Games for Treating and Diagnosing Post Traumatic Stress Disorder

  • Christoffer Holmgård
  • Karen-Inge Karstoft
Part of the Socio-Affective Computing book series (SAC, volume 4)


This chapter describes the use of games for addressing Post Traumatic Stress Disorder, a syndrome with a strong emotional component, characterized by among other things hyper-arousal. A number of games and game-like tools for treating Post Traumatic Stress Disorder are described. Subsequently, the chapter describes the design, development, and testing of a specific game for addressing Post Traumatic Stress Disorder which uses emotion recognition to characterize and target patient treatment. In clinical testing the game is found to elicit stress in patients suffering from Post Traumatic Stress Disorder based both on self-reports and physiological indicators of stress and arousal. Further, is shown that features extracted from the physiological signals can be combined with patient background information to predict measures of Post Traumatic Stress Disorder severity. This suggests that the combination of games and measurement of physiological indicators of emotional responses holds potential for creating novel tools for treating and diagnosing mental health disorders.


Post Traumatic Stress Disorder Skin Conductance Skin Conductance Response Physiological Arousal Automatic Feature Selection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This research was supported by the Danish Council for Technology and Innovation under the Games for Health project and by the FP7 ICT project ILearnRW (project no: 318803). We thank all veterans who chose to support the research with their participation.


  1. 1.
    Albright G, Goldman R, Shockley KM, McDevitt F, Akabas S (2012) Using an avatar-based simulation to train families to motivate veterans with post-deployment stress to seek help at the VA. Games Health Res Dev Clin Appl 1(1):21–28CrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DCGoogle Scholar
  3. 3.
    Benedek M, Kaernbach C (2010) A continuous measure of phasic electrodermal activity. J Neurosci Methods 190(1):80–91CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Benedek M, Kaernbach C (2010) Decomposition of skin conductance data by means of nonnegative deconvolution. Psychophysiology 47(4):647–658PubMedPubMedCentralGoogle Scholar
  5. 5.
    Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA (1996) Psychometric properties of the PTSD checklist (PCL). Behav Res Ther 34(8):669–673CrossRefPubMedGoogle Scholar
  6. 6.
    Boucsein W (2011) Electrodermal activity. SpringerGoogle Scholar
  7. 7.
    Cukor J, Spitalnick J, Difede J, Rizzo A, Rothbaum BO (2009) Emerging treatments for ptsd. Clin Psychol Rev 29(8):715–726CrossRefPubMedGoogle Scholar
  8. 8.
    First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition. (SCID-I/P). Biometrics Research, New York State Psychiatric Institute, New York, Nov 2002Google Scholar
  9. 9.
    Foa EB, Keane TM, Friedman MJ, Cohen JA (2009) Effective treatments for PTSD, practice guidelines from the International Society for Traumatic Stress Studies, 2nd edn. Guilford Press, New YorkGoogle Scholar
  10. 10.
    Gates MA, Holowka DW, Vasterling JJ, Keane TM, Marx BP, Rosen RC (2012) Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychol Serv 9(4):361CrossRefPubMedGoogle Scholar
  11. 11.
    Holmes EA, James EL, Coode-Bate T, Deeprose C (2009) Can playing the computer game “tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. PLoS One 4(1):e4153CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Holmgard C, Yannakakis GN, Karstoft K-I, Andersen HS (2013) Stress detection for PTSD via the startlemart game. In: 2013 humaine association conference on affective computing and intelligent interaction (ACII). IEEE, pp 523–528Google Scholar
  13. 13.
    Hoque ME, Lane JK, El Kaliouby R, Goodwin M, Picard RW (2009) Exploring speech therapy games with children on the autism spectrumGoogle Scholar
  14. 14.
    Kashdan TB, Breen WE, Julian T (2010) Everyday strivings in war veterans with posttraumatic stress disorder: suffering from a hyper-focus on avoidance and emotion regulation. Behav Ther 41(3):350–363CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kato PM (2010) Video games in health care: closing the gap. Rev Gen Psychol 14(2):113CrossRefGoogle Scholar
  16. 16.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52(12):1048–1060CrossRefPubMedGoogle Scholar
  17. 17.
    Mahan AL, Ressler KJ (2012) Fear conditioning, synaptic plasticity and the amygdala: implications for posttraumatic stress disorder. Trends Neurosci 35(1):24–35CrossRefPubMedGoogle Scholar
  18. 18.
    Martínez HP, Yannakakis GN (2011) Mining multimodal sequential patterns: a case study on affect detection. In: Proceedings of the 13th international conference on multimodal interfaces. ACM, pp 3–10Google Scholar
  19. 19.
    Parsons TD, Rizzo AA (2008) Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. J Behav Ther Exp Psychiatry 39(3):250–261CrossRefPubMedGoogle Scholar
  20. 20.
    Perala CH (2007) Galvanic skin response as a measure of soldier stress. Technical report, DTIC DocumentCrossRefGoogle Scholar
  21. 21.
    Pole N (2007) The psychophysiology of posttraumatic stress disorder: a meta-analysis. Psychol Bull 133(5):725CrossRefPubMedGoogle Scholar
  22. 22.
    Reger GM, Holloway KM, Candy C, Rothbaum BO, Difede JA, Rizzo AA, Gahm GA (2011) Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. J Trauma Stress 24(1):93–96CrossRefPubMedGoogle Scholar
  23. 23.
    Rizzo A, Reger G, Gahm G, Difede JA, Rothbaum BO (2009) Virtual reality exposure therapy for combat-related PTSD. In: Post-traumatic stress disorder, pp 375–399Google Scholar
  24. 24.
    Rizzo A, Buckwalter JG, John B, Newman B, Parsons T, Kenny P, Williams J (2011) Strive: stress resilience in virtual environments: a pre-deployment VR system for training emotional coping skills and assessing chronic and acute stress responses. Stud Health Technol Inform 173:379–385Google Scholar
  25. 25.
    Rothbaum BO, Rizzo A, Difede J et al (2010) Virtual reality exposure therapy for combat-related posttraumatic stress disorder. Ann N Y Acad Sci 1208(1):126–132CrossRefPubMedGoogle Scholar
  26. 26.
    Rumelhart DE (1995) Backpropagation: theory, architectures, and applications. Lawrence Erlbaum, HillsdaleGoogle Scholar
  27. 27.
    Schnurr PP, Lunney CA, Sengupta A, Waelde LC (2003) A descriptive analysis of PTSD chronicity in Vietnam veterans. J Trauma Stress 16(6):545–553CrossRefPubMedGoogle Scholar
  28. 28.
    Siepmann M, Grossmann J, Mück-Weymann M, Kirch W (2003) Effects of sertraline on autonomic and cognitive functions in healthy volunteers. Psychopharmacology 168(3):293–298CrossRefPubMedGoogle Scholar
  29. 29.
    Wagner J, Kim J, André E (2005) From physiological signals to emotions: implementing and comparing selected methods for feature extraction and classification. In: IEEE international conference on multimedia and expo. IEEE, pp 940–943Google Scholar
  30. 30.
    Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM et al (1993) The PTSD checklist (PCL): reliability, validity, and diagnostic utility. In: Annual meeting of the international society for traumatic stress studies, San AntonioGoogle Scholar
  31. 31.
    Wiederhold BK, Wiederhold MD (2008) Virtual reality for posttraumatic stress disorder and stress inoculation training. J Cyberther Rehabil 1(1):23–35Google Scholar
  32. 32.
    Wolpe J (1973) The practice of behavior therapy. Pergamon Press, New YorkGoogle Scholar
  33. 33.
    Wood DP, Webb-Murphy J, McLay RN, Wiederhold BK, Spira JL, Johnston S, Koffman RL, Wiederhold MD, Pyne J et al (2011) Reality graded exposure therapy with physiological monitoring for the treatment of combat related post traumatic stress disorder: a pilot study. Stud Health Technol Inform 163:696PubMedGoogle Scholar
  34. 34.
    Yannakakis GN, Hallam J (2008) Entertainment modeling through physiology in physical play. Int J Hum-Comput Stud 66(10):741–755CrossRefGoogle Scholar
  35. 35.
    Yannakakis GN, Martínez HP, Jhala A (2010) Towards affective camera control in games. User Model User-Adapt Interact 20(4):313–340CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Center for Computer Games ResearchIT University of CopenhagenCopenhagenDenmark
  2. 2.Forsvarets VeterancenterRingstedDenmark

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