Investigating Avatar Customization as a Motivational Design Strategy for Improving Engagement with Technology-Enabled Services for Health

Technology-enabled services for physical and mental health are a promising approach to improve healthcare globally. Unfortunately, the largest barrier for effective technology-based treatment is participants' gradually fading engagement with effective novel training applications, such as exercise apps or online mental health training programs. Engaging users through design presents an elegant solution to the problem; however, research on technology-enabled services is primarily focused on the efficacy of novel interventions and not on improving adherence through engaging interaction design. As a result, motivational design strategies to improve engagement---both in the moment of use and over time---are underutilized. Drawing from game-design, I investigate avatar customization as a game-based motivational design strategy in four studies. In Study 1, I examine the effect of avatar customization on experience and behaviour in an infinite runner game. In Study 2, I induce different levels of motivation to research the effects of financial rewards on self-reported motivation and performance in a gamified training task over 11 days. In Study 3, I apply avatar customization to investigate the effects of attrition in an intervention context using a breathing exercise over three weeks. In Study 4, I investigate the immediate effects of avatar customization on the efficacy of an anxiety reducing attentional retraining task. My results show that avatar customization increases motivation over time and in the moment of use, suggesting that avatar customization is a viable strategy to address the engagement barrier that thwarts the efficacy of technology-enabled services for health

How Avatar Customization Affects Fear in a Game-based Digital Exposure Task for Social Anxiety

The treatment of social anxiety through digital exposure therapy is challenging due to the cognitive properties of social anxiety-individuals need to be fully engaged in the task and feel themselves represented in the social situation; however, avatar customization has been shown to increase both engagement and social presence. In this paper, we harness techniques used in commercial games, and investigate how customizing self-representation in a novel digital exposure task for social anxiety influences the experience of social threat. In an online experiment with 200 participants, participants either customized their avatar or were assigned a predefined avatar. Participants then controlled the avatar through a virtual shop, where they had to solve a math problem, while a simulated audience within the virtual world observed them and negatively judged their performance. Our findings show that we can stimulate the fear of evaluation by others in our task, that fear is driven primarily by trait social anxiety, and that this relationship is strengthened for people higher in trait social anxiety. We provide new insights into the effects of customization in a novel therapeutic context, and embed the discussion of avatar customization into related work in social anxiety and human-computer interaction

More than skin deep: About the influence of self-relevant avatars on inhibitory control

AbstractOne important aspect of cognitive control is the ability to stop a response in progress and motivational aspects, such as self-relevance, which may be able to influence this ability. We test the influence of self-relevance on stopping specifically if increased self-relevance enhances reactive response inhibition. We measured stopping capabilities using a gamified version of the stop-signal paradigm. Self-relevance was manipulated by allowing participants to customize their game avatar (Experiment 1) or by introducing a premade, self-referential avatar (Experiment 2). Both methods create a motivational pull that has been shown to increase motivation and identification. Each participant completed one block of trials with enhanced self-relevance and one block without enhanced self-relevance, with block order counterbalanced. In both experiments, the manipulation of self-relevance was effective in a majority of participants as indicated by self-report on the Player-Identification-Scale, and the effect was strongest in participants that completed the self-relevance block first. In those participants, the degree of subjectively experienced that self-relevance was associated with improvement in stopping performance over the course of the experiment. These results indicate that increasing the degree to which people identify with a cognitive task may induce them to exert greater, reactive inhibitory control. Consequently, self-relevant avatars may be used when an increase in commitment is desirable such as in therapeutic or training settings

Digital Human Representations for Health Behavior Change: A Structured Literature Review

Organizations have increasingly begun using digital human representations (DHRs), such as avatars and embodied agents, to deliver health behavior change interventions (BCIs) that target modifiable risk factors in the smoking, nutrition, alcohol overconsumption, and physical inactivity (SNAP) domain. We conducted a structured literature review of 60 papers from the computing, health, and psychology literatures to investigate how DHRs’ social design affects whether BCIs succeed. Specifically, we analyzed how differences in social cues that DHRs use affect user psychology and how this can support or hinder different intervention functions. Building on established frameworks from the human-computer interaction and BCI literatures, we structure extant knowledge that can guide efforts to design future DHR-delivered BCIs. We conclude that we need more field studies to better understand the temporal dynamics and the mid-term and long-term effects of DHR social design on user perception and intervention outcomes

The (gami)fictional ego-center: Projecting the location of the self into an avatar

A rich body of research suggests that self-associated stimuli are preferentially processed and therefore responses to such stimuli are typically faster and more accurate. In addition, people have an understanding of what they consider their "Self" and where it is located, namely near the head and upper torso-further boosting the processing of self-related stimuli if they are presented near the felt location of the self. We were interested in whether the same mechanism can be found when people transfer their "Self" into a static avatar. We investigated this in two studies with N = 33 and N = 39 young, healthy adults, respectively. Taken together, the results showed that (i) people indeed show enhanced processing for self-avatar-related stimuli and (ii) that self-associations are stronger if the to-be-associated stimuli are closer to the avatar's upper torso-suggesting some kind of a projected location of the self in the avatar. This implies that attention is not equally distributed across the avatar. Beyond a theoretical level, this also has implications for practical use. For example, digital games opting for a non-traditional user interface where information is displayed on or in the direct vicinity of the character should take this effect into account when choosing which information to present where (i.e., present the most crucial piece of information close to the self-center of the avatar)

(Don’t) stand by me: How trait psychopathy and NPC emotion influence player perceptions, verbal responses, and movement behaviours in a gaming task

Social interactions are an essential part of many digital games, and provide benefts to players; however, problematic social interactions also lead to harm. To inform our understanding of the origins of harmful social behaviours in gaming contexts, we examine how trait psychopathy infuences player perceptions and behaviours within a gaming task. After measuring participants’ (n=385) traitlevel boldness, meanness, and disinhibition, we expose them to neutral and angry social interactions with a non-player character (NPC) in a gaming task and assess their perceptions, verbal responses, and movement behaviours. Our fndings demonstrate that the traits signifcantly infuence interpretation of NPC emotion, verbal responses to the NPC, and movement behaviours around the NPC. These insights can inform the design of social games and communities and can help designers and researchers better understand how social functioning translates into gaming contexts

Social VR design features and experiential outcomes:narrative review and relationship map for dyadic agent conversations

The application of virtual reality to the study of conversation and social interaction is a relatively new field of study. While the affordances of VR in the domain compared to traditional methods are promising, the current state of the field is plagued by a lack of methodological standards and shared understanding of how design features of the immersive experience impact participants. In order to address this, this paper develops a relationship map between design features and experiential outcomes, along with expectations for how those features interact with each other. Based on the results of a narrative review drawing from diverse fields, this relationship map focuses on dyadic conversations with agents. The experiential outcomes chosen include presence &amp; engagement, psychological discomfort, and simulator sickness. The relevant design features contained in the framework include scenario agency, visual fidelity, agent automation, environmental context, and audio features. We conclude by discussing the findings of the review and framework, such as the multimodal nature of social VR being highlighted, and the importance of environmental context, and lastly provide recommendations for future research in social VR.</p

Socially Anxious Play: Design, Development, and Evaluation of Game-Based Digital Behavioural Markers for the Assessment of Social Anxiety

Social relationships are essential for humans; neglecting our social needs can cause discomfort or even lead to the development of more severe issues such as loneliness, depression, or substance dependency. Although essential, some individuals face major challenges in forming and maintaining social relationships due to the experience of social anxiety, which is the intense fear of being evaluated by others. The burden of social anxiety can be reduced through accessible assessment that leads to treatment. However, socially anxious individuals who wish to seek help face many barriers stemming from geography, the characteristics of the fear itself, or disparities in access to systems of care. Recent research has suggested digital behavioural markers as a way to deliver cheap and easily accessible digital assessment for social anxiety that may help reduce barriers to care. However, prior work focused mostly on the relationship between social anxiety and the development of problematic gaming behaviours to cope with the potentially severe consequences of social anxiety. In this dissertation, we look at the relationship between social anxiety and digital games from the lens of assessment and analyze whether we can use digital behavioural markers embedded in a gaming task to assess the severity of social anxiety. In manuscript 1, we show that social anxiety may manifest in game and biases the preferences for in-game activities and the reasons why players play Massively Multiplayer Online Role Playing Games (MMORPGs). Further, Manuscript 2 shows that central game mechanics, such as the customization of the self-representation in-game, may affect the experience of social stress in-game. Manuscripts 3 and 4 explore the in-game movement of a player around a non-player character (NPC) and show that certain aspects of the movement path may be used to predict the degree of social anxiety. Further, we show that the camera perspective as well as the self-representation may affect the strength of these behavioural markers of social anxiety. Finally, Manuscript 5 explores how the found behavioral markers, as well as the developed gaming task, may be used to predict self-reported psychopathy---which is negatively related to social anxiety---and further shows that personal character traits manifest in-game and may explain certain phenomena such as the presence of anti-social behaviour in digital games. Overall, the results of this dissertation provide new insights about the relationship between social anxiety and its manifestation in-game, the influence of game mechanics on the experience of social stress, and how social anxiety as well as psychopathic traits may affect in-game behaviours, opening the way towards digital behavioural markers for the assessment of social anxiety

Merlynne: Motivating Peer-to-Peer Cognitive Behavioral Therapy with a Serious Game

Human-Computer Interaction researchers have explored how online communities can be leveraged for peer support, but general disinterest and a lack of engagement have emerged as substantial barriers to their use in practice. To address this gap, we designed Merlynne, a serious game that seeks to motivate individuals to support peers through Cognitive Behavioural Therapy (CBT). Our game explored use of the Proteus Effect — a phenomenon where players adopt characteristics of their in-game avatar — to motivate peer support through stereotyped 'helpful' and 'unhelpful' avatars. We then conducted a mixed-methods, exploratory study to investigate its design. We found that our game successfully motivated players to offer peer support, despite the substantial emotional labour required by CBT. However, we were not able to replicate the Proteus Effect, and did not find differences in that support based on a player's avatar. In reflecting on our findings, we discuss design challenges and considerations for the use of serious games to motivate participation in mental health support, including: fatigue, a player's need for self-expression and to relate to those they are supporting, and ludonarrative dissonance