Acceptance of Serious Games in Psychotherapy: An Inquiry into the Stance of Therapists and Patients.

BACKGROUND: Serious games are computer or video games that contain elements that are specifically designed for the purpose of education or training. Serious games are increasingly being used within healthcare, but their introduction into and application in psychotherapeutic settings as an e-mental health treatment modality raises questions for both patients and therapists. Current research demonstrates the potential role and effectiveness of serious games within a psychotherapeutic context. However, a limited understanding of patients' and therapists' existing knowledge and experience of serious games, as well as of their readiness to utilize and apply them for the treatment of psychological conditions, requires further investigation. MATERIALS AND METHODS: Acceptance, experience, and requirements for the utilization of serious games in therapeutic contexts were assessed through online surveys with German-speaking patients (n = 260) and psychotherapists (n = 234). Respondents' answers were analyzed by a combination of descriptive and inferential statistics by using SPSS. RESULTS: Current knowledge regarding serious games was very limited, with only 10.4% of patients and 11.5% of therapists reporting existing knowledge. However, a general openness toward the concept was observed: 88% of patients and 90% of therapists could envisage a therapeutic use. Patients (rs = 0.169, p = 0.006) who self-rated their level of computer and video game expertise as high were more likely to consider use within psychotherapy, compared with patients who self-rated their expertise as low. Therapists who currently play computer and video games perceive fewer disadvantages of serious game application in a psychotherapeutic context (p = 0.097). Consideration of serious game use was differentiated by the therapeutic approach (p = 0.003), specific mental disorders (highest rated relevant cases: anxiety disorders, affective disorders, disorders regarding impulse control, and adjustment disorders), and patient age (i.e., use with young adults was deemed the most appropriate by 91.8% of therapists). CONCLUSION: The application of serious games is conceivable for patients and therapists, especially as a complementary element to traditional face-to-face psychotherapy. Acceptance is strongly related to therapeutic context. Only a small number of therapists and patients agree on the possibility of using a serious game instead of face-to-face therapy.

Changes in neural connectivity underlie decision threshold modulation for reward maximization.

Using neuroimaging in combination with computational modeling, this study shows that decision threshold modulation for reward maximization is accompanied by a change in effective connectivity within corticostriatal and cerebellar-striatal brain systems. Research on perceptual decision making suggests that people make decisions by accumulating sensory evidence until a decision threshold is crossed. This threshold can be adjusted to changing circumstances, to maximize rewards. Decision making thus requires effectively managing the amount of accumulated evidence versus the amount of available time. Importantly, the neural substrate of this decision threshold modulation is unknown. Participants performed a perceptual decision-making task in blocks with identical duration but different reward schedules. Behavioral and modeling results indicate that human subjects modulated their decision threshold to maximize net reward. Neuroimaging results indicate that decision threshold modulation was achieved by adjusting effective connectivity within corticostriatal and cerebellar-striatal brain systems, the former being responsible for processing of accumulated sensory evidence and the latter being responsible for automatic, subsecond temporal processing. Participants who adjusted their threshold to a greater extent (and gained more net reward) also showed a greater modulation of effective connectivity. These results reveal a neural mechanism that underlies decision makers' abilities to adjust to changing circumstances to maximize reward.

Motion as input: a functional explanation of movement effects on cognitive processes.

Motion is often thought of as the result of perceptual and higher cognitive processes. Although this idea has been investigated in myriad ways, the understanding of how movements tune cognitive processes is still in its infancy. The present study examined the nonaffective tuning of movements (arm extension and arm flexion) on heuristic and systematic processes. In a departure from recent cognitive tuning models, a model was derived that defines the tuning effect based on the movement goal and not on the movement position. In the experiment, participants moved toward an extension or flexion position with a movement goal which connected the movement with either an avoidance or an approach function. Analysis indicated that cognitive tuning is a product of the movement goal rather than the movement position. Implications for models of motor control as well as for cognitive tuning models are presented.

Reduction of influence of task difficulty on perceptual decision making by STN deep brain stimulation.

Neurocomputational models of optimal decision making ascribe a crucial role-the computation of conflict between choice alternatives-to the subthalamic nucleus (STN). Specifically, these models predict that deep brain stimulation (DBS) of the STN will diminish the influence of decision conflict on decision making. In this work, patients with Parkinson's disease judged the direction of motion in random dot stimuli while ON and OFF DBS. To induce decision conflict, we varied the task difficulty (motion coherence), leading to increased reaction time (RT) in trials with greater task difficulty in healthy subjects. Results indicate that DBS significantly influences performance for perceptual decisions under high decision conflict. RT increased substantially OFF DBS as the task became more difficult, and a diffusion model best accounted for behavioral data. In contrast, ON DBS, the influence of task difficulty on RT was significantly reduced and a race model best accounted for the observed data. Individual data fits of evidence accumulation models demonstrate different information processing under distinct DBS states. Furthermore, ON DBS, speed-accuracy tradeoffs affected the magnitude of decision criterion adjustment significantly less compared to OFF DBS. Together, these findings suggest a crucial role for the STN in adjusting decision making during high-conflict trials in perceptual decision making.

Perceptual decision making: a bidirectional link between mind and motion.

Perceptual decision making is the process by which information gathered from sensory systems is combined and used to influence our behavior. Importantly, however, the route from perception to action is not a one-way street, rather, perception and action interact continuously. In this chapter, we synthesize a bidirectional view on perceptual decision making by discussing behavioral, neuroscientific, and computational findings in the context of one embodiment framework. We conclude that there is evidence for the liaison of action and perception in simple decision-making tasks. This framework may also be extended to reward-based decision making in humans.

How are actions physically implemented?

This chapter focuses on the interdisciplinary discussion between cognitive psychologists and neuroscientists on how actions, the results of decision processes, are implemented. After surveying the approaches used in action implementation research, we analyze the contributions of these different approaches in more detail. Topics covered include expertise research in sports science, knowledge structures, neuroscientific research on motor imagery and decision making, computational models in motor control, robotics, and brain-machine interfaces. This forms the basis for discussing central issues for interdisciplinary research on action implementation from different viewpoints. In essence, most findings show the need to abandon serial frameworks of information processing suggesting a step-by-step pattern from perception, evaluation, and selection to execution. Instead, an outlook on new approaches is given, opening a route for future research in this field.