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CTIN 503
Published on Dec 23, 2022

CTIN 503 • Readings & Resources Library

The course supplement to build your own adventure.

by Marientina Gotsis
Published onDec 23, 2022
CTIN 503 • Readings & Resources Library
·

About this library

Dear CTIN 503 student,

This collection has been curated over the past fifteen years (or so), and it is updated frequently. While it is unusual not to have specific assigned readings per topic or week, the goal of CTIN 503 is to exercise your curiosity and heuristic skills: to want and seek knowledge and media around a topic of interest.

Journal articles and books contain an abstract or description so you can quickly decide what you may want to get yourself into. Supplemental resources contain only a format description for now. All resources are freely available via the USC library, via Interlibrary Loan (ILIAD)[1], or via the ARES Course Reserves. If you encounter paywalls, you are not searching through the right channel. Be sure to link your Google Scholar account with the USC Library. I have been/will be adding a short paragraph or editorial in each section as time permits.

No single source could teach you everything you need to know about a single topic. Reading from at least three different disciplines will give you a more holistic and spherical view. Adding more disciplines until you see repetition and saturation demonstrates that insight can come from where you least expect it, but it also requires the variable of time (the right time). Be hungry, curious, and patient. Start with what is here and look at who references whom. Fall into rabbit holes. Save your readings into a tool like Zotero. Copy and paste what you find interesting and make a plan to read throughout the semester. Hoard things until you are in the right mood for them. Read many things at once. There is no one right way to do this.

Experienced readers may manage as many as forty to fifty articles in one semester. If this is your first experience sifting through scholarly works and media, you may not manage a deep read of more than a dozen. I can tell from your papers and scholarly journal what level you are currently at and how you change. Trust the process and make an effort. You will be surprised how much you can change your brain over a semester.

This collection is by no means complete, diverse enough, or inclusive enough. I welcome suggestions for new or alternative references and resources. Some references exist because, even if dated, they have historical significance on a continuum of knowledge. Just because something is on the list, it does not mean that I endorse it fully without critique or that I will not accept your commentary. Also, please report broken links.

Take the red pill and join the rebellion,

Marientina Gotsis, MFA
Professor of Cinematic Practice
[email protected]

Interactive Media & Games Division | Media Arts + Practice Division
School of Cinematic Arts, University of Southern California  
3470 McClintock Ave, SCI 201U, Los Angeles, CA 90089, USA

THE SCIENCE OF EARLY CHILDHOOD

Childhood is a critical period of brain development which lays the foundations for lifelong health. While early adversity is linked causally to health problems later in life, one cannot predict another’s future on an individual basis. We must never lose hope and should continue to make an effort to support those who have suffered from adversity. Even small interventions can add up over a lifetime. Despite vast scientific evidence revealing the impact of early childhood on brain and health, investment for early childhood innovation remains very small compared to spending for late age interventions.

National Scientific Council on the Developing Child. (2014). Excessive stress disrupts the architecture of the developing brain: Working paper No.3. Retrieved from http://developingchild.harvard.edu/resources/wp3/

This working paper from the National Scientific Council on the Developing Child defines the concept of “toxic stress”—what happens when children experience severe, prolonged adversity without adult support. It discusses how significant adversity early in life can alter a child’s capacity to learn and adapt to stressful situations, as well as how sensitive and responsive caregiving can buffer the effects of such stress. The paper also suggests how to create policies that minimize the disruptive impacts of toxic stress on young children.

National Scientific Council on the Developing Child. (2011). Building the brain’s “air traffic control” system: How early experiences shape the development of executive function: Working paper No.11. Retrieved from http://developingchild.harvard.edu/resources/building-the-brains-air-traffic-control-system-how-early-experiences-shape-the-development-of-executive-function/

Executive function skills help us plan, focus attention, switch gears, and juggle multiple tasks—much like an air traffic control system at a busy airport. Acquiring the early building blocks of these skills is one of the most important and challenging tasks of the early childhood years. Their strength is critical to healthy development throughout childhood, adolescence, and early adulthood. This working paper from the National Scientific Council on the Developing Child explains how these lifelong skills develop, what can disrupt their development, and how supporting them pays off in school and life.

Introducing ECD 2.0: A New Framework for Science-Informed Investment in the Early Foundations of Health and Development [ GUIDE ]

Over the past two decades, the “brain science story” has made a powerful case for investing in the early childhood period. Now, a devastating pandemic has exacerbated longstanding inequalities and disrupted vital services, while a groundswell of social activism has brought broader public attention to the deeply embedded inequities of institutional and systemic racism. These converging challenges have intensified the demand for fresh thinking about the future of the early childhood field. The resources in this guide are designed to support the efforts of change agents across a rich diversity of sectors, cultures, geographies, and political perspectives to drive a critical re-envisioning of the field.

Diamond, A., & Lee, K. (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science (New York, N.Y.), 333(6045), 959–64. http://doi.org/10.1126/science.1204529

To be successful takes creativity, flexibility, self-control, and discipline. Central to all those are executive functions, including mentally playing with ideas, giving a considered rather than an impulsive response, and staying focused. Diverse activities have been shown to improve children's executive functions: computerized training, Non-computerized games, aerobics, martial arts, yoga, mindfulness, and school curricula. All successful programs involve repeated practice and progressively increase the challenge to executive functions. Children with worse executive functions benefit most from these activities; thus, early executive-function training may avert widening achievement gaps later. To improve executive functions, focusing narrowly on them may not be as effective as also addressing emotional and social development (as do curricula that improve executive functions) and physical development (shown by positive effects of aerobics, martial arts, and yoga).

Parker, M. M., Hergenrather, K., Smelser, Q., & Kelly, C. T. (2021). Exploring child-centered play therapy and trauma: A systematic review of literature. International Journal of Play Therapy, 30(1), 2–13. https://doi.org/10.1037/pla0000136

Researchers continue to identify increasing rates of Adverse Childhood Experiences (ACES) and the devastating effects on individuals into adulthood. The relational focus of child-centered play therapy (CCPT) and the use of toys for personal expression better meets the developmental needs of children who experienced ACEs; however, CCPT is often not included within meta-analyses or explorations of efficacious treatments for children who experienced ACEs. To address this gap, the authors conducted a systematic literature review and explored the existing research on CCPT and ACEs. To explore the utility of CCPT to demonstrate significant therapeutic outcomes for children with a history of trauma. The authors identified 32 between-group design research studies exploring the effect of CCPT on children experiencing ACES including childhood poverty, systemic discrimination, attachment difficulties, abuse, and parental incarceration. Additionally, the authors assessed the research quality and potential sources of biases within the identified studies. Findings indicate potential methodological limitations within the current studies and promising results for the use of CCPT with children who experience ACEs. Implications, limitations, and directions for future research are discussed.

Graf, G. H., Biroli, P., & Belsky, D. W. (2021). Critical periods in child development and the transition to adulthood. JAMA Network Open, 4(1), 2020–2022. https://doi.org/10.1001/jamanetworkopen.2020.33359

Adverse childhood experiences (ACEs) can affect development in ways that disrupt the formation of human capital and contribute to later-life morbidity and mortality. Theories of development predict that the timing of adversity will affect its outcomes. However,empirical evidence for timing-specific effects remains scant. In this issue ofJAMA Network Open, Andersen reports an analysis of population-register data from Denmark that suggests timing-specific associations of household dysfunction ACEs with young people’s successful transition to adulthood.

Myers, L. J., & Arterberry, M. E. (2022). Digital media and children under 3 years of age. Infant Behavior and Development, 66(December 2021), 101677. https://doi.org/10.1016/j.infbeh.2021.101677

The editorial summary of a special issue on digital media and young children with a summary of the most timely research in this area.

MEDIA:

SCIENCE OF ADOLESCENCE, EARLY ADULTHOOD, EMERGENCE OF SELF-CONCEPT & IDENTITY

Adolescence and early adulthood are developmental periods that have been studied less than early childhood. The USA is conducting several national studies nationwide (ABCD study) to understand the impact of adversity and resilience on the brain. Adolescence and early adulthood are critical for strengthening existing skills and optimizing functions. Identity development and decision-making become more prominent processes during this time. These periods are marked by intense socialization (or pressure to socialize) and the necessity of acquiring skills related to independence and self-realization. In developed societies, adolescence lasts longer, sometimes into a persons 20’s. Those of us who teach are called to address the remarkable heterogeneity in our student population and there is no such things as “normal.” And remember: we bring our child brain to adolescence and our adolescent brain to young adulthood. It is a continuum!

Framing Racial Equity in Adolescence. (2021). FrameWorks Institute. Health+Studio. In partnership with the Funders for Adolescent Science Translation.[ PDF ]

FrameWorks research shows that adolescence is misunderstood and that these misperceptions create obstacles to implementing policies and practices that optimally support adolescents. These messaging recommendations are intended to help advocates, practitioners, policymakers, and journalists working in the youth space communicate more accurately and effectively about racism and equity and their impact on adolescent development.

Crone, E. A., & Fuligni, A. J. (2020). Self and others in adolescence. Annual Review of Psychology, 71, 447–469. https://doi.org/10.1146/annurev-psych-010419-050937

Research has demonstrated that adolescence is an important time for self- and other-oriented development that underlies many skills vital for becoming a contributing member of society with healthy intergroup relations. It is often assumed that these two processes, thinking about self and thinking about others, are pitted against each other when adolescents engage in social decision making such as giving or sharing. Recent evidence from social neuroscience, however, does not support this notion of conflicting motives, suggesting instead that thinking about self and others relies on a common network of social-affective brain regions, with the medial prefrontal cortex playing a central role in the integration of perspectives related to self and others. Here, we argue that self- and other-oriented thinking are intertwined processes that rely on an overlapping neural network. Adolescents' motivation to contribute to society can be fostered most when self- and other-oriented motives align.

Patton, G. C., Olsson, C. A., Skirbekk, V., Saffery, R., Wlodek, M. E., Azzopardi, P. S., … Sawyer, S. M. (2018). Adolescence and the next generation. Nature, 554(7693), 458–466. http://doi.org/10.1038/nature25759

Adolescence is increasingly recognized as a developmental period that has a potential for influencing life-course trajectories that is second only to early life, but that could also shape the growth and development of the following generation. George Patton and colleagues review the evidence around how an individual’s health, growth and nutrition during adolescence may affect the early growth of their offspring, and consider potential mechanisms for transmission. The current generation of adolescents—now considered to be all those aged between 10 and 24—will be the largest in human history to become parents. The greatest dividends from investments in today’s adolescents may be seen in the health and human capabilities of the next generation.

Dahl, R. E., Allen, N. B., Wilbrecht, L., & Suleiman, A. B. (2018). Importance of investing in adolescence from a developmental science perspective. Nature, 554(7693), 441–450. http://doi.org/10.1038/nature25770

Adolescence is a distinctive developmental period involving rapid growth, learning and neurobiological changes, with the potential for both positive and negative outcomes. This Perspective summarizes our current understanding of developmental processes that occur during adolescence, as well as the learning needed to develop the skills and self-regulatory capacity necessary for becoming independent and integrating into adult society. A more nuanced understanding of the distinctive features of adolescence, especially the enhanced social learning and exploration, may inform policy and interventions seeking to maximize windows of opportunity for shaping the future trajectories of the health, wellbeing and economic success of adolescents.

Graf, G. H., Biroli, P., & Belsky, D. W. (2021). Critical periods in child development and the transition to adulthood. 4(1), 2020–2022. https://doi.org/10.1001/jamanetworkopen.2020.33359

Adverse childhood experiences (ACEs) can affect development in ways that disrupt the formation of human capital and contribute to later-life morbidity and mortality. Theories of development predict that the timing of adversity will affect its outcomes. However,empirical evidence for timing-specific effects remains scant. In this issue ofJAMA Network Open, Andersen reports an analysis of population-register data from Denmark that suggests timing-specific associations of household dysfunction ACEs with young people’s successful transition to adulthood.

Weil, L. G., Fleming, S. M., Dumontheil, I., Kilford, E. J., Weil, R. S., Rees, G., … Blakemore, S.-J. (2013). The development of metacognitive ability in adolescence. Consciousness and Cognition, 22(1), 264–71. http://doi.org/10.1016/j.concog.2013.01.004

Introspection, or metacognition, is the capacity to reflect on our own thoughts and behaviours. Here, we investigated how one specific metacognitive ability (the relationship between task performance and confidence) develops in adolescence, a period of life associated with the emergence of self-concept and enhanced self-awareness. We employed a task that dissociates objective performance on a visual task from metacognitive ability in a group of 56 participants aged between 11 and 41 years. Metacognitive ability improved significantly with age during adolescence, was highest in late adolescence and plateaued going into adulthood. Our results suggest that awareness of one's own perceptual decisions shows a prolonged developmental trajectory during adolescence.

Sebastian, C., Burnett, S., & Blakemore, S.-J. (2008). Development of the self-concept during adolescence. Trends in Cognitive Sciences, 12(11), 441–6. http://doi.org/10.1016/j.tics.2008.07.008

Adolescence is a period of life in which the sense of 'self' changes profoundly. Here, we review recent behavioural and neuroimaging studies on adolescent development of the self-concept. These studies have shown that adolescence is an important developmental period for the self and its supporting neural structures. Recent neuroimaging research has demonstrated that activity in brain regions associated with self-processing, including the medial prefrontal cortex, changes between early adolescence and adulthood. These studies indicate that neurocognitive development might contribute to behavioural phenomena characteristic of adolescence, such as heightened self-consciousness and susceptibility to peer influence. We attempt to integrate this recent neurocognitive research on adolescence with findings from developmental and social psychology.

Giedd, J. N. (2015). The amazing teen brain. Scientific American, 312(6), 32–37. http://doi.org/10.1038/scientificamerican0615-32

MRI studies show that the teenage brain is not an old child brain or a half-baked adult brain ; it is a unique entity characterized by change ability and an increase in networking among brain regions. The limbic system, which drives emotions, intensifies at puberty, but the prefrontal cortex, which controls impulses, does not mature until the 20s. This mismatch makes teens prone to risk taking but also allows them to adapt readily to their environment. Earlier onset of puberty in children worldwide is expanding the years during which the mismatch occurs. Greater understanding of the teen brain should help parents and society better distinguish typical behavior from mental illness while helping teens become the people they want to be.

Salmivalli, C., Voeten, M., & Poskiparta, E. (2011). Bystanders matter: Associations between reinforcing, defending, and the frequency of bullying behavior in classrooms. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 40(5), 668–676. http://doi.org/10.1080/15374416.2011.597090

This study investigated whether the bystanders? behaviors (reinforcing the bully vs. defending the victim) in bullying situations are related to the frequency of bullying in a classroom. The sample consisted of 6,764 primary school children from Grades 3 to 5 (9-11 years of age), who were nested within 385 classrooms in 77 schools. The students filled out Internet-based questionnaires in their schools? computer labs. The results from multilevel models showed that defending the victim was negatively associated with the frequency of bullying in a classroom, whereas the effect of reinforcing the bully was positive and strong. The results suggest that bystander responses influence the frequency of bullying, which makes them suitable targets for antibullying interventions.

DIGITAL MEDIA IMPACT

Popular press is full of “media is good/media is bad” articles drawing views and clicks. While it is easy to roll our eyes over such news articles, below are some directions that can lead you to more thoughtful and nuanced discussion about the positive and negative impact of digital media. If you are enrolled in CTIN 503, you are likely someone who will influence the field later in life through your digital media creations and your code. Design is a powerful policymaking tool: if you succeed, hundreds, thousands or millions of people may be affected by the decisions you make.

Ito, M., Odgers, C., & Schueller, S. (2020). Social media and youth wellbeing: What we know and where we could go. https://clalliance.org/wp-content/uploads/2020/06/Social-Media-and-Youth-Wellbeing-Report.pdf

Adolescents have been early and enthusiastic users of social and digital media. These high levels of engagement have sparked growing concerns about the relationship between technology use and adolescent wellbeing, with heightened concerns around mental health in particular. The focus of this paper and our review was on online social media and communication, though we see related patterns and concerns with other forms of technology use, particularly gaming. We reviewed an interdisciplinary body of research and the technology ecosystem for wellbeing support and mental health, and we conducted interviews with various stakeholders and experts. We found that in many cases misplaced fears are deflecting attention from other real concerns, resulting in missed opportunities for leveraging technology and online communication to address adolescent mental health problems. We found that youth are actively seeking support for mental wellbeing online, but very few are connecting with digital mental health apps and expertise.

Sabella, R. a., Patchin, J. W., & Hinduja, S. (2013). Cyberbullying myths and realities. Computers in Human Behavior, 29(6), 2703–2711. http://doi.org/10.1016/j.chb.2013.06.040

Bullying has long been a concern of youth advocates (e.g., educators, counselors, researchers, policy makers). Recently, cyberbullying (bullying perpetrated through online technology) has dominated the headlines as a major current-day adolescent challenge. This article reviews available empirical research to examine the accuracy of commonly-perpetuated claims about cyberbullying. The analysis revealed several myths about the nature and extent of cyberbullying that are being fueled by media headlines and unsubstantiated public declarations. These myths include that (a) everyone knows what cyberbullying is; (b) cyberbullying is occurring at epidemic levels; (c) cyberbullying causes suicide; (d) cyberbullying occurs more often now than traditional bullying; (e) like traditional bullying, cyberbullying is a rite of passage; (f) cyberbullies are outcasts or just mean kids; and (g) to stop cyberbullying, just turn off your computer or cell phone. These assertions are clarified using data that are currently available so that adults who work with youth will have an accurate understanding of cyberbullying to better assist them in effective prevention and response. Implications for prevention efforts in education in light of these revelations are also discussed and include effective school policies, educating students and stakeholders, the role of peer helper programs, and responsive services (e.g., counseling).

Paat, Y.-F., & Markham, C. (2021). Digital crime, trauma, and abuse: Internet safety and cyber risks for adolescents and emerging adults in the 21 st century. Social Work in Mental Health, 19(1), 18–40. https://doi.org/10.1080/15332985.2020.1845281

The shift in the technology landscape has altered the technology ecosystem of adolescents and emerging adults in the 21st century. Yet, with greater use of digital gadgets comes greater mental health risks that technological advancement brings. This study provides a narrative review of contemporary cyber risks faced by adolescents and emerging adults. In particular, this review will cover dangers and effects of cyber-bullying, social media, cyber-dating violence, sextortion, sexting, revenge porn, online dating, catfishing, and scammers, with an emphasis to raise awareness and encourage proactive efforts dedicated to address these social concerns as the digital era continues to evolve.

Kelley, T. (2012). It Gets Better: Coming Out, overcoming bullying, and creating a life worth living. Archives of Pediatrics & Adolescent Medicine, 166(2), 195. http://doi.org/10.1001/archpediatrics.2011.735

In the middle of 2010, a rash of suicides by at least 10 boys ages 13 to 18 years brought into focus the brutal bullying gay kids face in school. After 15-year-old Billy Lucas hung himself in a barn in Greensburg, Indiana, Dan Savage, the syndicated columnist, expressed his outrage on his blog. A commenter, “Kim in Portland,” planted a fertile seed: “I wish I could have told him that it gets better, from one former bullied (and beaten) child to another.”

TaeHyuk Keum, B., & Hearns, M. (2021). Online gaming and racism: Impact on psychological distress among black, asian, and latinx emerging adults. Games and Culture, 0(0), 1–16. https://doi.org/10.1177/15554120211039082

Although online racism occurs frequently and explicitly in online gaming (e.g., anti-Black hate speeches), no research has examined the psychological impact on racial/ethnic minority players. Thus, the current study examined the mediating role of online racism in the link between time spent in online gaming and psychological distress. Using data from 765 racial minority emerging adults in the United States and with gender controlled, time spent in online gaming predicted greater exposure to online racism, which in turn was linked to higher psychological distress. Post hoc multi-group comparison suggested that the findings were consistent with the Black group but neither the direct nor indirect effects of the model were significant for the Asian and Latinx groups. The results highlight the unjust digital burden and psychological costs of racism in online gaming among racial minority emerging adults, particularly among Black individuals. Limitations and implications for research are discussed.

MEDIA:

  • Podcast - This American Life Episode #27 “The cruelty of children: Stories about kids being mean to each other... including a mysterious handbook for bullies, a surprising experiment conducted by a teacher who wants to make kids be nice, and a story of youthful backstabbing told by David Sedaris.

LIFESPAN THEORIES & AGING

Lerner, R. M. (2010). The handbook of life-span development. (M. E. Lamb & A. M. Freund, Eds.) (Vol. 2). Hoboken, New Jersey: John Wiley & Sons, Inc. USC LIBRARY LINK

In the past fifty years, scholars of human development have been moving from studying change in humans within sharply defined periods, to seeing many more of these phenomenon as more profitably studied over time and in relation to other processes. The Handbook of Life-Span Development, Volume 2: Social and Emotional Development presents the study of human development conducted by the best scholars in the 21st century. Social workers, counselors and public health workers will receive coverage of the social and emotional aspects of human change across the lifespan.

Jeste, D. V, Depp, C. a, & Vahia, I. V. (2010). Successful cognitive and emotional aging. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 9(2), 78–84. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22050770

We review the definitions, determinants, and ways of enhancing successful cognitive and emotional aging. Objective definitions of successful aging based on physical health emphasize outcomes including freedom from disability and disease, whereas subjective definitions center on well-being, social connectedness, and adaptation. Most older people do not meet objective criteria for successful aging, while a majority meet the subjective criteria. Older people with severe mental illness are not excluded from successful aging. The determinants of successful aging include complex interactions of lifestyle behaviors and social environment with genes. Depression interferes with nearly all determinants of successful aging. Evidence-based means of enhancing successful aging include calorie restriction, physical exercise, cognitive stimulation, social support, and optimization of stress.

Cabeza, R., Albert, M., Belleville, S., Craik, F. I. M., Duarte, A., Grady, C. L., … Rajah, M. N. (2018). Maintenance, reserve and compensation: The cognitive neuroscience of healthy ageing. Nature Reviews Neuroscience, 19(11), 701–710. http://doi.org/10.1038/s41583-018-0068-2

Cognitive ageing research examines the cognitive abilities that are preserved and/or those that decline with advanced age. There is great individual variability in cognitive ageing trajectories. Some older adults show little decline in cognitive ability compared with young adults and are thus termed ‘optimally ageing’. By contrast, others exhibit substantial cognitive decline and may develop dementia. Human neuroimaging research has led to a number of important advances in our understanding of the neural mechanisms underlying these two outcomes. However, interpreting the age-related changes and differences in brain structure, activation and functional connectivity that this research reveals is an ongoing challenge. Ambiguous terminology is a major source of difficulty in this venture. Three terms in particular — compensation, maintenance and reserve — have been used in a number of different ways, and researchers continue to disagree about the kinds of evidence or patterns of results that are required to interpret findings related to these concepts. As such inconsistencies can impede progress in both theoretical and empirical research, here, we aim to clarify and propose consensual definitions of these terms.

Pickard, S. (2018). Health, illness and frailty in old age: A phenomenological exploration. Journal of Aging Studies, 47(August), 24–31. https://doi.org/10.1016/j.jaging.2018.10.002

The aim of this paper is to subject the clinical classification of frailty to scrutiny through exploring, via a phenomenological lens, the lived experiences of older people who meet the objective, or clinical, criteria of frailty. Drawing on a range of published research that explores the heterogeneous experiences of embodied ageing, the paper highlights the continuity of phenomenological structures of experience across successful ageing, normal ageing and frailty, suggesting the permeability and contestability of the boundaries between them and highlighting the complexity of health and illness in old age. Such data suggests a need to question the perception of frailty as something both apart from ‘normal’ ageing, and constitutive of frailed or failed ageing, and challenges the construction of the third age/fourth age polarity that underpins much of the meaning accorded to old age today.

RESILIENCE

Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology, 5. https://doi.org/10.3402/ejpt.v5.25338

In this paper, inspired by the plenary panel at the 2013 meeting of the International Society for Traumatic Stress Studies, Dr. Steven Southwick (chair) and multidisciplinary panelists Drs. George Bonanno, Ann Masten, Catherine Panter-Brick, and Rachel Yehuda tackle some of the most pressing current questions in the field of resilience research including: (1) how do we define resilience, (2) what are the most important determinants of resilience, (3) how are new technologies informing the science of resilience, and (4) what are the most effective ways to enhance resilience? These multidisciplinary experts provide insight into these difficult questions, and although each of the panelists had a slightly different definition of resilience, most of the proposed definitions included a concept of healthy, adaptive, or integrated positive functioning over the passage of time in the aftermath of adversity. The panelists agreed that resilience is a complex construct and it may be defined differently in the context of individuals, families, organizations, societies, and cultures. With regard to the determinants of resilience, there was a consensus that the empirical study of this construct needs to be approached from a multiple level of analysis perspective that includes genetic, epigenetic, developmental, demographic, cultural, economic, and social variables. The empirical study of determinates of resilience will inform efforts made at fostering resilience, with the recognition that resilience may be enhanced on numerous levels (e.g., individual, family, community, culture).

Olsson, L., Jerneck, A., Thoren, H., Persson, J., & O’Byrne, D. (2015). Why resilience is unappealing to social science: Theoretical and empirical investigations of the scientific use of resilience. Science Advances, 1(4), 1–12. https://doi.org/10.1126/sciadv.1400217

Resilience is often promoted as a boundary concept to integrate the social and natural dimensions of sustainability. However, it is a troubled dialogue from which social scientists may feel detached. To explain this, we first scrutinize the meanings, attributes, and uses of resilience in ecology and elsewhere to construct a typology of definitions. Second, we analyze core concepts and principles in resilience theory that cause disciplinary tensions between the social and natural sciences (system ontology, system boundary, equilibria and thresholds, feedback mechanisms, self-organization, and function). Third, we provide empirical evidence of the asymmetry in the use of resilience theory in ecology and environmental sciences compared to five relevant social science disciplines. Fourth, we contrast the unification ambition in resilience theory with methodological pluralism. Throughout, we develop the argument that incommensurability and unification constrain the interdisciplinary dialogue, whereas pluralism drawing on core social scientific concepts would better facilitate integrated sustainability research.

MENTAL HEALTH

Kumar, A. (2013). The play is now reality: Affective turns, narrative struggles, and theorizing emotion as practical experience. Culture, Medicine and Psychiatry, 37(4), 711–36. http://doi.org/10.1007/s11013-013-9333-z

Discursive approaches to subjectivity have been critiqued most recently for its dismissal of a living body that moves and senses. While identity as performative has proven invaluable to contemporary cultural theory for its dynamic conceptualization of power in everyday practice, the emergence of what some scholars have named an "affective turn" has prompted calls for configuring the body as more than a complex set of significations, but also a vibrant energy field in perpetual emergence. Centered on an enacted story created by two clinical therapists and two South Asian immigrant domestic violence survivors during a therapeutic support group session, this paper brings the affective turn into dialog with narrative theory. I juxtapose two different readings of this clinical "performance." One interpretation recognizes affect theory's value for highlighting sensation and the virtual in moments of transformation. Nonetheless I argue it overlooks a lived history. Thus, using a specifically dramatistic approach to narrative, the second analysis stresses the importance of personal experience and meaning-making in strengthening the link between affect and subjectivity. In doing so, the case study also argues for emotion's critical link to practical and moral experience.

Beck, A. T., & Bredemeier, K. (2016). A unified model of depression: Integrating clinical, cognitive, biological, and evolutionary perspectives. Clinical Psychological Science, 2167702616628523. http://doi.org/10.1177/2167702616628523

We propose that depression can be viewed as an adaptation to conserve energy after the perceived loss of an investment in a vital resource such as a relationship, group identity, or personal asset. Tendencies to process information negatively and experience strong biological reactions to stress (resulting from genes, trauma, or both) can lead to depressogenic beliefs about the self, world, and future. These tendencies are mediated by alterations in brain areas/networks involved in cognition and emotion regulation. Depressogenic beliefs predispose individuals to make cognitive appraisals that amplify perceptions of loss, typically in response to stressors that impact available resources. Clinical features of severe depression (e.g., anhedonia, anergia) result from these appraisals and biological reactions that they trigger (e.g., autonomic, immune, neurochemical). These symptoms were presumably adaptive in our evolutionary history, but are maladaptive in contemporary times. Thus, severe depression can be considered an anachronistic manifestation of an evolutionarily based “program.”

Rosenthal, R. J., & Faris, S. B. (2019). The etymology and early history of ‘addiction.’ Addiction Research and Theory, 27(5), 437–449. https://doi.org/10.1080/16066359.2018.1543412

Contemporary usage of addiction is contradictory and confusing; the term is highly stigmatizing but popularly used to describe almost any strong desire, passion or pursuit. Does current usage involve a recent corruption of the term or is there a history of conflicting meanings? Method: A diachronic etymological study of the terms ‘addict,’ ‘addicted’ and ‘addiction,’ informed by contemporary linguistic theory and utilizing primary and secondary sources in Archaic and Classical Latin and in English. We examine three periods: Early Roman Republic, Middle and Late Roman Republic, and Early Modern England. Findings: ‘To speak to,’ its earliest meaning, is explained by legal and augural technical usage (5th cent. BCE). As addicere and addictus evolved in the Middle and Late Roman Republic, the notion of enslavement, a secondary derivation from its legal usage, persisted as descriptive and no longer literal. In the Early Modern period, the verb addict meant simply ‘to attach.’ The object of that attachment could be good or bad, imposed or freely chosen. By the 17th century, addiction was mostly positive in the sense of devoting oneself to another person, cause or pursuit. We found no evidence for an early medical model. Conclusion: Gambling appears to be the only behavior that could satisfy both original uses; it had a strongly positive meaning (its association with divination), and an equally negative, stigmatizing one. Historically, addiction is an auto-antonym, a word with opposite, conflicting meanings. Recent applications are not a corruption of the word but are rooted in earliest usage.

Wallace, D. (1998). The depressed person. HARPERS, pp. 57–64. Retrieved from http://harpers.org/wp-content/uploads/ HarpersMagazine-1998-01-0059425.pdf

“The Depressed Person” relays the life of a woman who, though shallow and unlikeable, struggles through a familiar brand of depression with her therapist and her few relatively supportive friends. Independent of the woman’s grating personality (which gathered a fair amount of criticism upon publication), her grapple with depression should resonate with those who have encountered it ourselves. The shame the depressed person experiences when calling members of her support system results in an all too recognisable sense of inadequacy at the formidable challenge of verbalising her anguish. Wallace neatly describes her drama with prescription medications as well as her complicated relationship with her therapist.” (Review by Kathleen Elise)

Di Nicola, V. (2019). “A person is a person through other persons”: A social psychiatry manifesto for the 21st century. World Social Psychiatry, 30–32. https://doi.org/10.4103/WSP.WSP_11_19 

A critical issue for our field is how to define contemporary social psychiatry for our times. In this article, I address this definitional task by breaking it down into three major questions for social psychiatry and conclude with a call for action, a manifesto for the 21st century social psychiatry: (1) What is social about psychiatry? I address definitional problems that arise, such as binary thinking, and the need for a common language. (2) What are the theory and practice of social psychiatry? Issues include social psychiatry’s core principles, values, and operational criteria; the social determinants of health and the Global Mental Health (GMH) Movement; and the need for translational research. This part of the review establishes the minimal criteria for a coherent theory of social psychiatry and the view of persons that emerges from such a theory, the social self. (3) Why the time has come for a manifesto for social psychiatry. I outline the parameters for a theory of social psychiatry, based on both the social self and the social determinants of health, to offer an inclusive social definition of health, concluding with a call for action, a manifesto for the 21st century social psychiatry.

MEDIA:

  • Podcast - This American Life Episode #52: “Edge of Sanity”, JAN 31, 1997. Stories about the border between mental health and mental illness.

  • Podcast - This American Life Episode #204 “81 Words”: The story of how the American Psychiatric Association decided in 1973 that homosexuality was no longer a mental illness.

DIGITAL MEDIA AS HEALTH INTERVENTIONS

REVIEWS OF EVIDENCE & PERSPECTIVE

These reviews are just to get you started. When you are exploring a new area that is unfamiliar, you should read 3-4 reviews at minimum: scoping, systematic, meta-analysis (if available), and integrative (if available).

Zheng, L. R., Oberle, C. M., Hawkes-Robinson, W. A., & Daniau, S. (2021). Serious games as a complementary tool for social skill development in young people: A systematic review of the literature. Simulation and Gaming, 52(6), 686–714. https://doi.org/10.1177/10468781211031283

Background: The use of games for social skill development in the classroom is accelerating at a tremendous rate. At the same time, the research surrounding games designed for teaching social skills remains fragmented. This systematic review summarizes the current existing literature on social skill serious games for young people ages 5 to 19 and is the first review of serious games to note the demographic and geographic component of these studies. Method: This review included papers that: evaluated a game designed to teach social skills; included measurable, quantitative outcomes; have a translation or be published in English; were peer-reviewed; date from January 2010 to May 2020; and have a nonclinical study population between ages of 5 to 19. Keywords were obtained from the CASEL 5 framework. Results: Our findings are mixed but suggest that serious games may improve social skills when used alongside in-person discussion. We also found potential effects of the length of time of gameplay, intervention, and follow-up on social skill serious game effectiveness. Although this review found promising research conducted in East Asian countries and with minority samples in the United States, the majority of social skill serious game research takes place in the United States and Australia, with unreported demographic information and white-majority samples. Conclusions: Due to the limited number of published studies in this area and studies lacking methodological rigor, the effectiveness of using games to teach social skills and the impact of background on social skill learning require further discussion.

Oliveira, C. B., Pinto, R. Z., Saraiva, B. T. C., Tebar, W. R., Delfino, L. D., Franco, M. R., Silva, C. C. M., & Christofaro, D. G. D. (2020). Effects of active video games on children and adolescents: A systematic review with meta-analysis. Scandinavian Journal of Medicine and Science in Sports, 30(1), 4–12. https://doi.org/10.1111/sms.13539

Objective: To investigate the effectiveness of active video games (AVGs) on obesity-related outcomes and physical activity levels in children and adolescents. Design: Systematic review with meta-analysis. Methods: Literature search was performed in five electronic databases and the main clinical trials registries. Randomized controlled trials investigating the effect of AVGs compared with no/minimal intervention on obesity-related outcomes (body mass index [BMI], body weight, body fat, and waist circumference) and physical activity levels of children and adolescents were eligible. Two independent reviewers extracted the data of each included study. PEDro scale was used to assess risk of bias and GRADE approach to evaluate overall quality of evidence. Pooled estimates were obtained using random effect models. Results: Twelve studies were considered eligible for this review. Included studies mostly reported outcome data at short-term (less or equal than three months) and intermediate-term follow-up (more than 3 months, but <12 months). AVGs were more effective than no/minimal intervention in reducing BMI/zBMI at short-term (SMD = −0.34; 95% CI: −0.62 to −0.05) and intermediate-term follow-up (SMD = −0.36; 95% CI: −0.01 to −0.71). In addition, AVGs were more effective in reducing body weight compared with no/minimal intervention at intermediate-term follow-up (SMD = −0.25; 95% CI: −0.46 to −0.04). Regarding physical activity levels, AVGs were not more effective compared with minimal intervention at short-term and intermediate-term follow-up. Conclusions: Our review identified that AVGs were better than minimal intervention in reducing BMI and body weight, but not for increasing physical activity in young people.

Kellidou, P. M., Kotzageorgiou, M., Voulgari, I., & Nteropoulou Nterou, E. (2020). A review of digital games for children with autism spectrum disorder. PervasiveHealth: Pervasive Computing Technologies for Healthcare, 227–234. https://doi.org/10.1145/3439231.3439270

In this study, we review existing free digital games for children with Autism Spectrum Disorder (ASD). We examine their features, aim, educational design, and learning theories that underlie them. Fourteen games were analysed. Based on our analysis, behaviourism seems to be a dominant educational approach for the design of games for ASD, despite the educational advantages of constructivist approaches. Through this review, we link the educational design of digital games for children with ASD to the potential learning outcomes, and we provide some insights for game developers, ASD specialists, and teachers, relevant to the design of more effective games for children with ASD.

Peñuelas-Calvo, I., Jiang-Lin, L. K., Girela-Serrano, B., Delgado-Gomez, D., Navarro-Jimenez, R., Baca-Garcia, E., & Porras-Segovia, A. (2020). Video games for the assessment and treatment of attention-deficit/hyperactivity disorder: A systematic review. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01557-w

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and serious disorder among children. Video games have shown potential for aiding in child healthcare. Video games could contribute to the assessment and management of ADHD, but there are no previous reviews on this topic. Here, we systematically review the evidence about video game-based assessment tools and interventions for children diagnosed with ADHD. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in PROSPERO database. We searched four databases—PubMed, PsycInfo, Embase and clinicaltrials.gov—to identify original studies exploring either video game-based interventions or video game-based assessment tools in children with ADHD. After initial screening, full text revision and study selection, 22 articles were finally included in the review. Most studies used PC as platform, with a minority using a video console, pad, or 3D device. Video game-based assessment tools were generally effective in discriminating ADHD cases from controls, and in discriminating between ADHD subtypes. Video game-based therapeutic interventions were well accepted and generally effective in improving cognitive areas and decreasing ADHD symptoms. Gamification and cognitive training could be the main mechanisms underlying the usefulness and effectiveness of video game-based assessment tools and interventions. Software optimization and greater collaboration between developers and healthcare professionals are some of the priorities for future research in this area.

Bayeck, R. Y. (2020). Examining board gameplay and learning: A multidisciplinary review of recent research. Simulation and Gaming, 51(4), 411–431. https://doi.org/10.1177/1046878119901286

Background: Recent years have seen the resurgence of board games designed for entertainment, and to teach or explicate real life problems. The revival of board gameplay has been discussed in mainstream media, and has drawn the attention of researchers. Yet, in the field of games studies, the conception of games as learning spaces is mostly emphasized through digital/video games. Aim: This literature review reveals the current knowledge regarding the learning potential of board games in various settings, subjects, and diverse learners. Results: Board games are spaces for mathematical learning and learning spaces that can enable the learning of various contents. Board games allow for various interactions that result in players engaging in computational thinking, teamwork, and creativity. Conclusion: The relationship between board gameplay and learning is evidenced across disciplines and countries. Board games simplify complex issues and systems, which make them appropriate to further explore learning and concepts such as motivation and computational thinking in formal and informal settings. Furthermore, there is need to expand research on learning in commercial board games.

Gauthier, A., Kato, P. M., Bul, K. C. M., Dunwell, I., Walker-Clarke, A., & Lameras, P. (2018). Board games for health: A systematic literature review and meta-analysis. Games for Health Journal, 8(2), g4h.2018.0017. http://doi.org/10.1089/g4h.2018.0017

Nondigital board games are being used to engage players and impact outcomes in health and medicine across diverse populations and contexts. This systematic review and meta-analysis describes and summarizes their impact based on randomized and nonrandomized controlled trials. An electronic search resulted in a review of n = 21 eligible studies. Sample sizes ranged from n = 17 to n = 3110 (n = 6554 total participants). A majority of the board game interventions focused on education to increase health-related knowledge and behaviors (76%, n = 16). Outcomes evaluated included self-efficacy, attitudes/beliefs, biological health indicators, social functioning, anxiety, and executive functioning, in addition to knowledge and behaviors. Using the Cochrane Collaboration tool for assessing bias, most studies (52%, n = 11) had an unclear risk of bias (33% [n = 7] had a high risk and 14% [n = 3] had a low risk). Statistical tests of publication bias were not significant. A random-effects meta-analysis showed a large average effect of board games on health-related knowledge (d* = 0.82, 95% confidence interval; CI [0.15-1.48]), a small-to-moderate effect on behaviors (d* = 0.33, 95% CI [0.16-0.51]), and a small-to-moderate effect on biological health indicators (d* = 0.37, 95% CI [0.21-0.52]). The findings contribute to the literature on games and gamified approaches in healthcare. Future research efforts should aim for more consistent high scientific standards in their evaluation protocols and reporting methodologies to provide a stronger evidence base.

Villani, D., Carissoli, C., Triberti, S., Marchetti, A., Gilli, G., & Riva, G. (2018). Videogames for emotion regulation: A systematic review. Games for Health Journal, 7(2), 85–99. https://doi.org/10.1089/g4h.2017.0108

Introduction: Emotion regulation (ER) supports multiple individual functions and promotes mental health and wellbeing. Among the tools that may be used to help people in managing their affective states, videogames are reaching attention and are showing positive effects. Yet, little is known about their effectiveness. Objective: This study aims to assess the amount and quality of studies investigating the effects and modalities of the use of videogames for ER. Materials and Methods: A systematic literature search according to PRISMA guidelines was performed. Subsequently, according to expert advice other few studies have been added. Results: Twenty-three studies met the inclusion criteria and were included in the review; they can be categorized into three groups, namely (1) cross-sectional and qualitative studies, (2) experimental studies investigating the effects of videogame experience on ER and (3) ER intervention with serious games. Discussion: Discussion of the reviewed studies highlights that frequent gaming with commercial games offers more opportunities for ER improvement (related to gameplay and enjoyment of fictional properties) than limited-time experiences, such as those supported by bespoke serious games. This research area is still in its infancy and findings need to be interpreted with caution; furthermore, future reviews are encouraged to include clinical populations. Conclusion: Videogames offer several opportunities for ER and a challenge for educational and psychological interventions.

Wiederhold, B. K., & Riva, G. (2019). Virtual reality therapy: Emerging topics and future challenges. Cyberpsychology, Behavior, and Social Networking, 22(1), 3–6. https://doi.org/10.1089/cyber.2018.29136.bkw

Virtual reality (VR) is no longer a fantasy or a novelty to be used for pure entertainment. It is a technology that has, over the past three decades, taken hold and enriched multiple areas of science, most notably healthcare. Starting from these premises, this special issue will specifically investigate how VR and other important advanced technologies are being adopted and adapted for use in the healthcare field, with a specific focus toward the diagnosis and treatment of mental health disorders.

Zayeni, D., Raynaud, J.-P., & Revet, A. (2020). Therapeutic and preventive use of video games in child and adolescent psychiatry: A systematic review. Frontiers in Psychiatry, 11, 36. https://doi.org/10.3389/fpsyt.2020.00036

Background: Over the past decade, the use of commercial video games and serious games has developed in child and adolescent psychiatry. These games may become relevant alternatives or adjuncts to traditional psychotherapy, providing that their effectiveness is properly established. The purpose of this literature review was to evaluate the effectiveness of serious games and commercial video games in the treatment or prevention of psychiatric disorders in children and adolescents. Methods: Medline's database was used to search articles published between January 2012 and July 2019. The following keywords were used for this search: "Video games" OR "Active video game" OR "serious gaming" OR "Serious game" OR "Exergame" AND "Child mental disorder" OR "Adolescent" OR "Child" AND "Therapy" OR "Prevention". Only comparative studies which targeted interventions on children and adolescents suffering from psychiatric disorders were included. Results: Twenty-two studies, focusing on a wide range of psychiatric conditions, met our inclusion criteria's: 14 evaluated serious games and 8 commercial games. All studies were randomized controlled trials but only two studies compared the intervention game to psychotherapeutic gold standard; other studies used a no-intervention control group or an alternative game as the control group. Eighteen studies reported significant improvements on the symptoms and test scores targeted. Conclusion: Serious games and commercially available video games can be an effective trajectory for psychotherapy in child and adolescent psychiatry. However, there is a lack of longitudinal studies which assess the sustained effects of these games, and standards for proper evaluation of their effectiveness are missing.

Granic, I., Lobel, A., & Engels, R. C. M. E. (2014). The benefits of playing video games. The American Psychologist, 69(1), 66–78. http://doi.org/10.1037/a0034857

Video games are a ubiquitous part of almost all children's and adolescents' lives, with 97% playing for at least one hour per day in the United States. The vast majority of research by psychologists on the effects of "gaming" has been on its negative impact: the potential harm related to violence, addiction, and depression. We recognize the value of that research; however, we argue that a more balanced perspective is needed, one that considers not only the possible negative effects but also the benefits of playing these games. Considering these potential benefits is important, in part, because the nature of these games has changed dramatically in the last decade, becoming increasingly complex, diverse, realistic, and social in nature. A small but significant body of research has begun to emerge, mostly in the last five years, documenting these benefits. In this article, we summarize the research on the positive effects of playing video games, focusing on four main domains: cognitive, motivational, emotional, and social. By integrating insights from developmental, positive, and social psychology, as well as media psychology, we propose some candidate mechanisms by which playing video games may foster real-world psychosocial benefits. Our aim is to provide strong enough evidence and a theoretical rationale to inspire new programs of research on the largely unexplored mental health benefits of gaming. Finally, we end with a call to intervention researchers and practitioners to test the positive uses of video games, and we suggest several promising directions for doing so.

Ceranoglu, T. A. (2010). Star Wars in psychotherapy: Video games in the office. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 34(3), 233–6. http://doi.org/10.1176/appi.ap.34.3.233

Background: Video games (VGs) are increasingly becoming the pastime of choice for American youth. Recent US surveys indicate that up to 99% of adolescents play VGs regularly. Caregivers and clinicians are appropriately concerned about the effects of VGs on children’s well being. Adolescents'; play habits may expose them to negative effects associated with VG play on sleep. Methods: This article selectively reviews the literature documenting effects of video game play on sleep. A search of medical literature was carried out by using the keywords “video games” “computer games,” “sleep,” “mental health” and “adolescents.” Results: There is a small but growing body of literature examining the extent of VG play effects on sleep. Timing and duration of VG play are among the most significant circumstances that are associated with changes in sleep onset latency, total sleep duration and sleep efficiency. Findings on effects on sleep architecture are less consistent. Conclusions: VG play at night may lead to delay of sleep onset and interfere with sleep duration and efficiency. These effects appear to be particularly robust in children and young adolescents. Caregiver supervision is crucial in ensuring the appropriate use of VGs. Clinicians have a valuable opportunity to inform the public about these effects of VG play. More research focusing on mechanisms of these effects is needed.

Gentile, D. A., Bailey, K., Bavelier, D., Brockmyer, J. F., Cash, H., Coyne, S. M., … Young, K. (2017). Internet gaming disorder in children and adolescents. Pediatrics, 140(Suppl 2), S81–S85. http://doi.org/10.1542/peds.2016-1758H

The American Psychiatric Association recently included Internet gaming disorder (IGD) as a potential diagnosis, recommending that further study be conducted to help illuminate it more clearly. This paper is a summary of the review undertaken by the IGD Working Group as part of the 2015 National Academy of Sciences Sackler Colloquium on Digital Media and Developing Minds. By using measures based on or similar to the IGD definition, we found that prevalence rates range between ∼1% and 9%, depending on age, country, and other sample characteristics. The etiology of IGD is not well-understood at this time, although it appears that impulsiveness and high amounts of time gaming may be risk factors. Estimates for the length of time the disorder can last vary widely, but it is unclear why. Although the authors of several studies have demonstrated that IGD can be treated, no randomized controlled trials have yet been published, making any definitive statements about treatment impossible. IGD does, therefore, appear to be an area in which additional research is clearly needed. We discuss several of the critical questions that future research should address and provide recommendations for clinicians, policy makers, and educators on the basis of what we know at this time.

Eisenstadt, M., Liverpool, S., Infanti, E., Ciuvat, R. M., & Carlsson, C. (2021). Mobile apps that promote emotion regulation, positive mental health, and well-being in the general population: Systematic review and meta-analysis. JMIR Mental Health, 8(11). https://doi.org/10.2196/31170

Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=–0.24, 95% CI –0.34 to –0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs.

Sliwinski, J., Katsikitis, M., & Jones, C. M. (2017). A review of interactive technologies as support tools for the cultivation of mindfulness. Mindfulness, 8(5), 1150–1159. https://doi.org/10.1007/s12671-017-0698-x

This paper reviews interactive technological approaches to improve mindfulness and fills a gap in the literature by using technology to target aspects of mindfulness that are missing in scientific research. Interactive approaches to train mindfulness are presented and discussed in relation to Bergomi’s conceptual mindfulness model and Vago and Silbersweig’s neurobiological approach for cognitive, emotional, and behavioral processes. Based on existing interactive technologies, key design guidelines are developed to investigate the delivery of mindfulness by interactive media, including the design recommendations of personalization, gamification, and social features for the S-ART component intention and motivation; biofeedback training and narrative for emotion regulation; moral dilemmas, perspective taking, and cooperative design for prosociality; and explorative self-reflection, visualization and immersive feedback, and the integration of internal stimuli for self-transcendence. The paper recommends to apply a more extensive definition of mindfulness, which includes ethical and spiritual development. As a design premise for mindfulness technology, it is advised to strive for embodied experiences that adapt to the user’s internal state.

Pine, R., Fleming, T., McCallum, S., & Sutcliffe, K. (2020). The effects of casual videogames on anxiety, depression, stress, and low mood: A systematic review. Games for Health Journal, 9(4). https://doi.org/10.1089/g4h.2019.0132

Introduction: Despite the variety of available treatments for mental health symptoms, many individuals do not engage with treatment and among those who do, dropout rates are often high. Therefore, providing alternative opportunities to access treatment is imperative. Research interest in the therapeutic effects of digital mental health initiatives and serious games has grown in recent years, but the potential of simple, easy-to-use casual videogames (CVGs) that can be played in short bursts of time has seldom been considered. Objective: The objective of the present study is to provide a systematic review of the literature examining the effects of CVGs on treating anxiety, depression, stress, and low mood. Method: A systematic search was conducted, using the terms (casual gam* or casual videogam* or mini gam* or minigam* or mini-gam* or gamif*) and (mental health or anx* or depress* or stress or mood) and (study or trial or treatment or prescribed or prevention) as "Title," "s," "Keywords," or "Topic" words across all years. A Google search was also completed to check for articles that may have been missed. Results:N = 13 studies met inclusion criteria (no studies were added via the Google search). These studies reported findings for nine different CVGs, with six studies aimed at reducing anxiety, two examining effects for depression, and four investigating the effects of CVGs on treating stress or low mood. Promising effects were identified. Conclusion: CVGs may have promise for treating anxiety, depression, stress, and low mood.

Sauter, M., Braun, T., & Mack, W. (2021). Social context and gaming motives predict mental health better than time played: An exploratory regression analysis with over 13,000 video game players. Cyberpsychology, Behavior, and Social Networking, 24(2), 94–100. https://doi.org/10.1089/cyber.2020.0234

Video gaming has become massively adopted over the last years and Internet gaming disorder (IGD) has been noted as an increasing mental health problem. In this context, earlier studies focused on raw playtime (number of hours). Later studies also incorporated gaming motives while social contexts were not considered directly. Because social inclusion is one of the most powerful predictors of general mental health, in this study, we focused on the social context in which games are played. The sample consisted of 13,464 participants from 109 different countries, who played an average of ∼22 hours per week. Psychological well-being was assessed with the Satisfaction with Life Scale, the Generalized Anxiety Disorder 7 questionnaire, and the Social Phobia Inventory. We found that raw playtime is an uninformative predictor of a gamer's mental health and believe that earlier studies with smaller sample sizes may have overestimated its influence. Gaming motives (achievement and escapism, in particular) were generally found to be predictive. Of importance, the social context in which gamers play had large influence on their mental health and can potentially, in combination with the gaming motives, serve as a powerful predictor of clinically relevant at-risk groups in gaming.

Fitzgerald, M., & Ratcliffe, G. (2020). Serious games, gamification, and serious mental illness: A scoping review. Psychiatric Services, 71(2). https://doi.org/10.1176/appi.ps.201800567

Objective: The use of serious games and gamification to promote learning has a long history. More recently, serious games and gamification have been used in clinical settings to promote treatment and recovery. Yet there is little evidence to support their use with populations that experience serious mental illness. Methods: A scoping review was used to answer the following research question, What is the current state of knowledge about how games and gamification are used to promote treatment of serious mental illness? Scoping reviews clarify, define, and develop conceptual boundaries within a topic area. Twenty studies were identified and reviewed by using thematic content analysis. Results: A range of game types, formats, and technology were assessed. Six themes emerged from analysis. Serious games and the use of gamification to promote treatment have potential to engage persons with serious mental illness in game content and promote treatment outcomes. Game design that supported clear instruction, a coherent narrative, a smooth interface between mechanics and play, and service user involvement early in the process of game design were important for the successful promotion of engagement and learning. Games reviewed offered the opportunity for problem solving, collaboration, and goal-oriented activity that supported the delivery of therapeutic outcomes. Conclusions: The use of serious games and gamification to promote treatment of serious mental illness had high levels of feasibility and acceptability among both users and providers. The potential treatment value of games, however, is dependent on key features related to the games' design, operation, and rationale.

Archibald, M. M., & Gerber, N. (2018). Arts and mixed methods research: An innovative methodological merger. American Behavioral Scientist, 62(7), 956–977. https://doi.org/10.1177/0002764218772672

Abstract: Integrating the arts with mixed methods research (MMR) presents untapped potential for innovative methodological approaches. Arts and MMR integration exists on a continuum, ranging from low-level (e.g., communicating about MMR using art) to high-level integration (e.g., interweaving arts-based and MMR approaches), and myriad art forms are available to facilitate concept formation, data collection, analysis, and representation. Given that a primary objective of the arts and MMR respectively is to explore and understand the complex social world, arts–MMR integration has potential to enable insights not possible through the use of either approach in isolation, and to present new opportunities for transformative social change. In this article, we explore such potentials and intersections philosophically and methodologically by way of four case examples framed by the newly conceptualized Art-MMR Integration Continuum, which ranges from communicative, data source, analytic, and conceptual integration.

SELECTED INTERVENTIONS

Poppelaars, M., Lichtwarck-Aschoff, A., Otten, R., & Granic, I. (2021). Can a commercial video game prevent depression? null results and whole sample action mechanisms in a randomized controlled trial. Frontiers in Psychology, 11, 3674. https://doi.org/10.3389/FPSYG.2020.575962/BIBTEX

Depressive symptoms and disorders are major public health concerns, affecting many adolescents and young adults. Despite extensive research, depression prevention programs for youth show limited effectiveness. Moreover, the maximal potential of youth psychotherapy — on which depression prevention programs are based — may have been reached. Commercial video games may offer an engaging alternative vehicle for youth to practice emotional and social skills vital to mental health. The current study investigated the potential for the commercial video game Journey to prevent the exacerbation of depressive symptoms. A pre-registered randomized controlled trial tested the effectiveness of Journey as an indicated depression prevention approach compared to a control game condition and a passive control condition (Dutch Trial Register: NL4873, https://www.trialregister.nl/trial/4873). Additionally, potential action mechanisms for depression prevention using video games were examined. Participants aged 15 to 20 years old with elevated depressive symptoms (n = 244, Mage = 17.11, SDage = 1.76, 66.4% female) were given 4 weeks to play Journey (Mduration = 3 h 20 min) or the control game, Flower (Mduration = 2 h 36 min). Results showed no beneficial effects of playing the commercial video game, Journey, on youth’s change in depressive symptoms above and beyond the active and passive control conditions up to 12-months after the intervention. Additionally, no action mechanisms were found specifically for Journey. Nevertheless, over the whole study, participants decreased in depressive symptoms, became less sensitive to rejection, and experienced more hope and optimism. Moreover, participants who during the study decreased in rejection sensitivity or rumination or who increased in hope and optimism or in distraction and problem solving showed the strongest decrease in depressive symptoms. Although results do not support the use of the studied commercial game as an effective indicated depression prevention strategy, our results do suggest that rejection sensitivity, hope, optimism, rumination, distraction, and problem solving are promising targets for future depression prevention efforts. We conclude with important lessons for future research on games to promote mental health. Particularly, encouraging careful consideration of research designs to explore for whom and how potential action mechanisms and associated game mechanics may be effective.

Weerdmeester, J., Rooij, M. M. J. W. van, Maciejewski, D. F., Engels, R. C. M. E., & Granic, I. (2021). A randomized controlled trial assessing the efficacy of a virtual reality biofeedback video game: Anxiety outcomes and appraisal processes. Technology, Mind, and Behavior, 2(2). https://doi.org/10.1037/TMB0000028

This study assessed the efficacy of a virtual reality biofeedback video game (DEEP) in reducing anxiety symptoms. In addition, changes in engagement and cognitive appraisals including self-efficacy, locus of control, and threat-challenge appraisals were measured and it was explored how these factors related to anxiety regulation. Undergraduates with elevated anxiety symptoms (N = 112) were randomly assigned to four training sessions with DEEP or a smartphone-guided breathing application. Trait anxiety was measured at screening, pretest, posttest, and 3 months later. State anxiety was assessed before and after each session. In addition, engagement and appraisals were assessed in each session. Participants in both conditions showed a significant decrease in trait anxiety symptoms from pre- to posttest and this decrease remained stable at follow-up. Furthermore, all participants decreased in state anxiety from pre- to postsession, except for DEEP sessions that included exposure. DEEP users increased in self-efficacy and observed resources to cope throughout the training. In addition, DEEP users felt more engaged in initial sessions than those who used the control application, but their engagement decreased toward the final session. In contrast, participants in the control group showed no change in appraisals nor engagement. Taken together, results demonstrate the potential of digital interventions such as biofeedback games and guided relaxation applications as anxiety regulation tools and show that self-efficacy and threat-challenge appraisals in particular are potential mechanisms of change in biofeedback interventions.

Kou, Y., & Gui, X. (2020). Emotion regulation in esports gaming: A qualitative study of league of legends. Proceedings of the ACM on Human-Computer Interaction, 4(CSCW2). https://doi.org/10.1145/3415229

Today eSports gaming is enjoying growing popularity in the world and much attention from various research areas, including CSCW. eSports gaming is a highly competitive environment commonly associated with negative emotions such as anxiety and stress. However, little attention has been paid to emotion regulation in eSports gaming. In this study, we empirically investigated how players experience emotion and regulate emotions in League of Legends, one of the largest eSports games today. We identify four emotive factors, as well as emotion regulation strategies that players deploy to manage the emotions of their selves, teammates, and opponents. We further report on how they use emotion regulation in emotional self-care and emotional leadership. Building upon this set of findings, we discuss how the competitive eSports gaming context conditions emotion regulation in League of Legends, foreground emotion regulation expertise in competitive gaming, and derive implications for designing emotion regulation technologies.

Lobel, A., Gotsis, M., Reynolds, E., Annetta, M., Engels, R. C. M. E., & Granic, I. (2016). Designing and utilizing biofeedback games for emotion regulation. Proceedings of the 2016 CHI Conference Extended Abstracts on Human Factors in Computing Systems - CHI EA ’16, 07-12-May-, 1945–1951. https://doi.org/10.1145/2851581.2892521

Biofeedback games have the potential to make gaming a deeply personal experience by linking the gamespace to each player's physiological state. First, this paper describes the psycho-educational potential of the horror-themed biofeedback game Nevermind. In Nevermind, players' heart rate is continuously read into the game which in turn adapts to the player's momentary levels of negative affective arousal. Greater negative arousal causes the game and its horror-themed settings to become more disturbing. As a result, Nevermind challenges players to improve their emotion regulation skills by encouraging them to healthily down-regulate their negative affective states in the face of stressful situations. Second, Nevermind implements valuable design practices, practices which we share here. Finally, we describe a recent study conducted on 47 players. We discuss potential physiological metrics which may be useful for understanding how behaviors in the real world relate to those in biofeedback games like Nevermind. 

MEDIA:

THEORY OF MIND, EMPATHY, MENTALIZATION, PERSPECTIVE-TAKING

REVIEWS OF EVIDENCE & PERSPECTIVE

Carlson, S. M., Koenig, M. A., & Harms, M. B. (2013). Theory of mind. Wiley Interdisciplinary Reviews: Cognitive Science, 4(4), 391–402. http://doi.org/10.1002/wcs.1232

Theory of mind and its development has been a significantly important—and challenging—topic of research in cognitive science for three decades. This review summarizes our knowledge of when and how children come to understand their own and others' minds, including the developmental timetable, old and new measures, and foundational skills in infancy. We review recent research on theory-of-mind (ToM) and learning, that is, ways in which children's understanding of other minds informs how they learn about the world, as well as evidence for an important role of domain-general cognitive skills (executive function) in the development of ToM, and the neural networks that are most strongly implicated. Finally, we propose future directions for research in this vast and growing field.

Gallagher, S. (2014). In your face: Transcendence in embodied interaction. Frontiers in Human Neuroscience, 8, 495. http://doi.org/10.3389/fnhum.2014.00495

In cognitive psychology, studies concerning the face tend to focus on questions about face recognition, theory of mind (ToM) and empathy. Questions about the face, however, also fit into a very different set of issues that are central to ethics. Based especially on the work of Levinas, philosophers have come to see that reference to the face of another person can anchor conceptions of moral responsibility and ethical demand. Levinas points to a certain irreducibility and transcendence implicit in the face of the other. In this paper I argue that the notion of transcendence involved in this kind of analysis can be given a naturalistic interpretation by drawing on recent interactive approaches to social cognition found in developmental psychology, phenomenology, and the study of autism.

Wellman, H. M. (2017). The development of Theory of Mind: Historical reflections. Child Development Perspectives, 11(3), 207–214. https://doi.org/10.1111/cdep.12236

In this article, I reflect on theory of mind as a field, including how it arose and how it developed. My research has been intertwined with this process; beginning right out of graduate school, my career developed along with the field, and I contributed to the field and its development at various points. So this essay also traces my path as I strived, and still strive, to understand how theory of mind begins and unfolds in human development, what forces shape that development, and what accounts best explain the timetables and progressions of theory-of-mind understandings in humans. I end with my sense of where theory-of-mind research is likely to head in the near future.

Heyes, C. (2018). Empathy is not in our genes. Neuroscience & Biobehavioral Reviews, 95, 499–507. https://doi.org/10.1016/j.neubiorev.2018.11.001

In academic and public life empathy is seen as a fundamental force of morality – a psychological phenomenon, rooted in biology, with profound effects in law, policy, and international relations. But the roots of empathy are not as firm as we like to think. The matching mechanism that distinguishes empathy from compassion, envy, schadenfreude, and sadism is a product of learning. Here I present a dual system model that distinguishes Empathy1, an automatic process that catches the feelings of others, from Empathy2, controlled processes that interpret those feelings. Research with animals, infants, adults and robots suggests that the mechanism of Empathy1, emotional contagion, is constructed in the course of development through social interaction. Learned Matching implies that empathy is both agile and fragile. It can be enhanced and redirected by novel experience, and broken by social change.

Schrier, K., & Farber, M. (2021). A systematic literature review of ‘empathy’ and ‘games.’ Journal of Gaming & Virtual Worlds, 13(2), 195–214. https://doi.org/10.1386/jgvw_00036_1

Scholarship on the intersection of games and empathy is limited. However, over the past decade peer-reviewed articles have started to be published in this area. This study investigates this emerging scholarship on empathy and games to understand how researchers are describing, defining and communicating their work. For example, how are research articles about games defining empathy? From which disciplines are the researchers framing their studies? Which types of games are being used in the investigations? Forty-nine articles were found, coded and analysed by searching six different databases. For this investigation, each article was analysed based on the discipline, keyword(s) used to find the article, definition(s) of empathy used, types of games used in the article and the themes used in the article. Articles emerged from twelve different disciplines and described over thirteen different types of empathy. Findings were shared, as well as recommendations for researchers studying this area.

Nakamura, L. (2020). Feeling good about feeling bad: Virtuous virtual reality and the automation of racial empathy. Journal of Visual Culture, 19(1), 47–64. https://doi.org/10.1177/1470412920906259

Virtual reality (VR)’s newly virtuous identity as the ‘ultimate empathy machine’ arrives during an overtly xenophobic, racist, misogynist, and Islamophobic moment in the US and abroad. Its rise also overlaps with the digital industries’ attempts to defend themselves against increasingly vocal critique. VR’s new identity as an anti-racist and anti-sexist technology that engineers the right kind of feeling has emerged to counter and manage the image of the digital industries as unfeeling and rapacious. In this article, the author engages with VR titles created by white and European producers that represent the lives of black and Middle Eastern women and girls in Lebanon, Nairobi, and Paris. She argues that the invasion of personal and private space that documentary VR titles ‘for good’ create is a spurious or ‘toxic empathy’ that enables white viewers to feel that they have experienced authentic empathy for these others, and this digitally mediated compassion is problematically represented in multiple media texts as itself a form of political activism.

Tone, E. B., & Tully, E. C. (2014). Empathy as a “risky strength”: A multilevel examination of empathy and risk for internalizing disorders. Development and Psychopathology, 26(4pt2), 1547–1565. https://doi.org/10.1017/S0954579414001199

Learning to respond to others' distress with well-regulated empathy is an important developmental task linked to positive health outcomes and moral achievements. However, this important interpersonal skill set may also confer risk for depression and anxiety when present at extreme levels and in combination with certain individual characteristics or within particular contexts. The purpose of this review is to describe an empirically grounded theoretical rationale for the hypothesis that empathic tendencies can be “risky strengths.” We propose a model in which typical development of affective and cognitive empathy can be influenced by complex interplay among intraindividual and interindividual moderators that increase risk for empathic personal distress and excessive interpersonal guilt. These intermediate states in turn precipitate internalizing problems that map onto empirically derived fear/arousal and anhedonia/misery subfactors of internalizing disorders. The intraindividual moderators include a genetically influenced propensity toward physiological hyperarousal, which is proposed to interact with genetic propensity to empathic sensitivity to contribute to neurobiological processes that underlie personal distress responses to others' pain or unhappiness. This empathic personal distress then increases risk for internalizing problems, particularly fear/arousal symptoms. In a similar fashion, interactions between genetic propensities toward negative thinking processes and empathic sensitivity are hypothesized to contribute to excess interpersonal guilt in response to others' distress. This interpersonal guilt then increases the risk for internalizing problems, especially anhedonia/misery symptoms. Interindividual moderators, such as maladaptive parenting or chronic exposure to parents' negative affect, further interact with these genetic liabilities to amplify risk for personal distress and interpersonal guilt as well as for consequent internalizing problems. Age-related increases in the heritability of depression, anxiety, and empathy-related constructs are consistent with developmental shifts toward greater influence of intraindividual moderators throughout childhood and adolescence, with interindividual moderators exerting their greatest influence during early childhood. Efforts to modulate neurobiological and behavioral expressions of genetic dysregulation liabilities and to promote adaptive empathic skills must thus begin early in development.

Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA, 286(15), 1897. https://doi.org/10.1001/jama.286.15.1897

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.

SELECTED INTERVENTIONS

Twemlow, S. W., Fonagy, P., & Sacco, F. C. (2005). A developmental approach to mentalizing communities: II. The Peaceful Schools experiment. Bulletin of the Menninger Clinic, 69(4), 282–304. http://doi.org/10.1521/bumc.2005.69.4.282

This paper summarizes a theoretical argument for the use of a mentalization-based approach to the systemic problem of school bullying. The Peaceful Schools Project of the Menninger Department of Psychiatry, Baylor College of Medicine, is an experimental test of this model. Data is presented from a randomized controlled trial of this intervention in nine elementary schools in the Midwest.

Kandalaft, M. R., Didehbani, N., Krawczyk, D. C., Allen, T. T., & Chapman, S. B. (2013). Virtual reality social cognition training for young adults with high-functioning autism. Journal of Autism and Developmental Disorders, 43, 34–44. http://doi.org/10.1007/s10803-012-1544-6

Few evidence-based social interventions exist for young adults with high-functioning autism, many of whom encounter significant challenges during the transition into adulthood. The current study investigated the feasibility of an engaging Virtual Reality Social Cognition Training intervention focused on enhancing social skills, social cognition, and social functioning. Eight young adults diagnosed with high-functioning autism completed 10 sessions across 5 weeks. Significant increases on social cognitive measures of theory of mind and emotion recognition, as well as in real life social and occupational functioning were found post-training. These findings suggest that the virtual reality platform is a promising tool for improving social skills, cognition, and functioning in autism.

Cebolla, A., Herrero, R., Ventura, S., Miragall, M., Bellosta-Batalla, M., Llorens, R., & Baños, R. M. (2019). Putting oneself in the body of others: A pilot study on the efficacy of an embodied virtual reality system to generate self-compassion. Frontiers in Psychology, 10(JULY). https://doi.org/10.3389/fpsyg.2019.01521

Compassion-based interventions (CBIs) have been shown to be effective for increasing empathy and compassion, and reducing stress, anxiety, and depression. CBIs are based on constructive meditations where imagery abilities are essential. One of the major difficulties that participants report during the training is the difficulty related to imagery abilities. Virtual reality (VR) can be a useful tool to overcome this limitation because it can facilitate the construction and sustainment of mental images. The machine to be another (TMTBA) uses multi-sensory stimulation to induce a body swap illusion. This system allows participants to see themselves from a third perspective and have the illusion of touching themselves from outside. The main objective of the present study was to analyze the efficacy of a self-compassion meditation procedure based on the TMTBA system versus the usual meditation procedure (CAU) in increasing positive affect states, mindful self-care, and adherence to the practice, and explore the influence of imagery abilities as moderators of the effects of the condition on adherence. A sample of 16 participants were randomly assigned to two conditions: TMTBA-VR and CAU. All participants had to listen to an audio meditation about self-compassion and answer questionnaires before and after the training. The TMTBA-VR condition also had a body swap experience at the end of the meditation while listening to self-compassionate messages. Afterward, they were invited to practice this meditation for 2 weeks and then measured again. After the compassion practice, both conditions significantly increased positive qualities toward self/others, decreased negative qualities toward self, and increased awareness and attention to mental events and bodily sensations, with no differences between the conditions. After 2 weeks, both conditions showed a similar frequency of meditation practice and increases in specific types of self-care behaviors, with the frequency of clinical self-care behaviors being significantly higher in TMTBA. Finally, lower imagery ability in the visual and cutaneous modality were moderators of the efficacy of the TMTBA (vs. CAU) condition in increasing adherence to the practice. Embodied VR could be an interesting tool to facilitate and increase the efficacy of CBIs by facilitating the construction of positive and powerful mental images.

Dishon, G., & Kafai, Y. B. (2020). Making more of games: Cultivating perspective-taking through game design. Computers & Education, 148(January), 103810. https://doi.org/10.1016/j.compedu.2020.103810

Perspective-taking – the consideration of others' mental states and subjective experiences – has been acknowledged as a vital component of interpersonal interactions and communication across divergent social groups. Yet, perspective-taking is neither simple nor automatic; it requires motivation and practice. Though still a nascent area of research, video games have been presented as means of engaging students in perspective-taking due to their immersive and interactive nature. We offer to expand this view and examine the relevance of game design to perspective-taking. Introducing a multiple-case exploratory case study of two groups' work in a game design workshop conducted with high school freshmen, we examine three facets of game design that position this practice as a potentially fruitful context for cultivating perspective-taking: (i) game design is other-oriented – games are created with the intent of being used by others – and hence could elicit motivation to analyze one's work from the perspective of future players; (ii) games are an interactive activity that can be pursued over short periods of time, in public, allowing designers to receive immediate feedback via playtesting sessions; (iii) as game design entails translating abstract insights concerning users' experiences to concrete design decisions, games can function as “objects-to-think-with” in the case of perspective-taking.

Peña, J., Hernández Pérez, J. F., Khan, S., & Cano Gómez, Á. P. (2018). Game perspective-taking effects on players’ behavioral intention, attitudes, subjective norms, and self-efficacy to help immigrants: The case of “Papers, Please.” Cyberpsychology, Behavior, and Social Networking, 21(11), 687–693. https://doi.org/10.1089/cyber.2018.0030

This study expands on game character perspective-taking effects on political opinions while controlling for players' social dominance orientation or inclination for inequality among social groups. Random assignment to play a game as an immigration inspector decreased intention, subjective norms, and self-efficacy to help immigrants relative to baseline scores. The scores of participants randomly assigned to play a game similar in style but instead featuring the role of a newspaper editor remained unchanged. Within-subjects effects implied that baseline reductions in intention, subjective norms, and self-efficacy to help immigrants were solely attributed to playing games as game immigration inspectors. The study provides initial evidence that taking on the perspective of game characters can influence players' opinions about political issues, such as immigration.

Barreda-Ángeles, M., Aleix-Guillaume, S., & Pereda-Baños, A. (2020). An “empathy machine” or a “just-for-the-fun-of-it” machine? Effects of immersion in nonfiction 360-video stories on empathy and enjoyment. Cyberpsychology, Behavior, and Social Networking, 23(10), 683–688. https://doi.org/10.1089/cyber.2019.0665

Immersive storytelling is widely considered to have a great potential to foster empathy toward suffering people, as well as to provide enjoyable experiences able to attract wider audiences. This article examines how the immersive presentation of 360-video nonfiction contents impacts both empathy toward the characters and enjoyment of the experience and the interplay between these two psychological outcomes. Participants watched a series of 360-video stories presented either on a virtual reality headset or a screen, and measures of spatial presence, empathy (in terms of perspective taking and empathic concern), and enjoyment were collected. Mediation analyses and structural equation models showed a direct positive effect of spatial presence on perspective taking and empathic concern, and an indirect negative effect of immersive presentation on empathic concern through enjoyment. These findings indicate that enjoyment of pleasurable aspects of the experience may hinder the affective dimension of empathy toward the characters, and point out to the need to carefully consider the targeted reactions from the audience, since different intended psychological outcomes may not be fully compatible.

Koch, S. C., Mehl, L., Sobanski, E., Sieber, M., & Fuchs, T. (2015). Fixing the mirrors: A feasibility study of the effects of dance movement therapy on young adults with autism spectrum disorder. Autism, 19(3), 338–350. https://doi.org/10.1177/1362361314522353

From the 1970s on, case studies reported the effectiveness of therapeutic mirroring in movement with children with autism spectrum disorder. In this feasibility study, we tested a dance movement therapy intervention based on mirroring in movement in a population of 31 young adults with autism spectrum disorder (mainly high-functioning and Asperger’s syndrome) with the aim to increase body awareness, social skills, self–other distinction, empathy, and well-being. We employed a manualized dance movement therapy intervention implemented in hourly sessions once a week for 7 weeks. The treatment group (n = 16) and the no-intervention control group (n = 15) were matched by sex, age, and symptom severity. Participants did not participate in any other therapies for the duration of the study. After the treatment, participants in the intervention group reported improved well-being, improved body awareness, improved self–other distinction, and increased social skills. The dance movement therapy–based mirroring approach seemed to address more primary developmental aspects of autism than the presently prevailing theory-of-mind approach. Results suggest that dance movement therapy can be an effective and feasible therapy approach for autism spectrum disorder, while future randomized control trials with bigger samples are needed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Ramirez, E. J., Elliott, M., & Milam, P.-E. (2021). What it’s like to be a _____: Why it’s (often) unethical to use VR as an empathy nudging tool. Ethics and Information Technology, 23(3), 527–542. https://doi.org/10.1007/s10676-021-09594-y

In this article, we apply the literature on the ethics of choice-architecture (nudges) to the realm of virtual reality (VR) to point out ethical problems with using VR for empathy-based nudging. Specifically, we argue that VR simulations aiming to enhance empathic understanding of others via perspective-taking will almost always be unethical to develop or deploy. We argue that VR-based empathy enhancement not only faces traditional ethical concerns about nudges (autonomy, welfare, transparency), but also a variant of the semantic variance problem that arises for intersectional perspective-taking. VR empathy simulations deceive and manipulate their users about their experiences. Despite their often laudable goals, such simulations confront significant ethical challenges. In light of these goals and challenges, we propose VR designers shift from designing simulations aimed at producing empathic perspective-taking to designing simulations aimed at generating sympathy for their targets. These simulations, we claim, can avoid the most serious ethical issues associated with VR nudges, semantic variance, and intersectionality.

Lara, F., & Rueda, J. (2021). Virtual Reality Not for “Being Someone” but for “Being in Someone Else’s Shoes”: Avoiding Misconceptions in Empathy Enhancement. Frontiers in Psychology, 12, 741516. https://doi.org/10.3389/fpsyg.2021.741516

In this article, we show that Ramirez et al.'s ethical rejection of empathy enhancement through VR is based on confusion. First, we show that this misunderstanding stems from the conception of empathy-enhancing simulations solely as failed attempts at “being someone else,” along with ignoring the crucial difference between the psychological perspective-taking processes of imagine-other and imagine-self. Then, having overcome that misconception, we argue that the ethical misgivings about the use of VR to promote empathy should disappear and that these projects have greater potential for behavioural change than purely sympathy-focused interventions.

MEDIA:

NEUROPLASTICITY & COGNITIVE-MOTOR REHABILITATION

REVIEWS OF EVIDENCE & PERSPECTIVE

Koch, I., Poljac, E., Müller, H., & Kiesel, A. (2018). Cognitive structure, flexibility, and plasticity in human multitasking—An integrative review of dual-task and task-switching research. Psychological Bulletin, 144(6), 557–583. http://doi.org/10.1037/bul0000144

Numerous studies showed decreased performance in situations that require multiple tasks or actions relative to appropriate control conditions. Because humans often engage in such multitasking activities, it is important to understand how multitasking affects performance. In the present article, we argue that research on dual-task interference and sequential task switching has proceeded largely separately using different experimental paradigms and methodology. In our article we aim at organizing this complex set of research in terms of three complementary research perspectives on human multitasking. One perspective refers to structural accounts in terms of cognitive bottlenecks (i.e., critical processing stages). A second perspective refers to cognitive flexibility in terms of the underlying cognitive control processes. A third perspective emphasizes cognitive plasticity in terms of the influence of practice on human multitasking abilities. With our review article we aimed at highlighting the value of an integrative position that goes beyond isolated consideration of a single theoretical research perspective and that broadens the focus from single experimental paradigms (dual task and task switching) to favor instead a view that emphasizes the fundamental similarity of the underlying cognitive mechanisms across multitasking paradigms.

Ghai, S., Ghai, I., & Effenberg, A. O. (2017). Effects of dual tasks and dual-task training on postural stability: A systematic review and meta-analysis. Clinical Interventions in Aging, 12, 557–577. http://doi.org/10.2147/CIA.S125201

The use of dual-task training paradigm to enhance postural stability in patients with balance impairments is an emerging area of interest. The differential effects of dual tasks and dual-task training on postural stability still remain unclear. A systematic review and meta-analysis were conducted to analyze the effects of dual task and training application on static and dynamic postural stability among various population groups. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, from inception until June 2016, on the online databases Scopus, PEDro, MEDLINE, EMBASE, and SportDiscus. Experimental studies analyzing the effects of dual task and dual-task training on postural stability were extracted, critically appraised using PEDro scale, and then summarized according to modified PEDro level of evidence. Of 1,284 records, 42 studies involving 1,480 participants met the review’s inclusion criteria. Of the studies evaluating the effects of dual-task training on postural stability, 87.5% of the studies reported significant enhancements, whereas 30% of the studies evaluating acute effects of dual tasks on posture reported significant enhancements, 50% reported significant decrements, and 20% reported no effects. Meta-analysis of the pooled studies revealed moderate but significant enhancements of dual-task training in elderly participants (95% CI: 1.16-2.10) and in patients suffering from chronic stroke (-0.22 to 0.86). The adverse effects of complexity of dual tasks on postural stability were also revealed among patients with multiple sclerosis (-0.74 to 0.05). The review also discusses the significance of verbalization in a dual-task setting for increasing cognitive-motor interference. Clinical implications are discussed with respect to practical applications in rehabilitation settings.

Rizzo, A., Requejo, P., Winstein, C. J., Lange, B., Ragusa, G., Merians, A., … Aisen, M. (2011). Virtual reality applications for addressing the needs of those aging with disability. Studies in Health Technology and Informatics, 163, 510–6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21335848

As persons with disabilities age, progressive declines in health and medical status can challenge the adaptive resources required to maintain functional independence and quality of life [1]. These challenges are further compounded by economic factors, medication side effects, loss of a spouse or caregiver, and psychosocial disorders [1-2]. With the gradual loss of functional independence and increased reliance on others for transportation, access to general medical and rehabilitation care can be jeopardized [2]. The combination of these factors when seen in the context of the average increase in lifespan in industrialized societies has lead to a growing crisis that is truly global in proportion. While research indicates that functional motor capacity can be improved, maintained, or recovered via consistent participation in a motor exercise and rehabilitation regimen [3], independent adherence to such preventative and/or rehabilitative programming outside the clinic setting is notoriously low [1]. This state of affairs has produced a compelling and ethical motivation to address the needs of individuals who are aging with disabilities by promoting home-based access to low-cost, interactive virtual reality (VR) systems designed to engage and motivate individuals to participate with "game"-driven physical activities and rehabilitation programming. The creation of such systems could serve to enhance, maintain and rehabilitate the sensorimotor processes that are needed to maximize independence and quality of life.

Glegg, S. M. N., & Levac, D. E. (2018). Barriers, facilitators and interventions to support virtual reality implementation in rehabilitation: A scoping review. In PM and R (Vol. 10, Issue 11, pp. 1237-1251.e1). Elsevier Inc. https://doi.org/10.1016/j.pmrj.2018.07.004

Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation-specific VR/AVG systems. Given clinicians’ eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self-reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end-user needs more effectively, competency development for end-users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers. Level of Evidence: IV

Valenzuela, T., Okubo, Y., Woodbury, A., Lord, S. R., & Delbaere, K. (2018). Adherence to Technology-Based Exercise Programs in Older Adults. Journal of Geriatric Physical Therapy, 41(1), 49–61. http://doi.org/10.1519/JPT.0000000000000095

Exercise participation and adherence in older people is often low. The integration of technology-based exercise programs may have a positive effect on adherence as they can overcome perceived barriers to exercise. Previous systematic reviews have shown preliminary evidence that technology-based exercise programs can improve physical functioning. However, there is currently no in-depth description and discussion of the potential this technology offers to improve exercise adherence in older people. This review examines the literature regarding older adults’ acceptability and adherence to technology-based exercise interventions.

Plummer, P., Zukowski, L. A., Giuliani, C., Hall, A. M., & Zurakowski, D. (2015). Effects of physical exercise interventions on gait-related dual-task interference in older adults: A systematic review and meta-analysis. Gerontology, 62(1), 94–117. http://doi.org/10.1159/000371577

Dual-task interference during walking can substantially limit mobility and increase the risk of falls among community-dwelling older adults. Previous systematic reviews examining intervention effects on dual-task gait and mobility have not assessed relative dual-task costs (DTC) or investigated whether there are differences in treatment-related changes based on the type of dual task or the type of control group. The purpose of this systematic review was to examine the effects of physical exercise interventions on dual-task performance during walking in older adults. A meta-analysis of randomized controlled trials (RCTs) compared treatment effects between physical exercise intervention and control groups on single- and dual-task gait speed and relative DTC on gait speed. A systematic search of the literature was conducted using the electronic databases PubMed, CINAHL, EMBASE, Web of Science, and PsycINFO searched up to September 19, 2014. Randomized, nonrandomized, and uncontrolled studies published in English and involving older adults were selected. Studies had to include a physical exercise intervention protocol and measure gait parameters during continuous, unobstructed walking in single- and dual-task conditions before and after the intervention. Of 614 abstracts, 21 studies met the inclusion criteria and were included in the systematic review. Fourteen RCTs were included in the meta-analysis. The mean difference between the intervention and control groups significantly favored the intervention for single-task gait speed (mean difference: 0.06 m/s, 95% CI: 0.03, 0.10, p < 0.001), dual-task gait speed (mean difference: 0.11 m/s, 95% CI 0.07, 0.15, p < 0.001), and DTC on gait speed (mean difference: 5.23%, 95% CI 1.40, 9.05, p = 0.007). Evidence from subgroup comparisons showed no difference in treatment-related changes between cognitive-motor and motor-motor dual tasks, or when interventions were compared to active or inactive controls. In summary, physical exercise interventions can improve dual-task walking in older adults primarily by increasing the speed at which individuals walk in dual-task conditions. Currently, evidence concerning whether physical exercise interventions reduce DTC or alter the self-selected dual-task strategy during unobstructed walking is greatly lacking, mainly due to the failure of studies to measure and report reciprocal dual-task effects on the non-gait task.

Law, L. L. F., Barnett, F., Yau, M. K., & Gray, M. A. (2014). Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: A systematic review. Ageing Research Reviews, 15, 61–75. http://doi.org/10.1016/J.ARR.2014.02.008

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.

Simons, D. J., Boot, W. R., Charness, N., Gathercole, S. E., Chabris, C. F., Hambrick, D. Z., & Stine-Morrow, E. A. L. (2016). Do “Brain-Training” Programs Work? Psychological Science in the Public Interest, 17(3), 103–186. http://doi.org/10.1177/1529100616661983

In 2014, two groups of scientists published open letters on the efficacy of brain-training interventions, or “brain games,” for improving cognition. The first letter, a consensus statement from an international group of more than 70 scientists, claimed that brain games do not provide a scientifically grounded way to improve cognitive functioning or to stave off cognitive decline. Several months later, an international group of 133 scientists and practitioners countered that the literature is replete with demonstrations of the benefits of brain training for a wide variety of cognitive and everyday activities. How could two teams of scientists examine the same literature and come to conflicting “consensus” views about the effectiveness of brain training?

In part, the disagreement might result from different standards used when evaluating the evidence. To date, the field has lacked a comprehensive review of the brain-training literature, one that examines both the quantity and the quality of the evidence according to a well-defined set of best practices. This article provides such a review, focusing exclusively on the use of cognitive tasks or games as a means to enhance performance on other tasks. We specify and justify a set of best practices for such brain-training interventions and then use those standards to evaluate all of the published peer-reviewed intervention studies cited on the websites of leading brain-training companies listed on Cognitive Training Data (www.cognitivetrainingdata.org), the site hosting the open letter from brain-training proponents. These citations presumably represent the evidence that best supports the claims of effectiveness.

Based on this examination, we find extensive evidence that brain-training interventions improve performance on the trained tasks, less evidence that such interventions improve performance on closely related tasks, and little evidence that training enhances performance on distantly related tasks or that training improves everyday cognitive performance. We also find that many of the published intervention studies had major shortcomings in design or analysis that preclude definitive conclusions about the efficacy of training, and that none of the cited studies conformed to all of the best practices we identify as essential to drawing clear conclusions about the benefits of brain training for everyday activities. We conclude with detailed recommendations for scientists, funding agencies, and policymakers that, if adopted, would lead to better evidence regarding the efficacy of brain-training interventions.

Thabrew, H., Stasiak, K., Garcia-Hoyos, V., & Merry, S. N. (2016). Game for health: How eHealth approaches might address the psychological needs of children and young people with long-term physical conditions. Journal of Paediatrics and Child Health, 52(11), 1012–1018. http://doi.org/10.1111/jpc.13271

AIM The aim of this study was to describe the psychological experiences of children and young people with long term physical conditions, their families and clinicians and to explore if these may be improved using eHealth interventions, including online information, support and e-therapy. METHODS Totally 11 children (7-12 years), 11 young people (13-18 years), 7 parents, 11 paediatricians and 10 general practitioners participated in a series of seven semi-structured digitally recorded focus groups. A general inductive approach was used to analyse interview data. RESULTS Feedback consisted of five main themes: (i) the experience of long-term physical conditions as an anxiety-provoking journey, (ii) limited access to information and eHealth-related interventions to support this journey, (iii) desires for interventions that assist with multiple aspects of the illness experience, (iv) diversity of preferences regarding the format and vehicle of such interventions, (v) the importance of trust regarding the source of interventions for children, young people and families and the sustainability of new interventions for clinicians. CONCLUSIONS eHealth interventions are currently being used in a limited manner by children and young people with long-term physical conditions and their families. Despite some concern expressed mainly by clinicians, there is overall support from all groups for the future development of eHealth interventions to address psychological issues for this audience, particularly anxiety. Relatable content, technological appeal and ease of access/referral to such interventions are likely to improve the uptake of these relatively new interventions.

Bayón-Calatayud, M., Peri, E., Nistal, F. F., Duff, M., Nieto-Escámez, F., Lange, B., & Koenig, S. (2016). Virtual Rehabilitation. In Biosystems & Biorobotics (Vol. 10, pp. 303–318). http://doi.org/10.1007/978-3-319-24901-8_12

Foundational chapter on virtual rehab technologies, opportunities and challenges written in a very accessible format. For a more detailed view into specific conditions see the other book chapters here: http://link.springer.com/book/10.1007/978-3-319-24901-8

SELECTED INTERVENTIONS

Finley, J. M., Gotsis, M., Lympouridis, V., Jain, S., Kim, A., & Fisher, B. E. B. E. (2021). Design and development of a virtual reality-based mobility training game for people with Parkinson’s disease. Frontiers in Neurology, 11, 1692. https://doi.org/10.3389/fneur.2020.577713

People with Parkinson's disease (PD) commonly have gait impairments that reduce their ability to walk safely in the community. These impairments are characterized, in part, by a compromised ability to turn and negotiate both predictable and unpredictable environments. Here, we describe the development and usability assessment of a virtual reality training application, Wordplay VR , that allows people with PD to practice skills such as turning, obstacle avoidance, and problem-solving during over-ground walking in a game-based setting. Nine people with PD completed three sessions with Wordplay VR , and each session was directed by their personal physical therapist. Our outcome measures included perceived sense of presence measured using the International Test Commission–Sense of Presence Inventory (ITC-SOPI), levels of motivation using the Intrinsic Motivation Inventory (IMI), overall system usability using the System Usability Scale (SUS), and setup time by the physical therapists. Both the people with PD and the physical therapists rated their sense of presence in the training system positively. The system received high ratings on the interest and value subscales of the IMI, and the system was also rated highly on usability, from the perspective of both the patient during gameplay and the therapist while controlling the experience. These preliminary results suggest that the application and task design yielded an experience that was motivating and user-friendly for both groups. Lastly, with repeated practice over multiple sessions, therapists were able to reduce the time required to help their patients don the headset and sensors and begin the training experience. 

Weerdmeester, J., Cima, M., Granic, I., Hashemian, Y., & Gotsis, M. (2016). A feasibility study on the effectiveness of a full-body videogame intervention for decreasing attention deficit hyperactivity disorder symptoms. Games for Health Journal, 5(4), 258–269. http://doi.org/10.1089/g4h.2015.0103

The current study assessed the feasibility and effectiveness of a full-body-driven intervention videogame targeted at decreasing attention deficit hyperactivity disorder (ADHD) symptoms, specifically inattention, hyperactivity, impulsivity, and motor deficiency. Materials and Methods: The game was tested in a Dutch sample (N = 73) of school-aged children with elevated ADHD symptoms. Children assigned to the intervention condition played “Adventurous Dreaming Highflying Dragon,” and those in the control condition played a comparable full-body-driven game without ADHD-focused training components. Games were played during six 15-minute sessions. Outcomes were teacher-rated ADHD symptoms and scores on neuropsychological tasks assessing motor skills, impulsivity, and sustained attention. There was some indication of greater improvement in the intervention group in comparison to the control group in terms of teacher-rated ADHD symptoms.

Gotsis, M., Lympouridis, V., Requejo, P., Haubert, L. L., Poulos, I. C., Frangoudes, F., … Jordan-Marsh, M. (2014). Skyfarer: Design case study of a mixed reality rehabilitation video game. In A. Marcus (Ed.), HCI International 2014 (pp. 699–710). Crete, Greece: Springer Berlin Heidelberg. http://doi.org/10.1007/978-3-319-07626-3_66

This paper outlines a design case study for Skyfarer, a mixed reality rehabilitation application developed for upper body exercise of individuals aging with disability. We describe how experience, experiential and participatory design methodologies were combined to develop a game, which was publicly exhibited at IEEE VR and ACM SIGGRAPH, and formally evaluated in a biomechanical study at Rancho Los Amigos National Rehabilitation Center RLANRC.

Rhythm & Dance Games: A K-12 Curriculum Guide for Ages 7+ (2018). Permanent link: http://scalar.usc.edu/works/curriculum-guide-for-rhythm-and-dance-games/index

These rhythm and dance games were originally developed in Transdisciplinary Media Design Practicum, a course which took place at the University of Southern California in Fall 2017 on the topics of “Interactivity, Play, Choreography & Neuroplasticity.” The class was a collaboration between the School of Cinematic Arts (taught by Professor Marientina Gotsis) and the Glorya Kaufman School of Dance (taught by Professor Thomas McManus), with students from multiple schools. The goal of the class was to explore and develop interactive interventions (such as digital or non-digital games) for a K-12 setting based on William Forsythe’s ‘Red Yellow Blue Green’ (RYBG) movement/vocal system, which could particularly benefit children and adolescents with developmental disorders as well as a general student population.

The interactive interventions developed in this course were transdisciplinary in nature and was informed by multiple areas of study. To this end, a number of guest lecturers shared their perspectives with students during development. The range of backgrounds of the guests helped instruct our approaches to the use of dance and play to engage cognitive functions. The final results of these workshops and efforts were interactive variations on RYBG which are intended to stimulate the participant physically and neurologically.

END-OF-LIFE, PALLIATIVE CARE, THANATOLOGY

Puri, S. (2019). That good night: Life and medicine in the eleventh hour. Penguin Books. (requested in ARES Course Reserve)

One of my favorite books on palliative care. “Puri writes about how palliative care specialists are working to change medicine from within—teaching other doctors how to talk to patients about their hopes and fears, not just their disease and treatment.”—NPR

“Sunita Puri’s luminous, lyrical memoir is a literary introduction to the work of palliative care…Her stories, combined with her sense that we’re guided by a benevolent force beyond comprehension, point toward love’s power and life’s fragility.”—THE CHRISTIAN CENTURY

Kaptelinin, V. (2018). Technology and the givens of existence: Toward an existential inquiry framework in HCI research. Conference on Human Factors in Computing Systems - Proceedings, 2018-April, 1–14. https://doi.org/10.1145/3173574.3173844

The profound impact of digital technologies on human life makes it imperative for HCI research to deal with the most fundamental aspects of human existence. Arguably, insights from existential philosophy and psychology are highly relevant for addressing such issues. Building on previous attempts to bring in existential themes and terminology to HCI, this paper argues that Yalom's notion of "the givens of existence", as well as related work in experimental existential psychology, can inform the development of an existential inquiry framework in HCI. The envisioned framework is intended to complement current approaches in HCI by specifically focusing on the existential aspects of the design and use of technology. The paper reflects on possible ways, in which existential concepts can support HCI research, and maintains that adopting an existential framework in HCI would be consistent with the overall conceptual development of the field.

Massimi, M. (2014). Stories from my thanatosensitive design process. Interactions, 21(1), 47–49. http://doi.org/10.1145/2543489

Reflections on working with the bereaved.

Gibbs, M., Kohn, T., Mori, J., & Arnold, M. (2012). Tombstones, uncanny monuments and epic quests: Memorials in World of Warcraft. Game Studies, 12(1), 1–19. Retrieved from http://gamestudies.org/1201/articles/gibbs_martin

Many people are increasingly carrying out more of their social life through online media such as online games. It is unsurprising to find these media are becoming vehicles for expressing grief and for memorializing the dead. In this paper we document a series of memorials found in the massively multiplayer online game World of Warcraft and outline the repertoire of game elements the game developers have used to build these memorials within the game world. We argue these memorials draw on a range of material and semiotic resources. They use a variety of game elements to produce memorials that resemble and allude to traditional and contemporary forms of memorialization. We also consider how game designers draw on diverse cultural materials to speak to profound issues associated with death and dying.

Menkin, E. S. (2007). Go wish: A tool for end-of-life care conversations. Journal of Palliative Medicine, 10(2), 297–303. https://doi.org/10.1089/jpm.2006.9983

The Go Wish card game is an advance care planning tool developed by Coda Alliance to help people have conversations about end-of-life care. Initially, this tool was designed as an easy, entertaining exercise for low-functioning assisted-living facility residents, their family members, and their CNA/nursing assistants (many of whom have limited English language skills.) Use of the tool can be proctored by staff or even a caregiver after minimal instruction. It turns out to be a widely applicable and inexpensive tool to help people discuss end-of-life care. The cards focus the conversations, provide important vocabulary to give voice to patients' needs and concerns, and offer a means for sharing those ideas. The Go Wish tool has developed into professionally designed and printed cards that are boxed as a game set. This paper describes the development of the Go Wish cards and reports on some of the diverse cases in which they have been useful. © Mary Ann Liebert, Inc.

Odom, W., Harper, R., Sellen, A., Kirk, D., & Banks, R. (2010). Passing on & putting to rest. In Proceedings of the 28th international conference on Human factors in computing systems - CHI ’10 (p. 1831). New York, New York, USA: ACM Press. http://doi.org/10.1145/1753326.1753601

While it can be a delicate and emotionally-laden topic, new technological trends compel us to confront a range of problems and issues about death and bereavement. This area presents complex challenges and the associated literature is extensive. In this paper we offer a way of slicing through several perspectives in the social sciences to see clearly a set of salient issues related to bereavement. Following this, we present a theoretical lens to provide a way of conceptualizing how the HCI community could begin to approach such issues. We then report field evidence from 11 in-depth interviews conducted with bereaved participants and apply the proposed lens to unpack key emergent problems and tensions. We conclude with a discussion on how the HCI design space might be sensitized to better support the social processes that unfold when bereavement occurs.

Sofka, C., Cupit, I. N., & Gilbert, K. R. (Eds.). (2012). Dying, death, and grief in an online universe (1st ed.). New York, NY: Springer Pub. Retrieved from https://uosc.primo.exlibrisgroup.com/permalink/01USC_INST/hs9vaa/alma991025611169703731

Historically we have always employed our foremost technology in the service of the dead. We have used whatever we had at our disposal to mourn, to support, to share memories and to tell stories. Carla J. Sofka, Illene Noppe Cupit, and Kathleen R. Gilbert reaffirm that principle reminding us that this new digital world both offers dramatic technologies and creates considerable opportunities to deal with dying, death, and grief. The editors are extraordinarily sensitive to the multiple ways that this new technology has impacted upon the death system or the ways that a society organizes behavior.

Moments, L., New, T., Times, Y., & Service, N. H. (2018). In life’ s last moments, open a window, 8–9. Retrieved from https://www.nytimes.com/2018/09/08/opinion/sunday/nhs-hospice.htm

My hospice patients were dying, but they still longed for fresh air and birdsong.

Coberly, B. (2017). After my dad died, he left behind thousands of hours of civilization save files. Retrieved January 5, 2017, from http://kotaku.com/after-my-dad-died-he-left-behind-thousands-of-hours-of-1790709703

Thomas Barber Coberly died, without warning, on May 1st, 2016, at exactly 7:04 in the morning. A heart attack, or maybe an aneurysm. It really doesn’t matter, at this point. The ambulance came promptly, but he died shortly after arriving at the hospital. Unexpected deaths leave behind a mess. Unfinished projects and obligations and all the detritus that life creates are all suddenly without the anchor that held them together or gave them meaning. At least with a lengthy illness, a person can try to set his life in order, but with a sudden death, everything is still unfinished and lived-in. So in between all the big questions, where is the funeral and who do we invite and did anyone tell Great Aunt Sally, you have all this stuff to deal with, stuff that’s taking up space on the kitchen table, stuff you can’t just ignore. What do you do with the Post-it notes on his desk, reminding him to call so-and-so or pay the gas bill? What do you do with his glasses, which I found right where he left them, on his desk, just before he went to bed that last night? Then, later, once everyone has gone home and you’ve handled all the big problems, as you’re left alone to bask in the awful realization that he’s really gone, you have to deal with all the little things. What do we do with his books? Where should we send the remainder of his subscription to The Economist? What do you do with all the video game save files on his computer?

Schott, G. R. (2020). Physical death, digital life, and post-self: That dragon, cancer as a digital memorial. Journal of Games, Self, & Society, 2(1), 85–103. https://hdl.handle.net/10289/13630

That Dragon, Cancer represents one of the first notable biographical documentary games to address terminal illness and personal loss. This article highlights how the actionable properties of games are repeatedly reversed to generate a thoughtful reflection on the impact of medical jurisdiction over the dying and its regulation over the end of life. Liberating the medium’s reliance on certain commonplace and overused design principles, That Dragon, Cancer seeks to foster empathy, and urge care, hesitation and preservation rather than progression, advancement and winning states. The resultant game is a poignant digital commemoration of the game creator’s son, Joel, whose life was affected and curtailed by cancer. In addition to being a document of parental grief and loss that offers an emotionally resonant and candid articulation of the effect of disease on the trajectory of life and biography of a child, this article also reasons that the game comprises Joel’s constructed post-self, allowing his life to be extended post-mortem.

MEDIA

Games:

Films:

COMPASSIONATE CARE

Sinclair, S., McClement, S., Raffin-Bouchal, S., Hack, T. F., Hagen, N. A., McConnell, S., & Chochinov, H. M. (2016). Compassion in health care: An empirical model. Journal of Pain and Symptom Management, 51(2), 193–203. http://doi.org/10.1016/j.jpainsymman.2015.10.009

Compassion is frequently referenced as a hallmark of quality care by patients, health care providers, health care administrators, and policy makers. Despite its putative centrality, including its institution in recent health care reform, an empirical understanding based on the perspectives of patients, the recipients of compassion, is lacking - making compassion one of the most referenced yet poorly understood elements of quality care. Objectives The objective of this study was to investigate palliative cancer patients’ understanding and experiences of compassion to provide a critical perspective on the nature and importance of compassion. Methods This grounded theory study used semi-structured interviews to investigate how patients understand and experience compassion in clinical care. Using convenience and theoretical sampling, 53 advanced cancer inpatients were recruited over a seven-month period from a specialized palliative care unit and hospital-wide palliative care service within a Canadian urban setting. Data were analyzed by four members of the research team through the three stages of Straussian grounded theory. Results Qualitative analysis yielded seven categories, each containing distinct themes and subthemes. Together, they constitute components of the compassion model - the first empirically based clinical model of compassion. The model defines compassion as a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action. Conclusion The components of the compassion model provide insight into how patients understand and experience compassion, providing the necessary empirical foundation to develop future research, measures, training, and clinical care based on this vital feature of quality care.

Lomas, T. (2015). Self-transcendence through shared suffering: An intersubjective theory of compassion. Journal of Transpersonal Psychology, 47(2), 168–187.

The value of compassion has often been appraised in terms of its benefits to the recipient, or its contribution to civil society. Less attention has been paid to the positive effect it may have upon the protagonists themselves, partly because compassion ostensibly appears to involve mainly dysphoric emotions (i.e., sharing another’s suffering). However, driven by the question of why traditions such as Buddhism and Christianity esteem compassion so highly, in this article, a theory of compassion is proposed that focuses on its transformative potential. In particular, I argue that compassion inherently involves a process of self-transcendence, enabling people to enter into an intersubjective state of selfhood. Drawing on Buddhist and Christian ideas, I then suggest that this intersubjective state is not only an antidote to the protagonists’ own suffering, but can accelerate their psychospiritual development. Thus, the article offers a new perspective on compassion that allows us to fully appreciate its transpersonal and transformative potential.

Back, A. L., Bauer-Wu, S. M., Rushton, C. H., & Halifax, J. (2009). Compassionate Silence in the Patient–Clinician Encounter: A Contemplative Approach. Journal of Palliative Medicine, 12(12), 1113–1117. http://doi.org/10.1089/jpm.2009.0175

In trying to improve clinician communication skills, we have often heard clinicians at every level admonished to ‘‘use silence,’’ as if refraining from talking will improve dialogue. Yet we have also noticed that this ‘‘just do it,’’ behavior-focused ‘‘use’’ of silence creates a new, different problem: the clinician looks uncomfortable using silence, and worse, generates a palpable atmosphere of unease that feels burdensome to both the patient and clinician. We think that clinicians are largely responsible for the effect of silence in a clinical encounter, and in this article we discuss what makes silence enriching—enabling a kind of communication between clinician and patient that fosters healing. We describe a typology of silences, and describe a type of compassionate silence, derived from contemplative practice, along with the mental qualities that make this type of silence possible.

Shea, S., Wynyard, R., & Lionis, C. (Eds.). (2014). Providing compassionate health care: Challenges in policy and practice. NY NY, USA: Routledge. Retrieved from https://www.routledge.com/Providing-Compassionate-Healthcare-Challenges-in-Policy-and-Practice/Shea-Wynyard-Lionis/p/book/9780415704960

Despite the scope and sophistication of contemporary health care, there is increasing international concern about the perceived lack of compassion in its delivery. Citing evidence that when the basic needs of patients are attended to with kindness and understanding, recovery often takes place at a faster level, patients cope more effectively with the self-management of chronic disorders and can more easily overcome anxiety associated with various disorders, this book looks at how good care can be put back into the process of caring. Beginning with an introduction to the historical va. Cover; Half Title; Title Page; Copyright Page; Table of Contents; List of figures; List of tables; Contributors; Foreword; Preface; Acknowledgements; Introduction; Part I Introducing the concept of compassion; 1 Understanding compassion: the tangled roots of compassion: historical origins, modern day reflections and concerns; 2 Compassion in nursing history: attending to the patient’s basic human needs with kindness; Part II Theoretical and therapeutic approaches to compassion; 3 Empathy, stress and compassion: resonance between the caring and the cared. 4 Who cares for the carers? Keeping compassion alive in care systems, cultures and environments: a psychologically minded approach 5 Experiential learning and compassionate care: encouraging changes in values, beliefs and behaviour; 6 Compassionate care: the theory and the reality; 7 Compassionate journeys and end-of-life care; Part III The implementation and impact of compassion in healthcare; 8 Encouraging a focus on compassionate care within general practice/family medicine; 9 Care, compassion and ideals: patient and health care providers’ experiences. 10 Compassionate Clowning: improving the quality of life of people with dementia: a playful compassionate approach from the Hearts & Minds ’Elderflowers’ 11 Compassionate care of patients with diabetes mellitus: a personal account; 12 The health impact of financial crisis: omens of a Greek tragedy; Part IV Organizational issues; 13 How good people can offer bad care: understanding the wider factors in society that encourage non-compassionate care; 14 Current initiatives for transforming organizational cultures and improving the patient experience. 15 Understanding and protecting against compassion fatigue Part V Concluding section; 16 Can compassionate care be taught? Experiences from the Leadership in Compassionate Care Programme.

MEDIA

  • Alma (2020) a game about self-care and compassion by Franscesca Palarama

SPIRITUALITY & RELIGION

Zaidi, D., Cases, E., Physicians, W. S., Brewer, J., Jr, E., Curlin, F. A., … Patel, S. (2018). Religion and spirituality in health care practice. AMA Journal of Ethics, 20(7), 607–674.

Before medical school, I studied theology at Harvard Divinity School and served as a chaplain-intern at Boston Children’s Hospital. Those experiences shaped the way I approach medicine and patients today. In particular, I acquired a newfound appreciation for how hospital hallways are places where values intersect and where profound decisions can be shaped by individuals’ religious and spiritual beliefs. Today, clinical chaplaincy remains an underutilized resource in health care, as patient spirituality continues to be an area that clinicians do not discuss as often as they should.1 This finding is disappointing, given the potential benefits of integrating patient religion and spirituality into clinical practice by improving empathy, building trust, and understanding behaviors. In looking at the state of religiosity of America, a Pew Research Center report found that 70.6% of US adults identified as Christian in 20142 ; the report also revealed trends toward religious diversity, with small increases from 2007 to 2014 in the percentage of the population identifying as Muslim and Hindu and a 6.7% increase in the unaffiliated or “nones,”2 some of whom may identify as “spiritual but not religious.”3 Acknowledging the moral underpinnings (spiritual or religious) that drive certain care-seeking behaviors—from end-of-life care to contraception—is critical in achieving a more holistic medical practice. Moreover, awareness of our patients’ spiritual or religious beliefs helps us to be more aware of our own motivations, as spirituality and religion are important components that shape behaviors of many clinicians.

Aydin, C., & Verbeek, P.-P. P. (2015). Transcendence in technology. Techne: Research in Philosophy and Technology, 19(3), 291–313. https://doi.org/10.5840/techne2015121742

According to Max Weber, the "fate of our times" is characterized by a "disenchantment of the world." The scientific ambition of rationalization and intellectualization, as well as the attempt to master nature through technology, will greatly limit experiences of and openness for the transcendent, i.e., that which is beyond our control. Insofar as transcendence is a central aspect of virtually every religion and all religious experiences, the development of science and technology will, according to the Weberian assertion, also limit the scope of religion. In this paper, we will reflect on the relations between technology and transcendence from the perspective of technological mediation theory. We will show that the fact that we are able to technologically intervene in the world and ourselves does not imply that we can completely control the rules of life. Technological interference in nature is only possible if the structures and laws that enable us to do that are recognized and to a certain extent obeyed, which indicates that technological power cannot exist without accepting a transcendent order in which one operates. Rather than excluding transcendence, technology mediates our relation to it.

MEDIA

●       Kūmāré (2011) documentary film by Vikram Gandhi

●       Man on the Moon (1999) biopic film by Milos Forman

ENTERTAINMENT MEDIA & ETHICS

GAMES, VR, AI

Gotsis, M. (2024). Ethical, moral, and philosophical challenges of creating and evaluating the impact of virtual reality experiences. In M. Bowdon, K. Yee & W. Dorner (Eds.), Ethical Considerations of Virtual Reality in the College Classroom (pp. 318–336). Routledge. https://doi.org/10.4324/9781003329718-22 (unproofed press pdf in GDrive)

Virtual reality’s (VR) expansion into consumer markets means more diverse makers are creating experiences now than ever before. While improved accessibility has resulted in groundbreaking progress, ethical challenges have emerged rapidly in educational settings. VR is a transdisciplinary conundrum for teacher-practitioners who must make sense of the boundaries between ethics frameworks. Whether formal or informal, the development of an experience and the evaluation of its impact present fundamental challenges for teachers regardless of their discipline. This chapter examines cases encountered in classroom and research labs. The definition of “virtual reality” is used broadly to include non-stereoscopic and non-head tracked experiences, as adjacent experiences represent a near future for consideration. A case study collection includes Darfur Is Dying, Our America, That Dragon Cancer, Alma, Adventurous Dreaming High Flying Dragon, and Becoming Dragon. Numerous challenges are encountered through the case study collection and related works, some of which can be mitigated while others are harder to manage. Challenges that can be mitigated include shallow expertise and novelty effects. Subjectivity, systemic inequality, intolerance, and legal and regulatory norms are more complex challenges to confront. Specific pedagogical are strategies shown to help include interdisciplinarity, intersectionality, and conscious self-awareness (positionality).

Burr, C., Taddeo, M., & Floridi, L. (2020). The ethics of digital well-being: A thematic review. In Science and Engineering Ethics (Vol. 26, Issue 4). Springer Netherlands. https://doi.org/10.1007/s11948-020-00175-8

This article presents the first thematic review of the literature on the ethical issues concerning digital well-being. The term ‘digital well-being’ is used to refer to the impact of digital technologies on what it means to live a life that is good for a human being. The review explores the existing literature on the ethics of digital well-being, with the goal of mapping the current debate and identifying open questions for future research. The review identifies major issues related to several key social domains: healthcare, education, governance and social development, and media and entertainment. It also highlights three broader themes: positive computing, personalised human–computer interaction, and autonomy and self-determination. The review argues that three themes will be central to ongoing discussions and research by showing how they can be used to identify open questions related to the ethics of digital well-being.

Schrier, K., & Al, E. (2014). Designing and using games to teach ethics and ethical thinking. Learning, Education and Games: Volume One: Curricular and Design Considerations, 141–158. https://dl.acm.org/doi/pdf/10.5555/2811147.2811156

Often when people hear the terms “ethics” and “games” in the same sentence, they initially think of violence, addiction, online bullying, sexism, and racism in games, and the like. They may be worried games such as Grand Theft Auto or Call of Duty are teaching their kids negative values; that their teenager is getting harassed by others in the real-time chats of Counterstrike; or, they are concerned their students are spending more time playing games rather than being socially, educationally, or civically engaged. This chapter is not about these issues, though they may be valid concerns. Rather, this chapter instead asks: can games also help us learn how to practice ethics and ethical thinking? If so, what does the research say about this? Are there best practices for designing and using games to teach ethics?

Marloth, M., Chandler, J., & Vogeley, K. (2020). Psychiatric interventions in virtual reality: Why we need an ethical framework. Cambridge Quarterly of Healthcare Ethics : CQ : The International Journal of Healthcare Ethics Committees, 29(4), 574–584. https://doi.org/10.1017/S0963180120000328

Recent improvements in virtual reality (VR) allow for the representation of authentic environments and multiple users in a shared complex virtual world in real time. These advances have fostered clinical applications including in psychiatry. However, although VR is already used in clinical settings to help people with mental disorders (e.g., exposure therapy), the related ethical issues require greater attention. Based on a thematic literature search the authors identified five themes that raise ethical concerns related to the clinical use of VR: (1) reality and its representation, (2) autonomy, (3) privacy, (4) self-diagnosis and self-treatment, and (5) expectation bias. Reality and its representation is a theme that lies at the heart of VR, but is also of specific significance in a clinical context when perceptions of reality are concerned, for example, during psychosis. Closely associated is the autonomy of VR users. Although autonomy is a much-considered topic in biomedical ethics, it has not been sufficiently discussed when it comes to applications of VR in psychiatry. In this review, the authors address the different themes and recommend the development of an ethical framework for the clinical use of VR.

Burr, C., Taddeo, M., & Floridi, L. (2020). The ethics of digital well-being: A thematic review. In Science and Engineering Ethics (Vol. 26, Issue 4). Springer Netherlands. https://doi.org/10.1007/s11948-020-00175-8

This article presents the first thematic review of the literature on the ethical issues concerning digital well-being. The term ‘digital well-being’ is used to refer to the impact of digital technologies on what it means to live a life that is good for a human being. The review explores the existing literature on the ethics of digital well-being, with the goal of mapping the current debate and identifying open questions for future research. The review identifies major issues related to several key social domains: healthcare, education, governance and social development, and media and entertainment. It also highlights three broader themes: positive computing, personalised human–computer interaction, and autonomy and self-determination. The review argues that three themes will be central to ongoing discussions and research by showing how they can be used to identify open questions related to the ethics of digital well-being.

Ito, M., Cross, R., Dinakar, K., & Odgers, C. (2021). Introduction: Algorithmic rights and protections for children. In Algorithmic Rights and Protections for Children. https://doi.org/10.1162/ba67f642.646d0673

Emerging from the COVID-19 pandemic that has made us even more reliant on digital platforms, society is struggling to balance opportunities and risks for children in online spaces. Despite children representing an especially marginalized and vulnerable population, the dominant platforms of the online world have not been constructed with the needs and interests of children in mind, leaving children dependent on adults to advocate for their interests and structure their experiences. This collection of essays provides perspectives, frameworks, and research for understanding diverse children’s evolving relationships with algorithms, and how stakeholders might shape these relationships in productive ways. Three common concerns are threaded through the essays: (1) the relationship between algorithms, culture, and society; (2) the unique needs and positionality of children; and (3) inequality in children’s risks and opportunities. We invite engagement, critique, and dialog here.

Madary, M., & Metzinger, T. K. (2016). Recommendations for good scientific practice and the consumers of vr-technology. Frontiers in Robotics and AI, 3(February), 1–23. http://doi.org/10.3389/frobt.2016.00003 

The goal of this article is to present a first list of ethical concerns that may arise from research and personal use of virtual reality (VR) and related technology, and to offer concrete recommendations for minimizing those risks. Many of the recommendations call for focused research initiatives. In the first part of the article, we discuss the relevant evidence from psychology that motivates our concerns. In section 1.1, we cover some of the main results suggesting that one’s environment can influence one’s psychological states, as well as recent work on inducing illusions of embodiment. Then, in section 1.2, we go on to discuss recent evidence indicating that immersion in VR can have psychological effects that last after leaving the virtual environment. In the second part of the article we turn to the risks and recommendations. We begin, in section 2.1, with the research ethics of VR, covering six main topics: the limits of experimental environments, informed consent, clinical risks, dual-use, online research, and a general point about the limitations of a code of conduct for research. Then, in section 2.2, we turn to the risks of VR for the general public, covering four main topics: long-term immersion, neglect of the social and physical environment, risky content, and privacy. We offer concrete recommendations for each of these ten topics, summarized in Table 1.

Focquaert, F. (2014). Mandatory neurotechnological treatment: Ethical issues. Theoretical Medicine and Bioethics, 35(1), 59–72. http://doi.org/10.1007/s11017-014-9276-6

What if neurofeedback or other types of neurotechnological treatment, by itself or in combination with behavioral treatment, could achieve a successful "rewiring" of the psychopath's brain? Imagine that such treatments exist and that they provide a better long-term risk-minimizing strategy compared to imprisonment. Would it be ethical to offer such treatments as a condition of probation, parole, or (early) prison release? In this paper, I argue that it can be ethical to offer effective, non-invasive neurotechnological treatments to offenders as a condition of probation, parole, or (early) prison release provided that: (1) the status quo is in no way cruel, inhuman, degrading, or in some other way wrong, (2) the treatment option is in no way cruel, inhuman, degrading, or in some other way wrong, (3) the treatment is in the best interests of the offender, and (4) the offender gives his/her informed consent.

GAMIFICATION

Marczewski, A. (2017). The ethics of gamification. XRDS: Crossroads, The ACM Magazine for Students, 24(1), 56–59. http://doi.org/10.1145/3123756

Gamification is manipulation; at least that is what many people think. Because gamification is a powerful tool for modifying behaviors, how we should consider ethics specifically for gamification?

Woodcock, J., & Johnson, M. R. (2018). Gamification: What it is, and how to fight it. The Sociological Review, 66(3), 542–558. http://doi.org/10.1177/0038026117728620

‘Gamification’ is understood as the application of game systems – competition, rewards, quantifying player/user behaviour – into non-game domains, such as work, productivity and fitness. Such practices are deeply problematic as they represent the capture of ‘play’ in the pursuit of neoliberal rationalization and the managerial optimization of working life and labour. However, applying games and play to social life is also central to the Situationist International, as a form of resistance against the regularity and standardization of everyday behaviour. In this article, the authors distinguish between two types of gamification: first, ‘gamification-from-above’, involving the optimization and rationalizing of work practices by management; and second, ‘gamification-from-below’, a form of active resistance against control at work. Drawing on Autonomism and Situationism, the authors argue that it is possible to transform non-games into games as resistance, rather than transferring game elements out of playful contexts and into managerial ones. Since the original ‘gamification’ term is now lost, the authors develop the alternative conception as a practice that supports workers, rather than one used to adapt behaviour to capital. The article concludes with a renewed call for this ‘gamification-from-below’, which is an ideal form of resistance against gamification-from-above and its capture of play in pursuit of work. 

Landers, R. N. (2018). Gamification misunderstood: How badly executed and rhetorical gamification obscures its transformative potential. Journal of Management Inquiry, 105649261879091. http://doi.org/10.1177/1056492618790913

Although management gamification has immense potential to broadly benefit both management and employees, its impact to date has been lackluster and its value unclear. I credit this to a market proliferation of rhetorical or “fake” gamification, a process which involves the decoration of existing organizational processes with game elements but with little or no attention paid to the psychological processes by which those elements influence human behavior. For gamification to be successful, specific psychological characteristics of employees or customers must be targeted, and game elements must be chosen to influence those characteristics. In theoretical terms, legitimate gamification in management can be defined as a family of work and product design techniques inspired by game design, whereas rhetorical gamification is at best novice gameful design and at worst a swindle, an attempt to make something appear “game-like” purely to sell more gamification. Only by carefully distinguishing legitimate and rhetorical gamification can legitimate gamification’s potential be fully realized.

MEDIA

●       PODCAST: A Philosophy of Games That Is Really a Philosophy of Life

SCREEN NARRATIVE MEETS HEALTHCARE

Wijdicks, E. F. M. (2020). Cinema, MD: A history of medicine on screen [Book]. Oxford University Press. https://uosc.primo.exlibrisgroup.com/permalink/01USC_INST/hs9vaa/alma991043418918603731

'Cinema, MD' argues that within cinema there is a history of medicine-one version in the many different histories of medicine. How did filmmakers write a history of medicine? This book discusses how cinema depicts medicine, in all its glory and all its failures, and what can we learn from it. It offers an account of all the major films with medical themes. The text asks a number of critical questions, such as why scriptwriters and directors chose the subjects, the plots, the cast, and the images that they did.

Colt, H., Quadrelli, S., & Lester, F. (2011). The picture of health: Medical ethics and the movies [Book]. Oxford University Press. https://uosc.primo.exlibrisgroup.com/permalink/01USC_INST/273cgt/cdi_askewsholts_vlebooks_9780199876006

Film and literature have long been mined for interesting examples and case studies in order to teach biomedical ethics to students. This volume presents a collection of about eighty very brief, accessible chapters written by international experts from medicine, social sciences, and the humanities, all of whom have experience using film in their teaching of medical ethics. Each chapter focuses on a single scene and the ethical issues it raises. While some of the films are obvious candidates with medical themes—“Million Dollar Baby,” “The Diving Bell and the Butterfly”—some are novel choices, such as “Pan's Labyrinth” or “As Good as it Gets.” The book contains several general introductory chapters to major sections, and a complete filmography and cross-index where readers can look up individual films or ethical issues.

Lo, V., Berry, C., & Guo, L. (2020). Film and the Chinese medical humanities (V. Lo, C. Berry, & L. Guo (eds.)) [Book]. Routledge. https://uosc.primo.exlibrisgroup.com/permalink/01USC_INST/hs9vaa/alma991043353310703731

"Chinese Film and the Medical Humanities is the first book to reflect on the power of film in representing medical and health discourse in China in both the past and the present, as well as in shaping its future. Drawing on both feature and documentary films from mainland China, the chapters each engage with the field of medicine through the visual arts. They cover themes such as the history of doctors and their concepts of disease and therapies, understanding the patient experience of illness and death, and establishing empathy and compassion in medical practice, as well as the HIV/AIDs epidemic during the 1980s and 90s and changing attitudes towards disability. Inherently interdisciplinary in nature, the contributors therefore provide different perspectives from the fields of history, psychiatry, film studies, anthropology, linguistics, public health and occupational therapy, as they relate to China and people who identify as Chinese. Their combined approaches are united by a passion for improving the cross-cultural understanding of the body and ultimately healthcare itself.

MEDIA

●       Coded Bias (2020) documentary film by Shalini Kantayya

PHILOSOPHY

Epicurus, Inwood, B., & Gerson, L. P. (1994). The Epicurus reader: Selected writings and testimonia. Hackett Publishing. Retrieved from http://books.google.com/books?hl=en&lr=&id=NUiYEH3H0S4C&pgis=1

Philosophy is where you should always go when you do not know where to start or you have hit a wall. I favor Epicureanism because I consider Epicurus to be the first humanist/neuroscientist of his era, taking on a practical and compassionate approach to living and understanding the human experience through the lens of suffering (much of which was through his own pain). Marcel Proust’s In Search of Lost Time is a good follow-up: “The universe is true for us all and dissimilar to each of us.”

Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and Psychosomatics, 83(1), 10–28. http://doi.org/10.1159/000353263

This article reviews research and interventions that have grown up around a model of psychological well-being generated more than two decades ago to address neglected aspects of positive functioning such as purposeful engagement in life, realization of personal talents and capacities, and enlightened self-knowledge. The conceptual origins of this formulation are revisited and scientific products emerging from 6 thematic areas are examined: (1) how well-being changes across adult development and later life; (2) what are the personality correlates of well-being; (3) how well-being is linked with experiences in family life; (4) how well-being relates to work and other community activities; (5) what are the connections between well-being and health, including biological risk factors, and (6) via clinical and intervention studies, how psychological well-being can be promoted for ever-greater segments of society. Together, these topics illustrate flourishing interest across diverse scientific disciplines in understanding adults as striving, meaning-making, proactive organisms who are actively negotiating the challenges of life. A take-home message is that increasing evidence supports the health protective features of psychological well-being in reducing risk for disease and promoting length of life. A recurrent and increasingly important theme is resilience - the capacity to maintain or regain well-being in the face of adversity. Implications for future research and practice are considered.

Vogt, K. M. (2011). All Sense-Perceptions are True : Epicurean responses to skepticism and relativism. In J. Lezra (Ed.), Lucretius and Modernity (pp. 1–23). New York, New York, USA. Retrieved from http://katjavogt.com/pdf/katja_vogt_truth_perception.pdf

Epicurean epistemology is infamous for the claim that all sense-perceptions are true. This is how Lucretius puts it: what is perceived by any of the senses at any given time is true (De rerum natura 4.499). This claim – which I shall call SPT – seems deeply misguided. It appears obvious that sense-perception can err. The plan for this paper is to show that SPT is a sophisticated philosophical proposal and, what is more, a proposal that aims to capture the truth in relativism.

MEDIA:

CHANGE/IMPACT FRAMEWORKS & PERSPECTIVES

Gotsis, M. (2009). Games, virtual reality, and the pursuit of happiness. IEEE Computer Graphics and Applications, 29(5), 14–19. http://doi.org/10.1109/MCG.2009.94

The paper discusses the aspects of games and virtual reality in human happiness.In the past few decades, scientists have focused most of their attention on developing technologies that sharpen only the minds or relieve minds and bodies of certain duties.

Rizzo, A. “Skip,” & Koenig, S. T. (2017). Is clinical virtual reality ready for primetime? Neuropsychology, 31(8), 877–899. https://doi.org/10.1037/neu0000405

Virtual reality (VR) technology offers new opportunities for clinical research, assessment, and intervention. Advances in the underlying VR-enabling technologies and methods can now support the creation of low-cost, yet sophisticated, immersive and interactive VR systems, capable of running on consumer-level computing devices. It is predicted that the clinical use of VR will have a significant impact on mental health care in areas where the research demonstrates added value.

Riva, G., Wiederhold, B. K., & Mantovani, F. (2019). Neuroscience of virtual reality: From virtual exposure to embodied medicine. Cyberpsychology, Behavior, and Social Networking, 22(1), 82–96. https://doi.org/10.1089/cyber.2017.29099.gri

Is virtual reality (VR) already a reality in behavioral health? To answer this question, a meta-review was conducted to assess the meta-analyses and systematic and narrative reviews published in this field in the last twenty-two months. Twenty-five different articles demonstrated the clinical potential of this technology in both the diagnosis and the treatment of mental health disorders: VR compares favorably to existing treatments in anxiety disorders, eating and weight disorders, and pain management, with long-term effects that generalize to the real world. But why is VR so effective? Here, the following answer is suggested: VR shares with the brain the same basic mechanism: embodied simulations. According to neuroscience, to regulate and control the body in the world effectively, the brain creates an embodied simulation of the body in the world used to represent and predict actions, concepts, and emotions. VR works in a similar way: the VR experience tries to predict the sensory consequences of an individual's movements, providing to him/her the same scene he/she will see in the real world. To achieve this, the VR system, like the brain, maintains a model (simulation) of the body and the space around it. If the presence in the body is the outcome of different embodied simulations, concepts are embodied simulations, and VR is an embodied technology, this suggests a new clinical approach discussed in this article: the possibility of altering the experience of the body and facilitating cognitive modeling/change by designing targeted virtual environments able to simulate both the external and the internal world/body.

Gotsis, M., & Jordan-Marsh, M. (2018). Calling HCI professionals into health research: Patient safety and health equity at stake. In Proceedings of 22nd Panhellenic Conference on Informatics PCI ‘18. New York, NY, USA: ACM Press. http://doi.org/10.1145/3291533.329156                            

The paper describes the need for expansion of the role of human- computer interaction (HCI) professionals into the field of e-health interventions, including games, virtual reality, and social media. Authors summarize critical practical, methodological, and philosophical gaps that prevent further synergy and collaboration. The necessity for closing these gaps is guided through a discussion on ethics and a health equity framework.

Gotsis, M. (2017). Beyond sadness and smiles: How to harness the potential of video games for treatment of depression. CHI Play 2017. Retrieved from https://games4mh.files.wordpress.com/2017/05/games4mh_paper_1.pdf

This paper is a primer framework to help guide designers of therapeutic video games for depression draw a hard line between awareness and therapy.

O’Neil, M. (2007). Can’t I Just Invent My Own Metaphors? Why Research Matters in Developing Metaphorical Models. Washington, DC: FrameWorks Institute. Retrieved from https://www.yumpu.com/en/document/view/46654877/why-research-matters-in-developing-metaphorical-models

For some time, FrameWorks has been developing simplifying models for its projects, identifying this as an important frame element. Simplifying models are brief user-friendly explanations of complex processes or constructs -– sometimes they capture a mechanism, like how global warming is produced or how children develop. In this way, simplifying models allow a lay public to actively engage with the perspectives of experts. The simplifying models that result from FrameWorks investigations can be shown to further public understanding of a social problem. FrameWorks researchers work with many elements of language to develop simplifying models, but a major research focus has been on metaphors. We work with metaphors in two primary ways. First, we analyze the metaphors that people use to describe, explain and reason about an issue. Second, we propose and test new metaphorical models that advocates might use to communicate with the public about that issue.

Kelly, M. P., & Barker, M. (2016). Why is changing health-related behaviour so difficult? Public Health, 136, 109–116. http://doi.org/10.1016/j.puhe.2016.03.030

To demonstrate that six common errors made in attempts to change behaviour have prevented the implementation of the scientific evidence base derived from psychology and sociology; to suggest a new approach which incorporates recent developments in the behavioural sciences. Study design The role of health behaviours in the origin of the current epidemic of non-communicable disease is observed to have driven attempts to change behaviour. It is noted that most efforts to change health behaviours have had limited success. This paper suggests that in policy-making, discussions about behaviour change are subject to six common errors and that these errors have made the business of health-related behaviour change much more difficult than it needs to be. Methods Overview of policy and practice attempts to change health-related behaviour. Results The reasons why knowledge and learning about behaviour have made so little progress in alcohol, dietary and physical inactivity-related disease prevention are considered, and an alternative way of thinking about the behaviours involved is suggested. This model harnesses recent developments in the behavioural sciences. Conclusion It is important to understand the conditions preceding behaviour psychologically and sociologically and to combine psychological ideas about the automatic and reflective systems with sociological ideas about social practice.

Rapp, A., Tirassa, M., & Tirabeni, L. (2019). Rethinking technologies for behavior change: A view from the inside of Human change. ACM Transactions on Computer-Human Interaction, 26(4). https://doi.org/10.1145/3318142

Human-Computer Interaction researchers are increasingly designing technologies aimed at supporting "behavior change." The model of change, which most of these works embrace, focuses on the idea that change occurs on the behavioral level and that it is externalistic, monistic, mechanistic, fragmented, and episodic. We think that a different take, focusing on the internal aspects of change, may integrate and extend what has been done using this behavioral model. We conducted 20 interviews exploring how individuals live, account for, and manage life changes. Then, we outlined five tentative patterns we identified across different kinds of changes reported by the interviewees, pointing out that change might be internalistic, multiple, intentional, holistic, and continuous. This led us to propose a set of design considerations for the evolution of the current behavior change technologies. Finally, we suggested some preliminary lines of future research, which aim to open the design space of technologies for change. 

Mummah, S. A., Robinson, T. N., King, A. C., Gardner, C. D., & Sutton, S. (2016). IDEAS (Integrate, Design, Assess, and Share): A framework and toolkit of strategies for the development of more effective digital interventions to change health behavior. Journal of Medical Internet Research, 18(12), e317. http://doi.org/10.2196/jmir.5927

Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions.

This article contains an invaluable checklist of steps for designers who wish to become interventionists, but is written from the perspective of clinicians and researchers and is helpful for teaching all the necessary steps in the right order. There is no recipe for being effective, but there are ingredients to be used to make the secret sauce :)

Turner, W. A., Thomas, B., & Casey, L. M. (2016). Developing games for mental health: A primer. Professional Psychology: Research and Practice, 47(3), 242–249. http://doi.org/10.1037/pro0000082

The development of digital technologies is rapidly providing mental health researchers and clinicians with innovative means of communication, assessment, and intervention. Video games provide an important new platform for the delivery of mental health assessments and effective interventions. However, researchers and clinicians wishing to make use of this new platform may find themselves overwhelmed by the unfamiliar terminology, processes, and logic employed by game developers. This article provides mental health researchers and practitioners with an overview of current trends in games for mental health, an introduction to games development theory and terminology, and a concise guide to the game development process from a researcher and practitioner perspective. Factors requiring consideration prior to the commencement of game development are highlighted, and a checklist to guide games development for mental health is presented. Potential issues specific to mental health research and practice in this area are also discussed. In light of current trends in video game play, adoption, and acceptance, researchers and mental health practitioners are strongly encouraged to explore the games development process and to become familiar with the field’s language and philosophy. Further development of empirically supported game-based mental health assessments and interventions is likely to help promote mental health research and practice into the ever expanding digital world.

Duncan, L. R., Hieftje, K. D., Culyba, S., & Fiellin, L. E. (2014). Game playbooks: Tools to guide multidisciplinary teams in developing videogame-based behavior change interventions. Translational Behavioral Medicine, 4(1), 108–116. https://doi.org/10.1007/s13142-013-0246-8

As mobile technologies and videogaming platforms are becoming increasingly prevalent in the realm of health and healthcare, so are the opportunities to use these resources to conduct behavioral interventions. The creation and empirical testing of game style interventions, however, is challenged by the requisite collaboration of multidisciplinary teams, including researchers and game developers who have different cultures, terminologies, and standards of evidence. Thus, traditional intervention development tools such as logic models and intervention manuals may need to be augmented by creating what we have termed "Game Playbooks" which are intervention guidebooks that are created by, understood by, and acceptable to all members of the multidisciplinary game development team. The purpose of this paper is to describe the importance and content of a Game Playbook created to aide in the development of a videogame intervention designed specifically for health behavior change in young teens as well as the process for creating such a tool. We draw on the experience of our research and game design team to describe the critical components of the Game Playbook and the necessity of creating such a tool. © 2013 Society of Behavioral Medicine.

Sakallaris, B. R., Macallister, L., Voss, M., Smith, K., & Jonas, W. B. (2015). Optimal healing environments. Global Advances in Health and Medicine, 4(3), 40–45. http://doi.org/10.7453/gahmj.2015.043

There is universal agreement that a healing environment is desirable for patients and for providers. What constitutes a healing environment is open to discussion and depends on individual perspectives. The Samueli Institute coined the term Optimal Healing Environment (OHE) in 2004 to describe a healthcare system that is designed to stimulate and support the inherent healing capacity of patients, families, and their care providers. An OHE consists of people in relationships, their health-creating behaviors, and the surrounding physical environment.1 The OHE framework (Figure) is a conceptual framework applicable to health professionals; patients, their families, and significant others; healthcare organizations; and healthcare systems. As an organizing framework, the 8 concepts contained in the 4 environments of the OHE framework provide direction to patients, families, care providers, and organizations to optimize the potential for healing. Each of the environments and constructs of the OHE framework work synergistically to support and stimulate health creation and healing (a concept known as salutogenesis).

Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2016). Mental health smartphone apps: Review and evidence-based recommendations for future developments. JMIR Mental Health, 3(1), e7. http://doi.org/10.2196/mental.4984

BACKGROUND The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. OBJECTIVE To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. METHODS A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. RESULTS Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. CONCLUSIONS Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

Karppinen, P., & Oinas-Kukkonen, H. (2013). Three approaches to ethical considerations in the design of behavior change support systems. In S. Berkovsky & J. Freyne (Eds.), Persuasive 2013 (pp. 87–98). Springer-Verlag. https://doi.org/10.1007/978-3-642-37157-8_12

Many ethical questions arise when developing persuasive systems. It has become evident that there is no silver bullet which would make it easy to resolve all ethical issues in all cases. This paper seeks to analyze and define po- tential ways to address ethical considerations in persuasive systems design. We suggest that there are three main approaches: a guideline-based approach, stakeholder analysis, and involving users. This paper helps to understand the strengths and weaknesses of these approaches when developing behavior change support systems, which, by their very nature, request deep engagement and commitment from their users. A pragmatic goal for this paper is to help designers choose an approach for their projects at hand.

Hekler, E. B., Klasnja, P., Froehlich, J. E., & Buman, M. P. (2013). Mind the theoretical gap. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems - CHI ’13, 3307. https://doi.org/10.1145/2470654.2466452

Researchers in HCI and behavioral science are increasingly exploring the use of technology to support behavior change in domains such as health and sustainability. This work, however, remain largely siloed within the two communities. We begin to address this silo problem by attempting to build a bridge between the two disciplines at the level of behavioral theory. Specifically, we define core theoretical terms to create shared understanding about what theory is, discuss ways in which behavioral theory can be used to inform research on behavior change technologies, identify shortcomings in current behavioral theories, and outline ways in which HCI researchers can not only interpret and utilize behavioral science theories but also contribute to improving them.

Markowitz, E., & Sweetland, J. (2018). Entering climate change communications through the side door. https://doi.org/10.48558/564F-DR75

Logline: Advocates can make progress on polarized issues by finding new ways into engaging people in different perspectives, rather than trying to knock down the front door with a barrage of facts.

MEDIA:

PUBLIC HEALTH - SPECIAL TOPICS

HEALTH DISPARITIES & HEALTH EQUITY

Matthews, M., & Doherty, G. (2009). The invisible user. Interactions, 16(6), 13. http://doi.org/10.1145/1620693.1620697

The World Health Organization estimates that approximately one million people per year commit suicide. Mental disorders such as depression are responsible for more than 90 percent of these deaths. In fact, depression is the leading cause of disability in the developed world, and the human and economic cost of mental illness is reaching crisis proportions. The stigma surrounding mental health issues exacerbates the problem, and many people are unable or reluctant to engage in and access effective treatment.

Sharma, M., Pinto, A. D., & Kumagai, A. K. (2018). Teaching the social determinants of health: A path to equity or a road to nowhere? Academic Medicine, 93(1), 25–30. https://doi.org/10.1097/ACM.0000000000001689

Medical schools are increasingly called to include social responsibility in their mandates. As such, they are focusing their attention on the social determinants of health (SDOH) as key drivers in the health of the patients and communities they serve. However, underlying this emphasis on SDOH is the assumption that teaching medical students about SDOH will lead future physicians to take action to help achieve health equity. There is little evidence to support this belief. In many ways, the current approach to SDOH within medical education positions the SDOH as "facts to be known" rather than as "conditions to be challenged and changed." Educators talk about poverty but not oppression, race but not racism, sex but not sexism, and homosexuality but not homophobia. The current approach to SDOH may constrain or even incapacitate the ability of medical education to achieve the very goals it lauds, and in fact perpetuate inequity. In this article, the authors explore how "critical consciousness" and a recentering of the SDOH around justice and inequity can be used to deepen our collective understanding of power, privilege, and the inequities embedded in social relationships in order to foster an active commitment to social justice among medical trainees. Rather than calling for minor curricular modifications, the authors argue that major structural and cultural transformations within medical education need to occur to make educational institutions truly socially responsible.

Veinot, T. C., Mitchell, H., & Ancker, J. S. (2018). Good intentions are not enough: How informatics interventions can worsen inequality. Journal of the American Medical Informatics Association, 25(8), 1080–1088. https://doi.org/10.1093/jamia/ocy052

Health informatics interventions are designed to help people avoid, recover from, or cope with disease and disability, or to improve the quality and safety of healthcare. Unfortunately, they pose a risk of producing intervention-generated inequalities (IGI) by disproportionately benefiting more advantaged people. In this perspective paper, we discuss characteristics of health-related interventions known to produce IGI, explain why health informatics interventions are particularly vulnerable to this phenomenon, and describe safeguards that can be implemented to improve health equity. We provide examples in which health informatics interventions produced inequality because they were more accessible to, heavily used by, adhered to, or effective for those from socioeconomically advantaged groups. We provide a brief outline of precautions that intervention developers and implementers can take to guard against creating or worsening inequality through health informatics. We conclude by discussing evaluation approaches that will ensure that IGIs are recognized and studied.

French, B. H., Lewis, J. A., Mosley, D. V., Adames, H. Y., Chavez-Dueñas, N. Y., Chen, G. A., & Neville, H. A. (2020). Toward a psychological framework of radical healing in communities of color. Counseling Psychologist, 48(1), 14–46. https://doi.org/10.1177/0011000019843506

Advancing beyond individual-level approaches to coping with racial trauma, we introduce a new psychological framework of radical healing for People of Color and Indigenous individuals (POCI) in the United States. We begin by providing a context of race and racism in the United States and its consequences for the overall well-being of POCI. We build on existing frameworks rooted in social justice education and activism and describe a form of healing and transformation that integrates elements of liberation psychology, Black psychology, ethnopolitical psychology, and intersectionality theory. We briefly review these conceptual foundations as a prelude to introducing a psychological framework of radical healing and its components grounded in five anchors including: (a) collectivism, (b) critical consciousness, (c) radical hope, (d) strength and resistance, and (e) cultural authenticity and self-knowledge. We conclude with a discussion of the applications of radical healing to clinical practice, research, training, and social justice advocacy.

Spiel, K., & Gerling, K. (2021). The purpose of play: How HCI games research fails neurodivergent populations. ACM Transactions on Computer-Human Interaction, 28(2), 1–40. https://doi.org/10.1145/3432245

Play presents a popular pastime for all humans, though not all humans play alike. Subsequently, Human- Computer Interaction (HCI) Games research is increasingly concerned with the development of games that serve neurodivergent players. In a critical review of 66 publications informed by Disability Studies and Self-Determination Theory, we analyse which populations, research methods, kinds of play and overall purpose goals existing games address. We find that games are largely developed for children, predominantly in a top-down approach. They tend to focus on educational and medical settings and are driven by factors extrinsic to neurodivergent interests. Existing work predominantly follows a medical model of disability, which fails to support self-determination of neurodivergent players and marginalises their opportunities for immersion. Our contribution comprises a large scale investigation into a budding area of research gaining traction with the intent to capture a status quo and identify opportunities for future work attending to differences without articulating them as deficit.

Spiel, K., Frauenberger, C., Keyes, O., & Fitzpatrick, G. (2019). Agency of autistic children in technology research—a critical literature review. ACM Transactions on Computer-Human Interaction, 26(6), 1–40. https://doi.org/10.1145/3344919

Autistic children are increasingly a focus of technology research within the Human-Computer Interaction (HCI) community. We provide a critical review of the purposes of these technologies and how they discursively conceptualise the agency of autistic children. Through our analysis, we establish six categories of these purposes: behaviour analysis, assistive technologies, education, social skills, therapy and well-being. Further, our discussion of these purposes shows how the technologies embody normative expectations of a neurotypical society, which predominantly views autism as a medical deficit in need of ‘correction’. Autistic children—purportedly the beneficiaries of these technologies—thus become a secondary audience to the largely externally defined purposes. We identify a lack of design for technologies that are geared towards the interests, needs and desires of autistic children. To move HCI’s research into autism beyond this, we provide guidance on how to consider agency in use and explicitly allow for appropriation beyond externally driven goals.

Nakamura, L. (2017). Racism, sexism, and gaming’s cruel optimism. In J. Malkowski & T.M. Russworm (Eds.). Gaming Representation: Race, Gender, and Sexuality in Video Games (pp. 245-250). Bloomington: Indiana University Press. https://lnakamur.files.wordpress.com/2017/12/nakamura-gaming-cruel-optimism.pdf

This book chapter is the antidote to a lot of rhetoric about the potential of games that without a critical viewpoint can become oppressive. An excerpt: “What are games but the “possibility of happiness as such”? Women, minorities, and queers who play in this way are doing “social justice” the right way. They are embodying liberal virtues: self-reliance, unfettered competition in unregulated space, in short, a neoliberal fantasy of the entrepreneurial self ’s power in precarious times. They are not breaking the game by seeking to changes its rules, customs, or its liberal contract. Gaming’s cruel optimism exploits minority gamers’ fierce attachment to the medium and sutures it to a notion of social justice that can only be earned, not given.”

Holone, H., & Herstad, J. (2013). Three tensions in participatory design for inclusion. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems - CHI ’13 (p. 2903). New York, New York, USA: ACM Press. http://doi.org/10.1145/2470654.2481401

One ideal of Participatory Design (PD) is active involvement by all stakeholders as co-designers. However, when PD is applied to real projects, certain compromises are unavoidable, no matter what stakeholders are involved. With this paper we want to shed light on some of the challenges in implementing “true” PD in the case of designing with children, in particular children with severe disabilities. We do this work to better understand challenges in an ongoing project, RHYME, and by doing so we hope to provide insight and inspiration for others.

DIGITAL HEALTH

Safavi, K., Mathews, S. C., Bates, D. W., Dorsey, E. R., & Cohen, A. B. (2019). Top-funded digital health companies and their impact on high-burden, high-cost conditions. Health affairs (Project Hope), 38(1), 115–123. https://doi.org/10.1377/hlthaff.2018.05081

Digital health companies hold promise to address major health care challenges, though little has been published on their impact. We identified the twenty top-funded private US-based digital health companies to analyze their products and services, related peer-reviewed evidence, and the potential for impact on patients with high-burden conditions. Data analytics (including artificial intelligence and big data) was the most common company type. Companies producing biosensors had the greatest funding. Publications were concentrated among a small number of companies. Healthy volunteers were most commonly studied. Few studies enrolled high-burden populations, and few measured their impact in terms of outcomes, cost, or access to care. These data suggest that leading digital health companies have not yet demonstrated substantial impact on disease burden or cost in the US health care system. Our findings indicate the importance of fostering an environment, with regard to policy and the consumer market, that encourages the development of evidence-based, high-impact products.

Sanches, P., Karpashevich, P., Doherty, G., Janson, A., Windlin, C., Sas, C., … Höök, K. (2019). HCI and Affective Health. Taking stock of a decade of studies and charting future research directions. Conference on Human Factors in Computing Systems -CHI’19 http://eprints.lancs.ac.uk/130240/1/hci_affective_health.pdf

In the last decade, the number of articles on HCI and health has increased dramatically. We extracted 139 papers on depression, anxiety and bipolar health issues from 10 years of SIGCHI conference proceedings. 72 of these were published in the last two years. A systematic analysis of this growing body of literature revealed that most innovation happens in automated diagnosis, and self-tracking, although there are innovative ideas in tangible interfaces. We noted an overemphasis on data production without consideration of how it leads to fruitful interventions. Moreover, we see a need to promote ethical practices for involvement of people living with affective disorders. Finally, although only 16 studies evaluate technologies in a clinical context, several forms of support and intervention illustrate how rich insights are gained from evaluations with real patients. Our findings highlight potential for growth in the design space of affective health technologies.

Gordon, W. J., Landman, A., Zhang, H., & Bates, D. W. (2020). Beyond validation: Getting health apps into clinical practice. Npj Digital Medicine, 3(1). https://doi.org/10.1038/s41746-019-0212-z

Fueled by advances in technology, increased access to smartphones, and capital investment, the number of available health “apps” has exploded in recent years. Patients use their smartphones for many things, but not as much as they might for health, especially for managing their chronic conditions. Moreover, while significant work is ongoing to develop, validate, and evaluate these apps, it is less clear how to effectively disseminate apps into routine clinical practice. We propose a framework for prescribing apps and outline the key issues that need to be addressed to enable app dissemination in clinical care. This includes: education and awareness, creating digital formularies, workflow and EHR integration, payment models, and patient/provider support. As work in digital health continues to expand, integrating health apps into clinical care delivery will be critical if digital health is to achieve its potential.

Burr, C., Taddeo, M., & Floridi, L. (2020). The ethics of digital well-being: A thematic review. In Science and Engineering Ethics (Vol. 26, Issue 4). Springer Netherlands. https://doi.org/10.1007/s11948-020-00175-8

This article presents the first thematic review of the literature on the ethical issues concerning digital well-being. The term ‘digital well-being’ is used to refer to the impact of digital technologies on what it means to live a life that is good for a human being. The review explores the existing literature on the ethics of digital well-being, with the goal of mapping the current debate and identifying open questions for future research. The review identifies major issues related to several key social domains: healthcare, education, governance and social development, and media and entertainment. It also highlights three broader themes: positive computing, personalised human–computer interaction, and autonomy and self-determination. The review argues that three themes will be central to ongoing discussions and research by showing how they can be used to identify open questions related to the ethics of digital well-being.

Evans, L., Evans, J., Pagliari, C., & Källander, K. (2023). Scoping review: Exploring the equity impact of current digital health design practices. Oxford Open Digital Health, 1, oqad006. https://doi.org/10.1093/oodh/oqad006

Background: Digital health interventions designed through human-centered design (HCD) have shown potential to impact health equity. This scoping review aims to understand how HCD approaches in digital health impact health equity.

INTERDISCIPLINARITY

Parkinson, C., & White, M. (2013). Inequalities, the arts and public health: Towards an international conversation. Arts and Health, 5(3), 177–189. https://doi.org/10.1080/17533015.2013.826260

This paper considers how participatory arts informed by thinking in public health can play a significant part internationally in addressing inequalities in health. It looks beyond national overviews of arts and health to consider what would make for meaningful international practice, citing recent initiatives of national networks in English-speaking countries and examples of influential developments in South America and the European Union. In the context of public health thinking on inequalities and social justice, the paper posits what would make for good practice and appropriate research that impacts on policy. As the arts and health movement gathers momentum, the paper urges the arts to describe their potency in the policy-making arena in the most compelling ways to articulate their social, economic and cultural values. In the process, it identifies the reflexive consideration of participatory practice – involving people routinely marginalised from decision-making processes – as a possible avenue into this work.

Boydell, K. M., Hodgins, M., Gladstone, B. M., Stasiulis, E., Belliveau, G., Cheu, H., Kontos, P., & Parsons, J. (2016). Arts-based health research and academic legitimacy: Transcending hegemonic conventions. Qualitative Research, 16(6), 681–700. https://doi.org/10.1177/1468794116630040

Using the Canadian context as a case study, the research reported here focuses on in-depth qualitative interviews with 36 researchers, artists and trainees engaged in ‘doing’ arts-based health research (ABHR). We begin to address the gap in ABHR knowledge by engaging in a critical inquiry regarding the issues, challenges and benefits of ABHR methodologies. Specifically, this paper focuses on the tensions experienced regarding academic legitimacy and the use of the arts in producing and disseminating research. Four central areas of tension associated with academic legitimacy are described: balancing structure versus openness and flexibility; academic obligations of truth and accuracy; resisting typical notions of what counts in academia; and expectations vis-à-vis measuring the impact of ABHR. We argue for the need to reconsider what counts as knowledge and to reconceptualize notions of evaluation and rigor in order to effectively support the effective production and dissemination of ABHR.

Jordan-Marsh, M. (2010). Health technology literacy: A transdisciplinary framework for consumer-oriented practice. Jones & Bartlett Publishers. https://uosc.primo.exlibrisgroup.com/permalink/01USC_INST/hs9vaa/alma991000717299603731

Award-winning book from nursing and consumer perspective on some of the most innovative ways technology can be used, challenges and opportunities, with emphasis on aging. A big treasure trove of ideas. Contents: Telehealth as a fulcrum in health technology -- Literacy for an age of eHealth -- Health information seeking behavior on the Web -- The personal health record building human capital for health -- Devices as adjuncts to being healthy at home -- Digital games : consumer resources for health capital -- Consumer-centric health technology : wicked problems and deliciously disruptive solutions.

Frodeman, R., Klein, J. T., & Pacheco, R. C. S. (Eds.). (2017). The Oxford handbook of interdisciplinarity. Oxford University Press. https://doi.org/10.1093/oxfordhb/9780198733522.001.0001

Interdisciplinarity has become as important outside academia as within. Academics, policy makers, and the general public seek insights to help organize the vast amounts of knowledge being produced, both within research and at all levels of education. The second edition of The Oxford Handbook of Interdisciplinarity offers a thorough update of this major reference work, summarizing the latest advances within the field of inter- and transdisciplinarity. The collection is distinguished by its breadth of coverage, with chapters written by leading experts from multiple networks and organizations. The volume is edited by respected interdisciplinary scholars and supported by a prestigious advisory board to ensure the highest quality and breadth of coverage.

Hall, K. L., Vogel, A. L., Huang, G. C., Serrano, K. J., Rice, E. L., Tsakraklides, S. P., & Fiore, S. M. (2018). The science of team science: A review of the empirical evidence and research gaps on collaboration in science. American Psychologist, 73(4), 532–548. https://doi.org/10.1037/amp0000319

Collaborations among researchers and across disciplinary, organizational, and cultural boundaries are vital to address increasingly complex challenges and opportunities in science and society. In addition, unprecedented technological advances create new opportunities to capitalize on a broader range of expertise and information in scientific collaborations. Yet rapid increases in the demand for scientific collaborations have outpaced changes in the factors needed to support teams in science, such as institutional structures and policies, scientific culture, and funding opportunities. The Science of Team Science (SciTS) field arose with the goal of empirically addressing questions from funding agencies, administrators, and scientists regarding the value of team science (TS) and strategies for successfully leading, engaging in, facilitating, and supporting science teams. Closely related fields have rich histories studying teams, groups, organizations, and management and have built a body of evidence for effective teaming in contexts such as industry and the military. Yet few studies had focused on science teams. Unique contextual factors within the scientific enterprise create an imperative to study these teams in context, and provide opportunities to advance understanding of other complex forms of collaboration. This review summarizes the empirical findings from the SciTS literature, which center around five key themes: the value of TS, team composition and its influence on TS performance, formation of science teams, team processes central to effective team functioning, and institutional influences on TS. Cross-cutting issues are discussed in the context of new research opportunities to further advance SciTS evidence and better inform policies and practices for effective TS.

Raasch, C., Lee, V., Spaeth, S., & Herstatt, C. (2013). The rise and fall of interdisciplinary research: The case of open source innovation. Research Policy, 42(5), 1138–1151. https://doi.org/10.1016/J.RESPOL.2013.01.010

A large, and purportedly increasing, number of research fields in modern science require scholars from more than one discipline to understand their puzzling phenomena. In response, many scholars argue that scientific work needs to become more interdisciplinary, and is indeed becoming so. This paper contributes to our understanding of the evolution of interdisciplinary research in new fields. We explore interdisciplinary co-authorship, co-citation and publication patterns in the recently emergent research field of open source innovation during the first ten years of its existence. Utilizing a database containing 306 core publications and over 10,000 associated reference documents, we find that inquiry shifts from interdisciplinary to multidisciplinary research, and from joint puzzle solving to parallel problem solving, within a very few years after the inception of the field. “High-involvement” forms of interdisciplinary exchange decline faster than “low-involvement” forms. The patterns we find in open source research, we argue, may be quite general. We propose that they are driven by changes in task uncertainty and the ability to modularize research, among other factors. Our findings have important implications for individual scholars, research organizations, and research policy.

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Hum Resources Health, 11(1), 19. http://www.ncbi.nlm.nih.gov.wwwproxy0.library.unsw.edu.au/pmc/articles/PMC3662612/pdf/1478-4491-11-19.pdf

Background: Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes. Method: This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work. Results: Ten characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles. Conclusions: We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.

Holley, K. A. (2009). Understanding interdisciplinary challenges and opportunities in higher education. Innovations in Higher Education, 34, 1–131. https://doi.org/10.1002/aehe.3502

Using data collected through case studies of 21 research universities in the United States, I reviewed the efforts institutions are undertaking to meet the growing demand for interdisciplinary knowledge. I adopted the framework of transformative change, where change occurs over time and brings important shifts in the way an institution views itself. Findings indicated that implementing interdisciplinary initiatives is accomplished not only through changes in how institutional work is organized and the facilities in which the work is carried out, but also through concurrent shifts in the institutional culture related to interdisciplinary endeavors.

Darbellay, F. (2015). Rethinking inter- and transdisciplinarity: Undisciplined knowledge and the emergence of a new thought style. Futures, 65, 163–174. https://doi.org/10.1016/j.futures.2014.10.009

There has been a visible increase in academic productivity in the field of inter- and transdisciplinarity (ITD) over the past decade. Does this greater visibility mean that ITD has entered a 'golden age' crowned with universal success, or does this new approach still face difficulties of an institutional, individual, epistemological or methodological nature? Does the researcher who situates himself between or beyond disciplines represent a new scientific profile that is transforming traditional disciplinary identities? Finally, is ITD a simple recombination of existing disciplines with varying degrees of originality, or does it embody a new thought style that calls for the dedisciplinarization of academic structures and the full recognition of its transgressive status? In this paper I shall attempt to answer these programmatic questions and shed light upon the following elements: the inter- and transdisciplinary approach is underway and still - beyond its potentialities and success - faces some obstacles; interdisciplinary research is often promoted or claimed, but it is sometimes not recognized as a form of research in its own right; and taking seriously the issues of ITD involves rethinking disciplinary identities. It represents a new thought style and a promising future for education and research.

Lynch, B. (2020). Introduction: Neither helpful nor unhelpful – A clear way forward for the useful museum. In Museums and Social Change (pp. 1-32). Routledge.

This will be enjoyed by humanists and artists alike.

NATURAL DISASTERS, CLIMATE CHANGE, & OTHER CRISES

Antle, A. N., & Frauenberger, C. (2020). Child–Computer Interaction in times of a pandemic. International Journal of Child-Computer Interaction, 26(January), 100201. https://doi.org/10.1016/j.ijcci.2020.100201

Emergent, Situated and Prospective Ethics for Child–Computer Interaction Research” that brought together a small group of researchers interested in sharing and discussing ethical issues arising when researching, designing, and deploying technologies for children.

Iacovides, I., & Mekler, E. D. (2019). The role of gaming during difficult life experiences. Conference on Human Factors in Computing Systems - Proceedings, 1–12. https://doi.org/10.1145/3290605.3300453

HCI has become increasingly interested in the use of technology during difficult life experiences. Yet despite considerable popularity, little is known about how and why people engage with games in times of personal difficulty. Based on a qualitative analysis of an online survey (N=95), our findings indicate that games offered players much needed respite from stress, supported them in dealing with their feelings, facilitated social connections, stimulated personal change and growth, and provided a lifeline in times of existential doubt. However, despite an emphasis on gaming as being able to support coping in ways other activities did not, participants also referred to games as unproductive and as an obstacle to living well. We discuss these findings in relation to both coping process and outcome, while considering tensions around the potential benefits and perceived value of gaming.

Semaan, B. (2019). “Routine infrastructuring” as “building everyday resilience with technology.” Proceedings of the ACM on Human-Computer Interaction, 3(CSCW), 1–24. https://doi.org/10.1145/3359175

Getting a divorce. Being diagnosed with a disease. Going through a relationship breakup. Living through a natural disaster. All of these events are often life disrupting and debilitating. While some disruptive events are short-lived, some can be a routine part of everyday life. This leads to the question of how people who experience prolonged disruption in their lives build resilience—that is, how do they manage and overcome such events? To explore this question, this paper utilizes a case study approach to explore the use, creation, and re-appropriation of technology across three prolonged disruptions-the Second Gulf War in Iraq, veteran transitions, and the coming out experiences of LGBTQ-identifying people. Using a conceptual frame that brings together routine dynamics and infrastructuring, we find that engaging in routine infrastructuring practices generated resilience in people’s daily lives—a phenomenon we dub ‘routine infrastructuring’ as ‘building everyday resilience with technology.’ We then theorize properties of infrastructure and infrastructuring practice that enable resiliency, and conclude with how infrastructuring is a form of care work that is oriented towards individuals, communities, and society.

Watney, S. (1987). The spectacle of AIDS. October, 43, 71–86. Retrieved from http://www.jstor.org/stable/3397565

In Simon Watney's article, “The Spectacle of AIDS”, Watney illustrates that the AIDS epidemic has become just that; a spectacle. Watney first places the blame for this confusion on the strategic constant misreporting of facts and figures relating to this epidemic. He then goes on to discuss how certain demographics are stigmatized as high risk groups.

Stein, P. J. S., Stein, M. A., Groce, N., & Kett, M. (2023). The role of the scientific community in strengthening disability-inclusive climate resilience. Nature Climate Change, 13(2), 108–109. https://doi.org/10.1038/s41558-022-01564-6

Logline: Despite the trajectory towards climate catastrophe, governments are failing to take disability-inclusive climate action. We discuss how the scientific community could advance and hasten the development of disability-inclusive climate resilience, and which areas should be prioritized.

Miller, W. H. (1855). Five days in quarantine. The Leisure Hour: A Family Journal of Instruction and Recreation, Jan. 1852-Dec. 1876, 180, 360–363. http://libproxy.usc.edu/login?url=https://search.proquest.com/docview/3388684?accountid=14749

A short story from a really incredible journal from the past century about the quarantine experience of gentlemen. “There is a story told about an Irishman, who, on being asked whether the natives of a country he had just returned from were considered hospitable, replied: "Hospitable! You may say so. Why, I was in hospital the whole time I was there.”

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