Metaverse Health

I’m probably stretching the boundaries with claiming this to be a health-related post, but here goes. I’ve covered Second Life’s Relay for Life previously, and it’s actually running over this weekend and appears it will be as big a success as previous years.

One Second Life resident, Laurence Simon created a machinima called Relay for Death, which aside from being humorous, also has a strong message in favour of the Relay For Life fundraising initiatives:

Health professionals involved with virtual worlds will understand the power of machinima. For those still coming to terms with virtual worlds and health, it’s further proof of the growing maturity of the platform to communicate health messages. Having an engaged population generating their own messages to support health is an ideal sought after – this is an example of it in practice, and it’s fun to boot!

A new working group looking at the psychology of immersive environments is about to launch in Second Life. The inaugural get-together is occurring Wednesday July 15th at 4pm SL time. Click here for the exact location.

Thanks to Dusan Writer for the heads up.

The Economist has an interesting article on the use of Second Life in training people around virtual consent. It’s an area where a virtual world has strengths (the ability to recreate a real-world situation) without some of the downfalls (lack of clinical complexity due to technological limitations).

Another aspect that has struck me over the past year is just how strong the UK is in virtual worlds and health. The Imperial College London (where this training exercise is being hosted) is one of the shining lights worldwide, with a number of other UK institutions undertaking research.

Over the past couple of years I’ve had the opportunity to chat with Andrew Campbell on a couple of occasions. As Director of the Prometheus Research Team, Andrew is heavily involved in the area of mental health and technology. I’ve always been struck by Andrew’s objective view of gaming and virtual worlds, which he rightly sees as simultaneously providing significant opportunities and challenges.

I caught up with Andrew to discuss his work and perspectives on mental health, gaming and immersive virtual worlds.

DH: Can you describe the main focus of your clinical work?

AC: The main focus of my clinical work is divided into two categories. Firstly, research. My primary job is an academic researcher and teacher in the field of Psychology. I conduct research particularly in the area of Cyberpsychology, which is the study of how technology is impacting human behaviour, both in good and bad ways. Secondly, I am a general practice psychologist who specialises in child and adolescent mental health and behavioural problems. My clinical work to date has been focused on treating children with ADD/ADHD, anxiety and depression, conduct problems, as well as parental counselling and family therapy.

DH: What led your career to the stage it is at today – what got you into the issue of mental health and technology?

AC: In 1997 I was finishing my undergraduate degree in Psychology and Education at The University of Sydney and decided to spend some time in the United States working as a teaching assistant at a few universities. I became captivated with work being done by a handful of academic psychologists in the US at the time who were focusing on how the internet was going to be a revolution to impact human behaviour and society at large.

I read everything I could get my hands on at the time to do with online relationships, virtual societies and even gaming communities that were developing international reputations and new cultures in cyberspace. I asked myself at the time ‘could this be the start of a new movement in human enrichment?’ and set forth to find out the good and the bad (and the down-right terrible) aspects of spending a lot of time engrossed in an online world, be it chat, gaming, shopping, finance, politics etc. Thus, my interests turned toward career aspirations to develop psychological research and an applied track record in the use of information communication technology and the use of other technologies in helping the ‘human condition’.

DH: Arguably the number one and two areas of broader public interest with mental health and technology is gaming and violence and addiction. What percentage of your work is spent dealing with actual or perceived issues in those areas?

AC: To date, my clinical work as a generalist psychologist in child and adolescent mental health has only touched lightly on these issues. I have mainly dealt with traditional mental health concerns of parents over their children, but of those clients I have seen about gaming violence and addiction, I’ve noted that the parents themselves do not know anything about the games their children are playing. They tend to have a view that all games are violent or addictive. Given this, I normally direct parents to learn more about what their kids enjoy about their game in order to learn more about behaviours they may be modeling from the game. For example, two of my client’s parents had no idea that strategic games such as ‘Age of Empires’ actually have huge cognitive and historic learning benefits. The game is akin to modern day chess, with historical lessons of ages past. Other games that promote team play
increase problem solving skills in a collaborative environment, therefore promoting team work and clear communication strategies.

Adversely, some team playing games are based on a violent theme, such as the popular game ‘Counter Strike‘. Overall, through my work I’ve found that parents do have concerns about violence and addiction to games, but really do not have an understanding of games themselves. This is troubling in an age where gaming is increasing in popularity across generations and content is still not regulated well by Government or other ‘watchdog’ agencies. As such, parents need to be cognisant of the types of games out there – their pluses and minus points – and be involved in selecting and learning about the titles with their children in order to curtail negative behaviours related to certain genres.

DH: The issue of technology and its influence on behaviour has been around for decades, with the TV / Film and violence link being hotly debated for most of that time. Before we get onto gaming / virtual worlds, is there yet any empirical agreement on TV/Film and violent behaviour?

AC: As surprising as this may sound, no, there is not any empirical agreement on TV/Film and violent behaviour in contemporary society. Incidents such as the Columbine School Massacre and more recently, the Virginia Tech shooting have led psychologists to argue for renewed policies censuring violent films and TV shows from minors and suggestible personality types. Although games are becoming a popular target for connecting atrocious violent crimes to the perpetrator, TV and Film are still front runners in the causation of violent behaviour in, not just the younger population, but the population in general.

DH: The popular media perception of gaming is that there is at least an anecdotal link between the regular playing of violent games and violent real-life behaviour. From your work, have you seen any evidence of this?

AC: Unequivocally, no! To say that violent games or even violent TV/Film is causation for a violent crime is ludicrous. I won’t go so far to say that violent games, TV or Film have zero impact on violent crimes, but to look at it as a sole causation does not address the pathology of the individual to begin with, let alone motive to carry out the behaviour that may lead to a crime. Ergo, playing a violent game is no more likely to trigger someone’s violent behaviour than eating your favourite food is going to motivate you to become a chef! In my private practice, any child who has presented with conduct disorder or oppositional defiant disorder, or even anger management problems, may or may not have been a gamer – however – all have had pathology and environmental problems that
have led to their disorder that are more consistent and pervasive than just playing a violent video game a few hours a day.

DH: Is there actually an argument that gaming can have an ameliorating effect on real-world behaviour and if so, is there research supporting this?

AC: Yes, a number of studies have shown wonderful results helping people to ameliorate either behaviour or, in some cases, the management of pain. My own research has looked at how biofeedback video games that encourage the player to control a task on a screen using their breathing technique, has led to improved attention and relaxation strategies in ADD/ADHD children. Other research has shown that virtual reality games that are immersive can actually help in the treatment of PTSD. One of the best breakthroughs in serious games has been the treatment of burn victims from the current Iraq and Afghanistan wars. These patients have to undertake pain dressing changes and skin grafts. During these procedures, the patient plays a game called ‘Snow world’ which immerses them in an environment that triggers their subconscious into believing they are in a cool and calm environment that distracts them from the pain of the treatment they are receiving. The research in all these examples is very new, but compelling. It is beginning to influence the game developers in entertainment to consider the market for ’serious games’. This has already commenced with popular programs such as the Nintendo Wii releasing Wii fit and associated sports programs to tackle obesity.

DH: In regards to addiction and online gaming or virtual world environments, what’s your overall take?

AC: My overall take on addiction is that it is possible in either the virtual world or gaming environments online. What needs to be clarified is what aspects of these activities and functions are ‘addictive’. To say we are addicted to the Internet is like saying we are addicted to shopping – what items are we addicted to? The internet houses many areas of interest. It is obvious to posit that sex addiction offline could also be met online, as could be gambling. But gaming offline vs gaming online has different stimulus effects I would theorise.

Also, virtual worlds – what do we gain in socialising in these worlds that we don’t in our offline world? Is there such a thing as addiction to socialising?! Most likely not, because socialising is part of being human. Therefore, what is the attraction to these worlds that stimulates us highly enough to spend hours online engaging with strangers vs. meeting strangers in the offline world? The answer probably lies somewhere between the functions of pursuing anonymity, creativity, cerebral connections and/or reducing the chance of being socially awkward – all reasons one person may prefer the online world.

DH: If addiction is only quantifiable in a small component of the population, is that component larger or smaller than other behaviours such as substance use, gambling etc?

AC: I think if we look at gaming addiction in comparison to substance use, for example, we can quickly conclude that substance abuse is both physically and psychologically damaging and perhaps more wide spread globally across ages, genders and cultures. But the damage of gaming addiction is growing in certain cultures, such as in Asia where gaming is an accepted pasttime for all ages and genders and thus could be on the rise without society realising it since it is not an illegal behaviour or even an invasive or obviously destructive past time compared to drug taking.

However, it is psychologically damaging both in psychosocial relationships, employment responsibility and accountability and can even affect our general health to a large degree. You might therefore say that although substance abuse and gambling are faster and
harder-hitting addictions, gaming addiction is fast becoming a contemporary societal problem that is slow to build in destructiveness,
but easier to ignore.

DH: For those who do require actual treatment for addiction, what’s your take on the use of online treatment when the issue is related to online behaviour i.e. addressing the traditional view that you can’t use the mechanism for facilitating addiction to treat the addiction itself.

AC: One of the earliest therapies provided online by Psychologist, Dr Kimberly Young, was treatment for online addiction. She began this service, online, in the early 1990’s. Although it has been a growth industry for Dr Young and others who believe in her treatment modality, I personally find it to be flawed therapy and lacking in best-practice evidence. Addiction, be it to specific functions of the internet, gaming, substance abuse, gambling etc, is an extremely difficult pathology to treat, let alone treat well. Therefore, all scientific practice indicates that addiction therapy should be done in a face-to-face or group counselling environment. It requires ongoing resource support utilising mentors, friends and family. It is something that may (but only in very specifically suitable cases) use the internet as a support tool, but in all other regards addiction, especially to internet functions and gaming, should be done away from the primary stimulus.

DH: With growing immersiveness in gaming and in virtual worlds more broadly, what do you see as the mental health challenges and opportunities?

AC: Research right now is looking out how we can harness immersive environments, be they virtual worlds or games, for tackling problems in health, behaviour and education. The challenges we face at the moment are actually not to do with the quality of the environments being delivered to consumers over the internet or through off-the-shelf games, but more through the cost of developing serious games or health purpose virtual worlds by the commercial sector. In addition, we are facing a health professional vs tech industry challenge in trying to have these two expert bodies effectively harness the ideas that are scientifically based delivery of health interventions. In short – the health professionals need to learn more about the tech industry and vice versa. Once this bridge is finally built, I believe we will be entering a new error of technology consumerism – games for wellbeing and ICT for personal health management.

The Chi-Town Daily News has a good article on The
University of Illinois at Chicago School of Public Health recruiting public health workers to participate in emergency preparedness training, in Second Life.

Why bother? Here’s why:

Emergency preparedness training usually requires closing down facilities and calling people off of work—but conducting emergency drills virtually is less disruptive and more convenient, says Colleen Monahan, the study’s principal investigator. Nearly all public health departments in the U.S. train workers for emergencies through traditional tabletop exercises and simulated real world drills.

Nothing beats the real thing but in the disaster preparation space that’s not usually an option so the virtual world route can be a very useful adjunct.

As mentioned last month, I had the pleasure of attending a conference on e-health as well as an evening discussion on the formation of a Games for Health special interest group as part of HISA.

Aside from the very exciting outcomes from both those events, which I’ll discuss further in the future, it forced me to try my somewhat amateur hand at creating a machinima showcasing some of the many impressive health presences in Second Life. It’s now available online for viewing:

Being so short it doesn’t do any of the presences featured the justice they deserve, let alone all the ones missed. I’m hoping to make a more substantive piece in the future, so if you have suggestions of other areas to feature, please don’t hesitate to put them in the comments.

The latest issue of the Journal of Medical Internet Research has an article on Second Life and its uses in a health context. The Canadian researchers surveyed 68 health presences in Second Life and came to the following conclusion:

We found a wide range of health-related activities on Second Life, and a diverse group of users, including organizations, groups, and individuals. For many users, Second Life activities are a part of their Web 2.0 communication strategy. The most common type of health-related site in our sample (n = 68) were those whose principle aim was patient education or to increase awareness about health issues. The second most common type of site were support sites, followed by training sites, and marketing sites. Finally, a few sites were purpose-built to conduct research in SL or to recruit participants for real-life research.

You can read the full article here. There’s also an appendix listing the 68 sites.

Nicola Johnson from the University of Wollongong in Australia, recently released a book titled The Multiplicities of Internet Addiction – The Misrecognition of Leisure and Learning. It’s an engaging read, not least for the very objective look it takes at the concepts of internet addiction and framing the issue within the realities of a net-connected society that has changed immensely in the past twenty years or so.

Bourdieu’s Theory of Practice is the frame for the qualitative study of eight New Zealander teenagers and the illumination it provided on the perception of technology use amongst those who’ve know no different (digital insiders), those who haven’t (digital newcomers) and those who are plain not interested (digital outsiders). Additionally, there’s some fascinating discussion on how expertise is being developed by digital insiders and how this expertise is at best partially gained from the traditional educational institutions in place at present.

It’s the elaboration of the experiences of these eight teens that allow Johnson to weave in a great deal of the substantive research that’s occurred into the nature of addiction in regard to online activity. There’s no assertion of internet addiction as non-entity, just a much smaller subset of use than usually claimed. As contributing writer Feldspar Epstein has written previously in relation to heavy use of virtual worlds by people with disabilities:

Can you imagine telling someone with no legs to forsake their wheelchair? How about someone with a pain disorder? Are you going to tell people with crippling mental disorders that they are not allowed to take drugs to normalize and enable them? Are you going to tell deaf people they can’t use Teletype in place of the telephone?

Each of these technological advances were radical in their time; some of them were seen as being destructive, to society or to the individual. It’s hard to imagine any of these people being denied their enabling technologies in today’s first world society (one hopes). I hope to live in a future where my enabling computer habits are accepted.

Johnson’s assertions based on a thorough exploration of the literature, reveal a similar conclusion: internet addiction does exist, but when the preconceptions of digital newcomers and digital outsiders are removed from the equation, the prevalence of internet addiction seems pretty limited indeed. As Johnson concludes:

Digital outsiders (and some digital newcomers) find it unfathomable to understand the preoccupation that digital insiders have with their online lives. Because it is not what they did in times gone by, they find it difficult to understand the value, worth and social capital received by avid users in what appears to be an unhealthy obsession. As I have argued, these practices are not only misrecognized as obessions or addictions, but they are misunderstood.

This book’s research base means it’s more likely to be consumed and digested by those who are doing research or study in the area themselves. Which is a shame, as the discussion deserves wider recognition and debate. Work like this balances out some of the excesses on the mainstream media side of the equation. It’s only a lack of dissemination of this perspective that will ensure the sensationalism camp prevails for some time to come.

You can purchase this book from our online bookstore, Amazon direct or direct from the publisher.

Australia’s ABC TV recently screened an interesting piece on the use of virtual reality in the treatment of Post-Traumatic Stress Disorder – you can view it here.

There’s also an extra 7-minute interview with a US Marine whose PTSD treatment was benefitted by the use of virtual reality.

As a Registered Nurse with a passion for the use of emerging technologies to improve health, it can sometimes be a little frustrating when things don’t seem to progress as fast as one would like. There’s also the ‘they just don’t get it’ phenomenon amongst some in health leadership and management roles, which can lead to the conclusion that progress is all too slow with new approaches.

A stark contrast to that is occurring this week in Melbourne, Australia, with the HealthBeyond e-health Consumer Day. I was very happy to be invited to attend this event to provide participants with a tour of some key health presences in Second Life in conjunction with what will no doubt be an engaging keynote from Mandy Salomon . It’ll be difficult to choose which health areas in Second Life with so many great options, but I do know the University of Plymouth’s sexual health sim is going to feature.

It’s great to see the Health Informatics Society of Australia taking such a lead, featuring virtual worlds, serious games for health and broader gaming for exercise and stimulation in a get-together of this calibre. I have a feeling there’s going to be some exciting announcements come out of the gathering for the Australian health sector, which I’ll report on in coming weeks.