réalité virtuelle. Ces approches exploitent les techniques de gamification avancées des jeux sérieux ajoutées à la technique d’ajustement dynamique de la difficulté empruntée au domaine du jeu vidéo, pour implémenter les interactions naturelles de l’humain avec l’environnement virtuel. Nous avons appliqué ces approches à un simulateur de conduite de camion en réalité virtuelle pour traiter les camionneurs souffrant de trouble de stress post-traumatique. Les résultats d’évaluation d’utilisabilité du simulateur conformément à ces approches y sont présentés : le sentiment de présence a été atteint à travers cet outil et les participants ont trouvé la qualité des interactions avec l’environnement virtuel optimale. En perspectives, nous avons décrit l’application clinique expérimentale qui sera effectuée avec des patients en résidence à « La Futaie », centre de thérapie avec lequel nous avons collaboré tout au long de cette recherche. Creating the means for humans to find themselves in a place different from the real world is nothing new. Tools such as paintings or books also allow humans to be transported by imagination into a fictitious world in order to escape from real life. This is also what virtual reality technologies allow. However, virtual reality environments are digital 3D environments usable on a human scale. They can maximize the perceptual skills of humans through their sensory channels while allowing them to actively influence the course of events that take place in these environments. Therefore, they are a major asset for the representation of information for various purposes. In this thesis, we focused on the use of virtual reality as part of exposure therapy for the treatment of post-traumatic stress disorder. By reviewing the literature in that area, we noted the essentially passive role attributed to the patient. Indeed, previous studies have focused on the "3D modeling" component of virtual reality as well as on sensory stimulation, with the main goal of helping the patient to narrate his trauma. That is done to the detriment of one of the main characteristics of virtual reality, which is the subject's interaction with the virtual world. So, given the benefits they offer, we believe that virtual reality technologies should be used to allow the patient to relive his trauma differently through interaction. So, we have proposed approaches based on the virtual reality reference model. These approaches exploit the advanced gamification techniques of serious games combined with the dynamic difficulty adjustment technique borrowed from the field of video games, to implement the natural interactions of humans with the virtual environment. We applied these approaches to a virtual reality truck driving simulator to treat truckers with post-traumatic stress disorder. The simulator usability evaluation results in accordance with these approaches are presented: the feeling of presence was achieved through this tool and the participants found the quality of interactions with the virtual world to be optimal. In perspective, we have described the experimental clinical application that will be carried out with patients in residence at "La Futaie", the therapy center with which we have collaborated throughout this research