Research Proposal

Introduction

Mental health and disabilities are two overlooked aspects of Virtual Reality. Whilst VR games and art are useful and groundbreaking in their own right – using VR to help those in need, will be the focus of this project.

Research – Mental Health

Increase In Use:

The use of Virtual Reality to aid mental health has grown drastically in a short period of time. In 2007, there was “a lack of good quality research on the effectiveness of VR therapy” (Gregg & Tarrier, 2007). Contrastingly, in 2017, 285 studies on the use of VR for mental health were identified (Freeman, Reeve, Robinson, Ehlers, Clark, Spanlang & Slater, 2017) – a huge increase from the amount of studies available just 10 years prior.

Alongside the increase in the amount of research conducted, the technology itself has improved considerably. This is mainly due to the funding increasing drastically in recent years, with an 85% increase from 2015 to 2016 (Carvalho, 2018).

(Carvalho, 2018)

The graph clearly demonstrates the immense increase in the popularity of VR as a whole through 5 short years. Now, in 2023, the market is even larger than that and, whilst the majority is most likely gaming related, more research can be conducted into the usefulness of VR for mental health problems.

Anxiety:

Anxiety is described as a feeling of “fear or unease” and it is a natural response to pressure (NHS, 2021). It is the most common mental disorder, with as many as 30% of adults being affected at some point during their lives (American Psychiatric Association, 2022).

Believed to be one of the most “effective treatments” for anxiety, exposure therapy is exposing a person to their “specific feared situations or objects that trigger anxiety” (Gorini & Riva, 2014). VR gives the patient the opportunity to be present in these environments, whilst knowing it is not real – allowing them to “easily face difficult situations in VR” compared to “real life and be able to try out new therapeutic strategies” (Freeman, Reeve, Robinson, Ehlers, Clark, Spanlang & Slater, 2017). The idea is that the fears they overcome in VR can then translate to the real world.

Some claim that there is “hardly any evidence that virtual reality therapy is effective in generalized anxiety disorder” (Emmelkamp & Meyerbroker, 2021), which is a long-term condition that makes people feel anxious about a “wide range of situations and issues” (NHS, 2021) compared to just one event. This may be because exposure therapy is catered towards curing the patients fear of a specific environment.

Despite being ineffective at treating generalised anxiety disorder, VR is still a useful tool at treating anxiety towards specific situations. Whilst traditional forms of therapy for anxiety have been “effective”, the cost and risks are higher than the use of VR (Oing & Prescott, 2018). For example, some forms of therapy include making the patient go into a public place – which risks “patient confidentiality” and circumstances that aren’t controllable such as the weather (Oing & Prescott, 2018). The use of Virtual Reality would negate these issues, whilst studies have shown them to be equally as effective.

Schizophrenia:

Schizophrenia is a long-term mental health condition in which a person cannot always distinguish between reality and their own thoughts. Some symptoms include hallucinations, delusions and feeling disconnected from your own feelings (NHS, 2021).

A study conducted in 2008 concluded that Virtual Reality has the potential to further the understanding and treatment of schizophrenia (Freeman, 2008). Now, with how much the technology has advanced, VR is a much more viable option for medical treatments – including schizophrenia.

In the modern day, Virtual Reality can be used to “streamline traditional evaluation / rehabilitation programmes” meaning that the technology is not just used to cure patients, but to identify them as well (Bras, 2015).

Whilst the data on VR treatment for schizophrenia is still limited, in the few studies that have been carried out, the treatment has illustrated its “effectiveness and versatility” in treating schizophrenia symptoms such as hallucinations and delusions (Bisso, Signorelli, Milazzo, Maglia, Polosa, Aguglia & Caponnetto). An advantage of VR treatment compared to standard schizophrenia treatment is that it allows for drug free interventions, meaning that any potential for side effects is non-existent.

Studies also exist that aim to break the stigma around schizophrenia and increase empathy towards those who suffer. By allowing individuals to experience what schizophrenia is like, they gain sympathy for people who have it. Through various experiments, it was found that VR was more effective than a standard 2D video at eliciting an attitude and knowledge change towards schizophrenia (Marques, Veloso, Araujo, Almeida, Correia, Pereira, Queiros, Pimenta, Pereira & Silva, 2022).

Conclusion:

Throughout the research of the use of Virtual Reality to aid mental health issues, it was found that it can be used in two main ways. One way is to diagnose and treat the specific problem such as anxiety or schizophrenia. The popularity of these methods has coincided with the increase of the VR market itself. The second way is to teach people what a specific mental health issue is in much more detail. By experiencing what it is like to have a specific mental health problem, the user gains a greater sense of empathy and understanding.

Initial Idea:

Much like the study on gaining empathy with schizophrenia through VR, creating a Virtual Reality experience that shows what the world is like for someone with anxiety may be beneficial. Putting the user in a situation where it feels like everyone is looking at you or that the world is speeding up and slowing down would allow them to experience some of the symptoms of anxiety (Mind, 2021).

Sound design such as fast and heavy breathing, as well as a quick irregular heartbeat could also make the experience more believable and impactful (Mind, 2021).

Although anxiety can make you feel sick, motion sickness is something users want to avoid whilst using VR. In Virtual Reality, motion sickness “happens when the brain receives conflicting signals about the environment” around the user (Thompson, 2023).

If this idea is the one that is chosen, motion sickness during sections that are sped up or slowed down to mimic anxiety will have to be play tested until it is not an issue.

Whilst this idea seems promising, research into disabilities and VR must be conducted before a final decision on the project is made.

Research – Disabilities

Dementia:

Dementia is a syndrome connected with the ongoing decline of brain functioning (NHS, 2023). Both the cognitive and physical impairments created by dementia are recognised as a disability by both domestic law and international convention (Alzheimer’s Society, 2019). These impairments include memory loss, mental sharpness, mood and movement.

One way Virtual Reality may be used to assist those with dementia is to educate and train caregivers in order to improve their communication skills and empathy. Whilst there is some indication that this is an effective method, there is little to no studies on the matter that comment on the effectiveness of VR itself (Hirt & Beer, 2020). Since simulation processes have been a long tradition in the medical field to train novices, perhaps the potential for VR in this area is still untouched (Hirt & Beer, 2020).

Another way VR can be helpful towards dementia is by raising awareness of the disability. A Walk Through Dementia is an app that is designed to let you experience someone living with dementia (Alzheimer’s Research UK, 2017). This video is an example of one of the scenarios on available on the app.

(AlzheimersResearch UK, 2017)

The video puts you in the shoes of an old woman suffering with dementia as she goes shopping. Events that occur include her picking up the wrong items and not knowing where her son is. But perhaps the most powerful moment is when she states that “the shop is different” and the actual layout of the shop changes – highlighting how dementia confuses the brain.

Experiences such as these are even more powerful in Virtual Reality as the user steps into the shoes of the person with dementia for those brief few minutes.

Additionally, VR can be used to give dementia patients new experiences and help them remember things they had forgotten. Videos are shown on the headsets that stimulate their brains in ways that were not possible before (KVUE, 2018). By watching VR videos of recreated events that they may have been a part of, such as a street party for the Queen’s coronation, “they suddenly remember the time, the day, who they were with and they start to tell you all about it” (Chapman, 2017).

One way this may be improved in the future is to tailor the Virtual Reality experience towards a specific person. For example, the individual with dementia or family members may be asked about a certain event that they want recreating in VR. That event can then be recreated using Unreal Engine or real life actors with a 360 camera, allowing the dementia patient to experience and remember a memory long forgotten. It would be interesting to see how successful the effects of this would be compared to the generic experience videos that already exist today.

Quadriplegia:

It’s no secret that for most VR experiences, the use of hands is needed. Whether it’s the use of controllers to move around and navigate or, like the Meta Quest 3, using just your hands – people who cannot move easily, or at all, are left behind (Carter, 2023).

Quadriplegia is a form of paralysis that affects all four limbs as they are often paralysed from the neck down (Spinalcord, 2020). People with this disability, alongside arm amputees, cannot use Virtual Reality in the intended way due to the reliance on hand input.

Since 2017, it has been possible to navigate around VR using just your thoughts alone (Strickland, 2017). This technology could potentially allow people who cannot use their arms to experience Virtual Reality. However, even in 2023 this technology is not widely commercially available.

Electromyography (EMG) measures nerve and muscle electrical activity. Theoretically, tiny movements in the face could be picked up and applied to the VR world (Stein, 2023). Meta is developing EMG based wristbands which could become commercially available, however it only measures finger and hand movements (Stein, 2022).

EMG might still have a use for those with quadriplegia however, as although a spinal cord injury prevents the brain from sending and receiving electrical signals, only a brain injury undermines the brain’s ability to process them (Spinalcord, 2020).

With the use of just the brain to control a Virtual Reality experience still being far away, especially in a commercial sense, perhaps there is another technique that could be used whilst that technology is being developed.

People with spinal damage can often still speak, especially if the damage occurs below the C4 neck vertebra (Aguirre, 2019). Therefore, a Virtual Reality experience that is entirely controlled by the users voice may be an alternative to brain control.

Conclusion:

Throughout the research of Virtual Reality use for disabilities such as dementia and quadriplegia, it was found that VR support is still lacking in these areas. Although VR is being used to help dementia patients, perhaps personalised VR experiences could support them even more in remembering past events. It was also discovered that there is a lack of consideration for those with disabilities that inhibit the use of arms. Even though controlling VR purely through thoughts is contemplated, such devices are not available easily for the public to use.

Initial Idea:

Since there is a real lack of support for those with limited or no use of their hands, an idea for this project is to fix that problem. Whilst controlling a game with just your brain is a promising avenue to go down to correct this issue, entire companies have failed to create a market for these special headsets. The extra equipment and technology needed to read the users brain activity would most likely cost too much for the average person regardless.

Consequently, controlling a game via the users voice input is a much more sensible option. No extra equipment, apart from a microphone, would be needed and so this alternative is much more cost effective.

Concept

Choosing An Idea:

After researching both mental health and disabilities within the Virtual Reality space, two main ideas were left. The first being a simulation of what anxiety is like in order to raise awareness for this common mental health issue. The second idea is a game that can be played without controllers and just the users voice – mainly for those who have limited or no use of their arms.

The idea that will be carried forwards is the voice controlled game as it has the potential to help people who are overlooked within the VR community. Anxiety is still a huge issue, however simulations for other mental health issues such as schizophrenia have already been made and so it may only be a matter of time before someone else makes one for anxiety.

Type Of Game:

Now that the general idea of a voice controlled game has been chosen, it was time to decide what genre of game would be most suitable and feasible to display these mechanics.

One idea may be an endless runner in a first person style, similar to how Mirror’s Edge (DICE, 2008) looks and plays. In these games the player character moves automatically and the user usually has a jump button. As a replacement, the user could say “Jump” whenever they have to cross an obstacle.

A huge problem with this idea, however, is motion sickness. When the user sees themselves accelerate in the game world without accelerating in real life, that disconnect often makes them feel sick (Still, 2022).

Whilst the game would be simple to create, a problem may be that it isn’t complex enough to show off the voice detection technology. If the only word said by the player is “Jump”, that isn’t as impressive as having multiple commands they can use.

An idea that may fix these problems is an escape room. Whilst still simple enough to create in the time limit, an escape room would need more voice commands in order to work. For example;  “Pick Up”, “Use *Objects Name*” and “Move Forwards” to name a few.

An escape room could also use teleporting in order to limit motion sickness for the player. Teleportation to move is the most popular option for Virtual Reality movement right now and whilst it can break immersion, it is a better option than making the user feel sick (Still, 2022).

Therefore, the voice-only game created will be an escape room as it is the more complex idea and has less potential for motion sickness.

User Experience:

Many of our users will have disabilities – including quadriplegia. For this reason, multiple accessibility options will need to be included. For example, an option for eye tracking.

This will be a necessary option as some of our users may not be able to turn their heads to look around the environment. Those who can move their heads will be able to turn this option off and just use standard head tracking. However, for those who struggle with this, using their eyes to control a reticle on the screen will still be a valid option.

That reticle can also help prevent motion sickness. Alongside communicating certain things to the player, such as which objects can be interacted with, reticles are always in the middle of the screen – allowing the player to focus on them and find their bearings (Polygon, 2019).

As mentioned previously, teleportation will be used to move around the level. Whilst this is an effective method of preventing motion sickness, it isn’t without its own cons. Teleporting will take awhile to get used to for the user and may feel unnatural due to it not existing in the real world. Furthermore, it can easily cause spatial disorientation and confuse the player (Still, 2022).

To combat this, small transitions will be used in order to give the player a brief second to process where they are going. Without this, teleportation would be instantaneous and there may be a larger chance of disorientation.

Moreover, the User Interface for tutorials will be placed at a comfortable distance for the user – to avoid eye strain. As there is no real standard for this in video games, play testers will give feedback and adjustments will be made accordingly.

Software:

Around 60% of all AR / VR video games are made using Unity as of 2023 (VintageIsTheNewOld, 2023). This large popularity, alongside it being free to download, means that there are many tutorials out there for developing VR games. Furthermore, Unity is coded in C# which is a more familiar coding language personally.

Unreal Engine has better 3D graphics and a huge collection of free high quality assets on its store. However, the point of this project is more to demonstrate the potential of voice controlled game in VR – rather than having the best graphics available. Although C# is more familiar, Unreal’s blueprint system is easy to understand and is good for beginner coders (Telles, 2022).

To conclude, although Unreal’s graphics are better, Unity is the engine that will be used for this project as it is the most popular engine for VR development and so tutorials will be abundant.

Concept Storyboard:

To gain a better understanding of what the game will play like, creating a storyboard of the first level was the next step.

Storyboards are most commonly used in films, comics and traditional video games to communicate certain sequences or interactions (McCurley, 2016). They are usually used to sketch out frames from a scene, however in VR there is no frame. This can be overcome with level design techniques that guide the player through the level.

(McCurley, 2016)

Even without these techniques used, the user is more likely to look at the darker areas in this diagram.

Above is a rough storyboard of how the level may play out. Alongside the lighting techniques applied, level design techniques such as a coloured outline appearing around an object when the player hovers over it will be used to guide the player through the level. This is especially crucial in an escape room game as the main mechanic is players interacting with objects, therefore they need to know what they can and cannot use.

When the player approaches the desk, they will see a note and be prompted to say “Interact”. The player can then read the note and discover the code for the safe. This acts as a tutorial for how the user will pick up and use objects.

Similar to the desk, the player will then walk up to the safe, say “interact” and then input the code on a number pad.

Project Plan

The project planning website that was chosen was Monday.com due to the variety of different views that are available to plan projects – such as a table and a Gantt chart.

The plan was split into multiple different sections, including level concepts, blockouts, the voice mechanic etc.

Within these sections, subsections which detailed the plan further existed. This feature is extremally useful as the overarching goal of concepting levels, for example, can be broken down into smaller and much more manageable chunks.

The status bar clearly tells me what sections and subsections are being worked on. The greyed out ones have not been touched yet.

As mentioned previously, a great feature of this website is the ability to easily swap between different types of views. This Gantt chart view demonstrates how long each task will take and if any of them overlap with each other more clearly than the table view. However, it does not include the status section like the table view. Each view has its own advantages and disadvantages and therefore utilising a few of them together is best.

Conclusion

The aim of this research proposal was to find a method of helping those with either mental health problems or disabilities using Virtual Reality – due to it being an under looked aspect of VR / AR compared to standard video games.

After researching both mental health and disabilities within the VR space, it was found that the most effective idea would be a simple video game that helps those with limited or no use of their arms as there is a huge reliance on hand use for VR.

The future solution to this problem will most likely be controlling the virtual world with the user’s brain, however after years of research, that is still a long way from being available at an affordable price to those in need. Therefore, the temporary solution for this would be a voice controlled game.

Although this will not help everyone who cannot use their arms, as some with quadriplegia cannot speak, it may potentially help a lot of people who simply do not have access to the world of Virtual Reality at this current moment.

References

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