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Enhancing meditation techniques within Virtual Reality to treat neck impairments during rehabilitation and recovery.

Guilherme Yukio Ogassawara  

 

Abstract 

 

A Research documentation states the relationship between both meditation methods and virtual reality, it demonstrates how they can operate together to support neck impairment rehabilitation. An artefact will be produced with a detailed design guide line that shows current methods of meditation within virtual reality and how they can be enhanced through an developed application. The application artefact will serve as a point to feature the design guideline. The application is designed and executed by the design guideline that serves as a guide to demonstrate methods of meditation that can be applied to virtual reality.

Chapter 1 - Introduction

 

1.1 Statement of intent


The purpose of this research is to understand and demonstrate how current Virtual Reality methods deal with patients going through neck impairment rehabilitation.

 

To be specific, we will dive into the topics of the numerous beneficial effects of meditation and how the practice can be incorporated into virtual reality, as well as how virtual reality can be used for aiding patients with chronic pain and physical injuries, on their journeys towards recovery and reaching full neck mobility, which has most likely been stolen away from them.

 

When people are afflicted with serious neck injuries, some form of neck rehabilitation is often required in order to get them back to their previous and healthy state, or at the very least, it can dramatically speed up the process of doing so. However, most of us are aware of the necessity of physical rehabilitation when dealing with injuries. The main question is, what does virtual reality have to do with this? Why would someone choose to undergo physical therapy by using virtual reality, rather than just receiving standard rehabilitation?

 

Firstly, I want to make it clear that I’m not advocating for virtual reality to take over from normal physical rehabilitation as the primary source of recovery. Instead I suggest that it should be used as either the first step in the recovery process, when patients aren’t quite yet ready physically for the standard procedures, or lack confidence in their ability levels to manoeuvre properly. Or to be used as a subsidiary regime to compliment the physical rehabilitation process. This could potentially be used by doctors while treating patients who are bedridden or have little to no mobility. We may need to train the doctors in how to properly apply and use this with their patients, or potentially train and bring in VR medical specialists. Alternatively it could also be turned into a software program that’s run on VR and put on sale to the public so that they can buy and use it from home. There are few possibilities when it comes to how it's incorporated and distributed. Examples of this could be releasing the app on Steam, or even the Oculus app. 

 

1.2 - Clients who may benefit from this work

There are many different causes for neck pain. I’ll briefly cover some of the most common causes. One of the most common types is whiplash where your head is abruptly and unexpectedly, thrown forwards and backwards with a sudden jolt. The severity of these injuries can vary, from ligament damage, muscle damage, and sometimes even nerve damage. A common cause for this particular injury are car crashes, although it can occur from other sources too.

 

 Sporting injuries are also another cause of neck injuries, players in high contact sports such as rugby can easily pick up a neck injury from a bad tackle or fall. 

 

Poor posture and stress can also be a factor in neck injuries, hunching without proper posture can cause all kinds of muscle imbalances in your body which can lead to neck strain, the same can occur with poor sleeping posture. 

 

Arthritis is yet another cause, but in this case it is caused by the cartilage, which is the protective layer of your bones, breaking down which will then result in pain since the protective layer is no longer there. 

 

There are certain illnesses that also can lead to pain such as cancer and meningitis. In the case of meningitis the cause of the pain is due to inflammation.

 

 Last but not least, are pinched nerves. Which can be caused by spinal issues such as age related degeneration where the disks in your back may compress or shorten.

 

 For the sake of this research, I’m going to be mainly focusing on the rehabilitation of neck injuries caused by physical injuries, such as whiplash caused by car crashes, or sports injuries. This is because the methods I’ll be using will most likely show more benefit towards those kinds of injuries, compared to nerve damage and inflammation which are causes of the other types.

 

Neck pain can be very limiting to those who suffer from it, so it’s important to offer people suffering from these afflictions more options and paths towards their recovery. It’s quite easy to only focus on the physical aspects of recovery and to neglect the mental side of recovery. Infact, it’s possible that certain people don’t even realise the benefits of being in the correct state of mind when it comes to your overall health and recovery process. I hope to enlighten these sufferers to these benefits and help guide them to the best recovery they can achieve. By giving them the confidence to tackle these neck mobility problems. As I’ve been made aware, it can be very scary to push yourself into doing advanced neck movements when you know you have limitations, but by bringing Virtual Reality into the equation, we can use methods to slightly deceive patients into pushing themselves further than they realise, without going overboard into dangerous territory. I’ll expand more on this later. 

 

The main goals for the patients are to get them in an optimal mood and mental state that will reduce anxiety levels and promote recovery. To help them sleep more efficiently, as sleep is crucial to the body’s health and recover, and is also a big obstacle for a lot of people suffering from neck pain. A study on soccer players highlights the importance of sleep ”Sleep is an essential part of recovery management. Sleep disturbance after a match is common and can negatively impact the recovery process.”(Mathieu Nédélec, Alan McCall, Chris Carling, Franck Legall, Serge Berthoin & Gregory Dupont, 2012) This is further supported in a 2009 study. “In the long run, reduced or impaired sleep leads to metabolic diseases, depression, burnout, and mortality. Stress and irregular hours are among the main causes of disturbed sleep.” (Torbjörn Åkerstedt, Peter M. Nilsson, Göran Kecklund, 2009) Good sleep is vital in keeping your body healthy and preventing these nasty side effects that will hinder your recovery. As well as incorporating the necessary physical recovery elements. But ultimately the overall goal is to restore the patients full range of motion within their necks, without experiencing pain. Once this has been achieved, I can consider the process a success.

 

Targets towards neck rehabilitation

  • Doing daily, neck focused stretches.

  • Daily meditation (within VR)

  • Teaching and maintaining correct posture

  • Massage therapy / cervical traction

 

The daily stretches will help to rebuild the muscles within the neck, making them stronger and also more flexible. Another added benefit is that depending on the type of neck injury, this can also help to reduce swelling in the neck, which in turn reduces the pain the patients will feel.

 

The meditation will help to reduce stress, and may encompass gentle and relaxing stretches during the process. This process could even be combined with rehabilitation devices such as a Multi Cervical Unit, which supports the neck and head, holding it in place, while the patient does their stretches. A VR headset could be worn throughout this process to make it more engaging and calming.

 

Ensuring proper posture is crucial to a healthy rehabilitation as it will reduce the chances of worsening the injury that has already occured, as well as help to prevent further injuries in the future. This is especially important with the neck as asymmetrical injuries can occur from poor posture. Certain people will have imbalances caused by this where they have a larger range of mobility turning or leaning to one side, while the opposite side will be much tighter and restricted when it comes to the same movements. This correct posture is also essential when considering your sleep position too.

 

With cervical traction there are two options, manual traction, which is performed by a physical therapist. The patient will lie down flat on their backs, usually with some sort of head or neck support under them. Then the therapist will slowly pull the patient's head away from their neck. However this can also be done with a mechanical device, where the patient is strapped down with a harness. Whichever method is chosen, the goal is to rid the patients of sprains, spasms and even trapped nerves by stretching the spine and neck out. Unfortunately there is little scientific proof to validate how effective this method truly is, however this process is optional and certain patients give promising anecdotal evidence of it helping.

 

By doing these exercises on a daily basis we hope to achieve the following:

 

  • Recovering neck mobility to its usual range of motion.

  • Eliminating pain, swelling and stiffness.

  • To strengthen the neck muscles.

  • Prove the patient with adequate knowledge to prevent reinjury.

 

The usual neck flexion range is anywhere from around 40 to 80 degrees in human beings. People suffering with neck pain will generally be unable to achieve this range of motion without feeling pain or discomfort, sometimes the task will even be impossible for them. So once they are able to gain back a normal range of motion between 40 to 80 degrees, we can gauge that as a sign of a healthy neck. This can be measured by the usage of a Goniometer

 

Eliminating any pain and discomfort while rotating the neck is also crucial. Even if the patient can rotate their neck to the appropriate degrees that is expected, it doesn’t mean much if it's still causing them discomfort and pain. So not until both of these two factors are achieved in unison can we consider the therapy to be a success.

 

After we have achieved these two main milestones. We want to focus on building back strength in the neck muscles and equipping patients with the ability to prevent future injuries from reoccurring. Correct posture can play a huge role in this, as it will decrease the stress and strain put on your neck, as it won’t have to compensate for other muscle groups elsewhere in the body.

1.3 - What needs further research

In order to grasp a proper understanding of how efficient this treatment can be, I will need to study the effects of meditation when combined with the use of virtual reality, as it's not something that has been greatly explored just yet. Meditation in general, has many studies that seem to find mostly positive effects from meditation, which I will cover in the research corpus section of this paper. So the hope is that we can enhance the preexisting benefits through the added use of VR.

 

 We also would have to do more research into the different types of meditation and try to discover which kind will have the most positive effects for this recovery process. As well as which methods synergies the best in a virtual environment. So more research into these areas can definitely be done. 

 

1.4 - My approach to meditation

The methods that I will be using will be meditation techniques combined with virtual reality. There are many different types of meditation styles out there, such as; spiritual meditation, focused meditation, movement meditation, mantra meditation, transcendental meditation, progressive meditation and visualisation meditation, however for the majority of this paper I’ll be referring most of my research towards mindfulness meditation. Mindfulness meditation has had the most research and concrete information done about it. However if a patient were to try out different styles, and showed progress using that certain technique, that wouldn’t be a problem. It’s possible that we could offer the different styles to them and let them choose their favourite approach. That being said if I found one technique to be more effective overall for most people, we’d most likely stick with that approach. As visualisation meditation and movement mediation seem to have potentially promising indications too.

 

1.5 - Possible problems I need to consider

Another topic I need to strongly consider is the implementation and creation of my software. I will need to design and come up with exercises for neck movements and meditation sessions that will be beneficial to the patients. I will also need to incorporate some sort of difficulty settings / time settings that increase and they go along their recovery journey in order for it to stay effective as they progress forward. Since they’ll wear the VR headset on their head, I’ll also need to consider if the added weight of the headset to the head will impact their neck injury, if this does end up being the case, maybe they’ll have to wear the headset in a certain position, or they’ll need a newly designed, lighter headset, or maybe something like virtual reality goggles, if that’s possible. These are the many things that will need to be carefully planned out and tested over time.

 

Chapter 2 - Research Corpus

2.2 - History of Meditation

Moving on to the meditation side of things. There are many benefits to meditation, which I will cover throughout this essay, but first I want to look back at the history of meditation. Meditation has supposedly been traced back to as far as 5,000 BCE and has been practiced in many different cultures and religions, such as in Buddhism, Judaism, Jainism, Sikhism and Hinduism. The fact that meditation has cemented its way into the practices of so many cultures and religions, while also standing the test of time, as it’s still quite a popular practice even in this day and age for certain groups of people, gives you a good indication that meditation is very impactful for those who practice it. But is this all just spiritual placebo, or is there scientific data and facts to back up the claims of meditation, and more importantly, what does it have to do with physical rehabilitation and virtual reality.

 

2.3 - Different types of Meditation

Just as a preface to this section on meditation. I’m aware that there are many different types of meditation styles out there, as i mentioned earlier, those are:

 

  • Mantra meditation.

  • Spiritual meditation.

  • Focused meditation.

  • Movement meditation.

  • Transcendental meditation.

  • Progressive meditation.

  • Visualisation meditation.

 

Manta meditation is where the person focuses and repeatedly says a certain phrase or word that holds value to them, or something that they want to achieve or manifest. This is often done to help keep their mind focused and free from distraction, however it can also be used as a tool towards spiritual meditation, which often will incorporate a religious based mantra or sentiment instead. This also can be replaced with a prayer or message to God or the universe. 

 

Visualisation meditation is where you try to focus on a certain outcome or event, something you want to achieve or obtain. You try to imagine what it would feel like to obtain it, how would you feel, what would you say, how would you act, you try to imagine the sensations of your five senses to vividly imagine this reality. 

 

Movement meditation is essentially meditation combined with movement. Many yogas practices incorporate this sentiment and try to combine the two, in order to create a union between the physical body and the mind. This tends to stress having your attention on the breath as you move your body into different poses and positions.

 

However for the majority of this paper I’ll be referring most of my research towards mindfulness meditation.  

 

2.4 - What is Mindfulness Meditation

Since mindfulness meditation is the technique that I’m going to focus on, I’m going to go into further detail as to what the process entails. Mindful meditation is the most popular form of meditation to be accepted into western culture and has said to have originated from the Buddhist faith. While practicing mindfulness meditation you are often advised to observe your body and breathe, while allowing thoughts to come and go, while resisting the urge to get caught up in them or judge those thoughts, as soon as you notice that your mind has wandered, you bring back your realisation back to your breathe, or whatever physical sensation you're focusing on. This meditation practice is known for increasing your concentration and awareness. 

2.5 - Benefits of meditation 

Now that we’ve established the different forms of meditation, as well as the one that we’re going to be focusing on, it’s time to get into and analyse the numerous benefits of meditation and they explain how these benefits can play a crucial role towards the recovery process of the patients.

Reducing pain

When we think of pain we often just think of it as a physical ailment. However there is research that shows that your emotional and mental state can impact the amount of pain you sense and feel. “Several potentially modifiable psychological risk factors for chronic pain have been identified, such as anxiety, depression, pain catastrophizing and pain-related fear” (Melanie Berube, Celine Gelinas, Manon Choiniere, Nancy Freely, Geraldine Martorella. Stefan Parent and David L. Streiner, September  2017).

As shown by this study, if you can reduce or even eliminate these physical factors from a patient's condition, you greatly decrease their odds at suffering from chronic pain in the future. This is why I’ve highlighted meditation as a key implementation within Virtual Reality rehabilitation, as meditation has had many studies done, that show indications that it can lessen the symptoms of anxiety, depression and other negative emotional and mental states of mind, that may hamper a person's recovery.


 

A study from 2015 evaluated meditations effects within the role of reducing physical pain, along with other placebo sources and came to this conclusion. “mindfulness meditation produces greater pain relief and employs distinct neural mechanisms than placebo cream and sham mindfulness meditation. Specifically, mindfulness meditation-induced pain relief activated higher-order brain regions, including the orbitofrontal and cingulate cortices. In contrast, placebo analgesia was associated with decreased pain-related brain activation. These findings demonstrate that mindfulness meditation reduces pain through unique mechanisms and may foster greater acceptance of meditation as an adjunct pain therapy.” (Fadek Zeidan, Nichole M. Emerson, Suzan R. Farris, Jenna N. Ray, Youngkyoo Jung, John G. McHaffier, and Robert C. Coghill, November 2015)These findings tell us that meditation causes a great sense of pain relief when compared to other standard placebo procedures and products, which strongly suggests that there is something more to meditation than it just being a mere placebo effect. Considering the results of the research, it's my belief that it’s worth investing into and offering patients this option as an added form of recovery while they go through this painful and sometimes crippling affliction.

 

Improving mental state

Using guided mindfulness meditation within virtual reality, has shown to have a beneficial impact on a person’s mental state after participating. Even if people are skeptical at first, after one session, I believe there is a strong chance that they will notice the difference and be more open to the idea of trying VR meditation in the future. This is supported by the following study. “participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed.” Further going on to state “These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to practice mindfulness based on clinical expert feedback.” (Maria V. Navarro-Haro, Yolanda Lopez-del-Hoyo, Daniel Campos, Marsha M. Linehan, Hunter G. Hoffman, Azucena Garcia-Palacios, Marta Modrego-Alarcon, Luis Borao, Javier Garcia-Campayo, November 2017) It makes sense for people to be skeptical about new approaches, especially if they’ve never heard about them, or experienced them before. But it is easier to convince people after they try it out for themselves and experience the benefits first hand. However, like I stated earlier, the combination of these methods are still fairly new with limited research, so we would need to test and research these principals ourselves.

2.6 - Common Methods of Meditation Within Virtual Reality

Guided meditation seems to be the common form of meditation within virtual reality. This makes sense, as most people who are getting into meditation are a little unsure of how exactly to meditate properly and like to have a little bit of guidance to put them on the right track. It’s also helpful for beginners to get little prompts and reminders now and again to prevent them from derailing and getting lost in their thoughts for extended periods of time.

2.7 - Benefits of Meditation in Virtual Reality

Compared to normal meditation, virtual reality can make meditation much more engaging and powerful for some people. One reason for this is that virtual reality does a much better job at engaging your senses and cutting down external distractions from the outside world. With virtual reality, you can go literally anywhere in the world, a beach, a garden, a forest, a waterfall, or even a quiet cosy cabin in the middle of the alps. On Top of this, you can also select any kid of musical soundtrack or background noise that you want, waves crashing, the wind howling, the rain pattering down, or birds chirping, you can customise these sensory settings to your own preference which will really help the patients to relax in their favourite or ideal places to be. This experience is something that you can’t often do in the real world, well not without a lot of time and money, unfortunately most of use can’t just get up and end up on a beach, it's too far, costs too much money and we have other commitments, but with the world of virtual reality, you can end up there within an instant. I believe these sentiments are supported by the research of a 2016 paper.  “In a user study of 43 subjects, we were able to show that the RelaWorld system elicits deeper relaxation, feeling of presence and a deeper level of meditation when compared to a similar setup without head-mounted display or neurofeedback.” (Iikka Kosunen, Mikko Salminen, Simo Jarvela, Antti, Ruonala, Niklas Ravaja and Giulio Jacuci, March 2016). Making sure that patients stick to their daily routines of rehabilitation is vital for optimum recovery. However certain patients may get bored or not find the motivation to complete these daily tasks. So by using virtual reality to make this recovery time an enjoyable experience, it can really help patients to stay on track, and it may even become a part of the day that they look forward to. 

“Acute and chronic neck pain are common medical conditions, and the treatment typically includes physical therapy involving daily exercises. Insufficient motivation of people afflicted with neck pain to adhere to the prescribed exercise regimen may delay their recovery. Accordingly, in this work, we propose a system that motivates the users to perform neck exercises by engaging them in a serious exergame within virtual reality (VR) environment.” (Zeljka Mihajlovic, Sinisa Popovic, Karla Brkic and Kresimir Cosic, November 2017)

2.8 - Does Virtual Reality Offer Any Physical Benefits

Another huge benefit of virtual reality when it comes to neck rehabilitation over the standard procedures, is that you have the ability to trick the patients senses in a positive manner, which can lead to them outperforming what’s possible without the use of VR. As demonstrated in this one study; “This study examined how individuals with and without neck pain performed exercises under the influence of altered visual feedback in virtual reality. Actual head rotation angles were measured for different gains. On average, chronic pain individuals reported that neck rotation was feasible for 84% of the unity gain trials, 66% of the individual just-noticeable difference trials, and 50% of the “nudged” just-noticeable difference trials. This research demonstrated that virtual reality may be useful for promoting the desired outcome of increased range of motion in neck rehabilitation exercises by altering visual feedback.” By altering the perception settings of the VR headset, you can trick the patients into being able to move more than they think they’re capable of. This is a great way to help overcome mental blockages and fears when it comes to moving their necks. Without the use of VR and the deception it can cause to the senses, these extra improvements might not be possible in such a short period of time. (Karen B. Chen, Mary E. Sesto, Kevin Ponto, James Leonard, Andrea Mason, Gregg Vanderheiden, Justin Williams, Robert G Radwin, October 2016).

 

However there are certain drawbacks that we have to consider before using VR to aid a patients recovery process. The biggest issue we may possibly face is that the VR headset is worn on the patients head, which considering the fact that they will have a bad neck, any extra added weight for the neck to support may actually end up being detrimental to the patients health and recovery, as their neck muscles may not yet be strong enough to support the added pressure of the headset. A newly built lightweight headgear option is a potential fix to this. Another potential fix is to use the VR headset in combination with Multi Cervical Unit which will help to support the patient's neck and head while the VR headset is attached. This combination could allow the patient to wear the headset without feeling any added discomfort or pressure.  However if neither of these options are possible, we may simply just need to use these methods later on in their road to recovery, instead of it being something that is used from the very start. As we don’t want to end up hindering their physical recovery instead of aiding it.




 

3.1 - Ethical Review 

 

According to Connelly, Lynne M, In every study, authors are required to report on the ethical considerations of their research. Most readers determine if the study was approved by a review board and if there was participant consent(2014), The project doesn’t involve gathering any sort of personal information for the participants. The identity of the subjects of the test will remain anonymous. Majority of the of the research focus on understanding how meditation techniques within virtual reality can support neck impairment when going rehabilitation, there will be a development part for this project but the participants involved will not at any circumstances will be categorized as risk participants, this strictly means that the participants taking part in testing the artefact will be categorized as healthy and not being exposed to any risks. The participants before and during the testing of the artefact can withdraw completely from the testing process if they wish to do so. Before testing the artefact it will be required by the participant to give their formal consent in order to test the artefact which protects myself and the university from any potential queries.  Project Can be found on Projects Tab.


 

4.1 - Evaluation 

 

Through critical and analytical research, thinking and action plans as well as the main core context of the research, this research documentation has developed well, The analytical research of literature review and experts of the industry led this research to specific a narrowed object path to produce a design document guideline artefact as well a software development artefact to enhance some of the design document aspects. The design document guideline produced is to  demonstrate the traits and techniques that could go into rehabilitation when taking under Virtual Reality meditation and the software artefact is to assist the documentation with visuals and Virtual reality appliances.

 

The project will be developed to have a detailed design guideline that explains the enchantment of meditation techniques within virtual reality to treat neck impairment during rehabilitation, if successful the guideline will be the core of the research with an application artefact that features and demonstrates the high concept of the guideline. Once the application is completed it will show that the design guideline has been successfully applied to the development of the application artefact.

5.1 - Conclusion 

 

Meditation has shown many mental and emotional benefits when practiced on a daily basis, this is due to meditation showing signs of reducing stress levels, which leads to having a positive mental and emotional state of mind, which has also been linked to physical health and  increased recovery, as they are both processed by the same central nervous system. From the research done, we have discovered that these benefits  of meditation can be further enhanced by being facilitated within a virtual reality environment. The first benefit is that virtual reality is much more engaging than traditional rehab techniques, to the point that patients may  even look forward to participating in the process when compared to traditional methods. The next big draw of meditation with virtual reality is the engagement of the senses. It’s much easier to escape from reality and get into a deep meditative state while in virtual reality because all of your senses are actively engaged with that virtual world, while being cut off from real life distractions. Being able to choose and kind of music or sounds, as well as any kind of scenery or backdrops that suit the person’s preference, also goes a long way towards a satisfying and mentally cleansing experience. When combining  these positive mental and emotional benefits with the deceptive physical aspects of virtual reality neck rehabilitation, it's clear to see how this process can be a huge aid in a patients recovery process. These are my reasons for pursuing these combined technologies and practices.

References 

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Iikka Kosunen, Mikko Salminen, Simo Jarvela, Antti, Ruonala, Niklas Ravaja and Giulio Jacuci (March 2016)

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(Accessed January 6 2021).

Academic Research Based on Nemorosum Bites

Guilherme Yukio Ogassawara  

 

How can the psychological model of tension and suspense be applied to game design? 

 

Introduction

The purpose of this research is to find out how tension can be built and implemented into the game design process in a variety of different ways. Particularly focusing on horror and suspense games. In this research essay, I will be basing the large majority of my research on Moritz Lehne’s and Stefan Koelsch’s research paper and how it can be applied to games design. They are both highly respected neuroscientists and psychologists that focus on brain music and emotions. Despite this, they branch out and cover quite a vast amount of topics in their research paper. I will highlight the key topics that are the most relevant to game designers, and go on to explain what we can learn from these topics, to create a game that has tension and suspense as a core design element. I’ll also elaborate on the purpose of this process and also what effects it may have on the players who are playing the game.

 

 

But first I’d like to talk a little about why I decided to choose this research paper by Moritz Lehne and Stefan Keolsch over other research papers that I came across. The first reason for this is that the paper had a great depth of information in it. It was a lot more comprehensive when compared to other research papers and contained a lot of really good information. But more importantly than that, the information used was from a wide variety of sources, to be precise, it had 109 sources! Naturally, since it had so many sources attached, this also meant that there were a lot of different points of view, from different aspects and topics. Having conflicting points of view to read was extremely useful to help keep the report non-bias and keep a broader perspective on each of the topics. I was considering using other papers such as Factors Involved In Generating Suspense by Paul Comisky and Jennings Bryant, or The Paradox of Suspense by Aaron Smuts. However, these papers, just like many others, had far fewer sources, usually around 5 - 15. This wasn’t such a terrible thing though, as these sources were much more focused on one particular subject and went into greater depth with it, however for this paper it was more useful to have a wider range of sources that covered multiple different areas and topics so I could hit all the different elements of game design. Both of those papers were used as sources in the main paper that I selected.

 

The second reason is that they are both highly respected professionals in their chosen fields of work. Stefan Koelsch is a German psychologist and neuroscientist who researches brain music. While Mortiz Lehne is a professional in regards to digital health and cognitive neuroscience, as well as music psychology. They are very knowledgeable in their selected fields which makes their information very noteworthy and reliable. Like I said earlier too, they use a ton of sources for their work, so they relentlessly research all the information that they use before coming to full conclusions of their own. 

 

 

Now that I’ve explained what I'm going to be covering in this essay as well as my chosen source, it's time to move onto the main questions that may arise after reading the title for the first time, those questions are:

 

  • Firstly, why? What is the purpose of creating tension and suspense in video games? What exactly is the game designer hoping to achieve by focusing on this particular aspect of design? 

 

  • Secondly, what does this mean for the players? How will this theory and design element impact the players who are playing the game? 

 

  • Next, how is this achieved, what are the steps that a game designer can take to create a meaningful sense of tension and suspense for the player? 

 

  • Lastly, how can you find a healthy balance of tension and suspense without going overboard and creating a negative experience for your player base. What are the key things should you consider and keep in mind whilst implementing these ideas and philosophies? 

 

Tension and Suspense in General

Before I jump into the specifics of video games, I’d first like to touch on the more general aspects of tension and suspense in all forms of media and everyday storytelling in general.

In reality, suspense in storytelling dates all the way back to early human civilization, from when we developed speech and learnt how to communicate with each other, sharing stories around a campfire. Building a sense of tension and suspense while telling a story is a fantastic way to grip the listeners’ attention and keep them engaged with the story. Which is heavily supported by a 2015 study. “Researchers used MRI machines to measure the brain activity of subjects while they watched scenes from thrillers, including two Hitchcock films, as well as Alien and Misery. Throughout these film clips, a flashing checkerboard pattern appeared around the sides of the screen. During tense moments, the subjects developed “tunnel vision”; their vision narrowed and they focused more closely on the film. During less suspenseful moments, participants were more likely to notice the checkerboards.” (M.A Bezdek, R.J. Gerring, W.G. Wenzel, J.Shin, K.Pirog Revill, E.H Schumacher. Neural evidence that suspense narrows attentional focus). For these reasons, suspense does a splendid job of immersing the listener by giving them an experience of emotion and feelings that could only otherwise be experienced if they were taking part in the story themselves as a character. This applies from simple verbal storytelling to books and stories, to tv shows and movies and of course, even video games.

 

Creating tension and suspense in games design 

You may ask yourself, why would you want to create a game that revolves around, or incorporates a sense of tension and suspense as one of its core features. When many people first think of playing a game, they think of fun, which leads to emotions such as happiness and joy. So why base the game around concepts that can have a negative connotation attached to them and that are associated strongly with negative emotions such as fear or anxiety? Well, people often play games to deal with stress, blow off steam or sometimes even escape from reality, by experiencing those positive emotions that come along with playing a game. This is supported by the research of Amanda Roy and Christopher J Ferguson: “Many gamers report that playing video games, including those with violent content, helps them to reduce stress. Results indicated stress levels declined overtime at equal levels during both competitive and cooperative gameplay. Participants in the competitive condition held a slightly less positive impression of the confederate following gameplay, although players held a generally positive impression of the confederate overall.” (Amanda Roy, Christopher J.Ferguson, March 2016).

"In some contexts, experiences of tension are associated with negative emotions such as fear, concern, or distress, which are generally tried to be avoided; in other contexts, tension is experienced as positive, and can be a major motivator to engage in certain activities." (Moritz Lehne, Stefan Koelsch 2015), according to the research of Moritz Lehne and Stefan Koelsch, experiencing certain kinds of suspense and tension, can create a positive overall experience for the people engaging in the activity, and can even be a leading motivator as to why they even want to participate in the first place, Which makes sense when you consider the fact that horror is a popular genre amongst video games, tv-series, and movies. 

 

But that doesn't explain why people want to experience this elevated tension and suspense. Do people enjoy being scared, are they all just simply masochists? Well according to Moritz Lehne and Stefan Koelsch, hope may be a deciding factor as to why people enjoy experiencing these turbulent emotions. The pair go on to state, "The resulting tension experiences are closely related to the emotions of hope and fear (cf. the concept of Prospect emotions described in Ortony et al., 1988): anticipated events with positive valence elicit emotions of hope, whereas negative events create fear (or anxiety if the anticipated events are more diffuse and not clearly specified). In typical tension experiences, both emotions can co-occur because often both positive and negative outcomes are possible." (Moritz Lehne, Stefan Koelsch 2015) From this, we can gather that people enjoy going through the process of uncertainty, at least in the context of experiencing it through media. As Rudolph Kremers says in his book, “People like dealing with their fears in a safe environment. If there is no real risk involved, there is nothing to worry about.” (Rudolph Kremers. 2009, Level Design: Concept, Theory, and Practice.)  They can enjoy the adrenaline rush of playing the game or watching the movie without any real fears of concerns about their physical or emotional wellbeing. The sense of uncertainty that is created makes you feel more invested in the story as you now want to know what path the story is going to take and what the outcome will be. Is it going to be a happy ending, or perhaps a sad ending filled with misery? Well, you have to keep playing the game to find out. It is this hope and desire that encourages people to play on through the game, despite the scares and possible anxiety. It feels amazing to overcome and conquer your fears, especially when there is no severe consequence for failing. As they stated, the best way to do this is to constantly dangle the constant possibility of a favourable and unfavourable outcome in front of the viewers, by cycling through a wide range of positive and negative anticipation. 

Now that we've established why invoking these range of emotions in a player is actually a positive that keeps them engaged with the gameplay and story, I now want to talk about how this is achievable from a game designer’s point of view. 

 

There are many ways for a designer to convey these feelings of suspense and tension. From the plot of the story, the music, the soundtracks, sound effects and voice acting that plays throughout the game. Also the ambience and artistic choices made with the aesthetics of the game and of course even the gameplay itself. 

 

The story is probably the main and most obvious area to identify for building suspense and tension in a game. By “story” I am mostly referring to the cutscenes, character interactions and dialogues that occur throughout the game. If you write a gripping story that is unpredictable with many possible outcomes, it's going to get the player invested into the game, once they are invested you can then create ups and downs to create the hope/fear emotions that we talked about earlier (see figure 1 down below to see a visual representation of this), which will make the player keep playing in the hopes of attaining a favourable outcome at the end of the game. You don't want things to go too smoothly as that may become boring and uninteresting, at which point you need to heavily rely on your gameplay to carry the experience, yet you also don't want to create too much of a negative experience that leaves the player with no room for hope or optimism. Finding that right balance is essential. A fantastic example of this being done right is the game Until Dawn by Supermassive Games. You play as a group of college students who are going on vacation in a remote and snowy mountainside, that has many unpleasant folktales about killers and monsters. Throughout the story the group gets split up several times through the dark snowy night and depending on your gameplay choices, certain characters get killed off, all while the player is unsure of who the killer is, but it is strongly hinted that the killer may be part of the group. The great thing about this game is that you can save all the characters and keep them all alive as well as getting several different story endings depending on how you progress through the story. “What seems to be clear, though, is that there is always a process of give and take involved, where audience members are willing to be presented with these negatives, but only if they get something out of it themselves” (Rudolph Kremers. (2009) Level Design: Concept, Theory, and Practice). As you can see from the research of Rudolph Kremers, although the possibility of having your favourite characters horribly mutilated and killed off from the story isn’t a pleasant one, it makes the outcome where they survive that much more satisfying and fills you with a sense of achievement, knowing that you could be experiencing a far different outcome for the rest of the game’s duration.

 

(Figure 1. An appropriate way to build tension and suspense in video games, by using peaks and valleys.)

 

The gameplay is also an essential part of creating this tension, as it's generally the main element of the majority of games. For gameplay to have a meaningful sense of suspense, you will need to incorporate actual consequences attached to the gameplay. For example, if you mess up and fail a section of gameplay your character may get captured and even killed. This can cause suspense in the form of the player receiving a game over and having to replay parts of a level. In certain cases, games can even go a step further and have other storyline consequences, such as having characters die off if the mission fails, and having them live on if it succeeds, by having a branching story based on your outcomes (Until Dawn is a great example of this). “Tension experiences also share many of the components that are relevant to the perception of risk (e.g., in decision-making) such as uncertainty, predictive processing, and emotion. Brain regions associated with tension experiences may, therefore, overlap with regions that have been implicated in risk processing such as the anterior insula or dorsomedial and dorsolateral prefrontal cortex” (Mohr et al.,2010). You just need to ensure that the consequences and outcomes are appropriate for the decisions made, whether they are the correct or wrong choice. This is because the responsibility of having to make a decision in a risky situation is already somewhat stress-inducing and forces the player into the shoes of the character, which makes you feel like you're responsible for their life or are sharing their fate, this is taken to another level if the game designer does a good job of making the player relate and feel empathy for the character. 

 

Environmental aspects of the game are a huge opportunity to build suspense through the use of the scenery. What kind of ominous objects and features can you add to create anxiety and uncertainty? Can you make them interactive, perhaps they're hiding potentially good or bad things within or behind them. Lighting is also a fantastic opportunity to create this aesthetic, whether the entire game is a shadowy and low light or whether you decide to reserve it for a select moment to give those individual moments even more impact compared to the rest of the game. 

 

“One important application to games is that, of course, you must use emotions to guide and delight your players. Music can be used to signal players that they are safe or that they need to be aware of imminent danger. (Many action games have different music when the player is in the exploration mode as compared to when enemies are about to attack, for example.) Sound effects can also be used to indicate threats, failures, and successes through conditions (The Legend of Zelda series developed by Nintendo has compelling examples of rewarding sounds.) The art direction will have an impact on players’ overall appreciation of the game, and that includes menu and user interface presentation Game feel, the satisfaction felt through the mere interaction with the system, will also have an impact” (The Gamer’s Brain: How Neuroscience and UX Can Impact Video Game Design, Celia Hodent, 2017). As Celia Hodent states, music is a great way to indicate that something is about to go down, and will instantly get the player’s heart pumping and get them ready for action. But it is also important to make the noises identifiable, is it a good noise, a bad noise or maybe just irrelevant ambient background noise. Keeping your sounds consistent is key to achieving this, which gives the player a greater understanding of the potential upcoming situations.

 

Summary of key tension building mechanics

To summarize, I would like to go over the key aspects of each game design element, and then go on to further explain how I decided to implement these design elements into my game after conducting and analysing my research.

 

 

Story

The key takeaways here are to create ups and downs within the story. I feel like a great way to implement this is a chapter type of system. Certain chapters of the game will end on positive notes, while others will end on negatives. You can even mix it up and have both occur within the course of a chapter. But like I was explaining earlier, you don’t want to make this too predictable, frequent or infrequent.

 

Another fantastic way of executing this is by simply adding the opportunity for multiple different outcomes within the story, either based on which “path” you decided to take, either from a story point of view or perhaps from a gameplay consequence or reward. It’s a lot more work to implement but the payoff is huge for the players' experience, as the player gets a real sense that their choices have a real impact within the game.

 

Gameplay

As for the gameplay, it largely depends on the type of game you're creating and the core mechanics that you want to build, however regardless of which mechanics you choose for your game, one thing you can always do is to make sure there are good and bad consequences for your gameplay results, whether this is by having gameplay or story consequences. Perhaps you unlock different content based on your results. This is a good way to keep things from becoming stale. Even just having the illusion of choice can be very powerful. 

 

On Top of that, having challenging mechanics such as stealth, where you have to remain undetected, or timed puzzles or riddles can lead to a lot of high-intensity moments.

 

Environmental

Environmental choices are hugely important as they set the scene of the game, this is why lighting is such a huge factor, having your vision obscured is one of the most effective ways to ramp up the tension. 

 

Yet another way to do this is by the addition of mysterious interactive items, some of which may be beneficial, some of which may be a threat. Having this mix of good and bad will encourage the player to explore and put a lot of pressure on their choice when choosing what to interact with, which in turn causes an element of tension every time you encounter something new and suspicious. The player's mind starts running through potential possibilities and does your work for you.

 

Music

Choosing appropriate and fitting music is key in building the perfect scene and ramping up suspense, but more crucially than that, is perhaps the timing. You want to reserve the right music for the right times, without overusing it. As soon as you hear the music change you know things are about to go down, these are potentially the most tension inducing moments you can have in a game.

 

 

Motivation

 

Original Game Idea 

The idea of my game is a 2.5D stealth, puzzle platformer game that incorporates suspense and tension. The storyline is about a mouse that is trying to save his colony from being cooked and tormented by a repugnant chef. It will be his job to solve puzzles and remain undetected while running around the kitchen and finding his family. If you're not careful, you'll be seen by the chef and will get caught, which will mean that you were unsuccessful in saving your colony from the evil chef. 

 

How it relates to my game 

 

In my last summarising segment on tension building mechanics, I mentioned some of the key ones that I took away from my research. Well, here I want to explain some of those elements that I have chosen to incorporate into my game, as well as explaining a little bit about how I decided to do so.

 

 

How I’ve Implemented these aspects into my game

 

Story

After what I've researched about offering uncertain outcomes via the story, I was encouraged to implement differing outcomes depending on certain choices you decide to make. I want the players' choices to feel like they have an impact in a meaningful way. One way I decided that I could do this was to add split choice routes, where you can decide to take a certain course of action, an example would be: try to save mouse A or mouse B, Go down path A or path B. I want to combine these potential path choices with prior knowledge given to the player so that they can try to make their best/favourite decision based on the likely outcome, this responsibility of choice will cause a lot of potential pressure and stress, while also giving the game some replay value!

 

Gameplay

I have chosen to design a stealth orientated game. So stealth will be the core mechanic of this game. At most stages of the game, you will have to remain unseen throughout the countless obstacles and challenges set for you, even while completing a challenging puzzle by figuring how to unlock a door or get access to a certain item without being spotted. 

 

Then to expand on this I’ve decided to add storyline and gameplay consequences based on your gameplay results. An example of this is losing access to certain items or characters that could serve as teammates to you throughout the game. The combination of these challenging mechanics combined with the potential consequences of failing are going to be effective at driving home desired intent.

 

 

Environmental

For environmental choices, I’ve strongly decided that restrictive lighting is a great tool to use. So I’ll be using a moving searchlight system. For example, there might be swinging lights that you have to avoid while scurrying around the kitchen. If you get caught in one, then you may get caught and will begin to be chased by the Chef.

 

I also intend on using a vast array of tools that may aid or harm the player's character, it's up to the player to figure out how to effectively use each item to its full potential, and which items to stay clear of. As some items will be the key to advancing to new areas, potentially being used as slingshots or catapults, to be used offensively. Other items may have collective purposes or perhaps there might be left behind items that other characters would be happy to receive if you were to find them. Which could also lead to gameplay or story changes.

 

 

 

 

Music

As for music I have reflected strongly on where best to insert certain soundtracks and sound effects, I’ve tested out many possibilities to see which ones have the best impact after some peer review. Examples of key moments are when you're about to be spotted, the music will slowly ramp up, the music will also drastically change once you have been spotted and are actively being chased. Also when you’re potentially at a low health threshold. Having music in these situations should help to amplify the experience in these vital moments

 

 

From my time researching articles and research papers, I have been made aware that uncertainty is a huge factor in building suspense, especially combined with a potentially bad outcome. Uncertainty can take on many different forms in the medium of video games, which leaves the player asking these subconscious questions; what will happen, how will it happen, when will it happen and most importantly of all, will it happen?. “In many games, if you don’t have a clear indication of danger or what can kill you, for example not having a health bar or being clear on the damage you may take from an enemy, this can be considered bad game design. However, for horror games, or games that are simply trying to build suspense, this can work in your favour to accentuate that experience of uncertainty, which then creates more suspense. Hiding the numbers that run the game simulation forces the player to think in context rather than systematically., It’s better to only reveal data through some contextual abstraction. For example, Resident Evil and Silent Hill have traditionally used rough categories to display health (“Fine,” “Caution,” “Danger”), even though under the hood they track hit points like every other game. Resident Evil also uses character animation to communicate health. You might not be able to tell how close you are to death, but when the protagonist bends forward and holds their stomach you know it’s pretty bad. Hiding information and rules prevents the player from charting a safe route through the game via min/maxing. It also removes certainty from any given system. When the player can’t be sure exactly how an underlying system works he must rely on the environment and story to inform his decisions.” (Chris Pruett, The Mechanics of Tension, 2015). After understanding this concept I have decided to deliberately make certain things a little bit ambiguous in my game. One example of this would be when you are being seen and chased by the chef. You know that you are in danger, but you’re not quite sure just how much time you have, before being spotted or captured, this lack of knowledge causes elevated stress levels. Another example of this is fall damage. Say you are being chased, you are in a rush to get away, do you risk jumping off a high shelf or counter and risk dying to the potential fall damage, or do you take a slower but safer route and risk being caught?

 

A game that I took major inspiration from was a game called Little Nightmares. It's a 2.5D stealth puzzle platformer that incorporates a lot of key elements that I’ll try to replicate in my game. You play as a very small character in a very big world, with a big monster. In the game, your character is so small and weak, that they don’t have any way of fighting back, and most of the time their only options are to run and hide. This forces the player to make very important and swift decisions on which pieces of furniture to interact with. This may result in you finding someplace to hide, climb, or even to use something offensively. But overall the game portrays the sense that your character is completely defenceless in this world and their only hope of survival is to outsmart their opponents and hide from them without being seen. Avoiding confrontation and remaining undetected is the main goal of the player. You constantly feel the suspense of being hunted, and not always knowing when or where the next threat is about to come from because of the dimly lit aesthetic of the game. All of this leads to the player feeling distressed at the circumstances of this defenceless character, as you don’t want to be responsible for their death. Compared to having a strong character that can fight back and defend themselves, it makes you empathise with the character more. 

 

Another game that I also took inspiration from was Ratatouille the game and movie. Just like Little Nightmares, the main character is tiny in a huge world full of possible threats which are much bigger. He has no way of defeating the enemy in a fight and his only way to get around is to survive and outsmart everyone. From this game, I’m more taking inspiration from the plot and premise of a mouse freeing his brethren from an evil chef, while little nightmares, incorporates many more of the suspense elements that I’m looking for. It's the combination of these two games that have been the cornerstones in inspiring the creation of mine. 

 

Reflection

Throughout the process of researching all of this information, it has helped me with deciding on certain features that should be added and taken away from the game that I’m creating. One recurring theme from the research I was reading was to build suspense and tension in the right ways, without causing unnecessary frustration for the player.

 

During my time in games design, I’ve learnt the importance of a good clean UI for the players, so that they have all of the appropriate information they need. “A game hurts itself by providing too little information or too much, requiring too many inputs, confusing the player with unhelpful prompts or making it hard for a new player to interact. Poor UI design can even break your game completely.”(Game UI By Example: A Crash Course in the Good and the Bad, Desi Quintans, 2013) Generally, if things are too unclear it just feels extremely frustrating for the player. When they die, it’s not because of a lack of skill, but rather a lack of knowledge, which you can blame on bad game design. However, after reading the articles, I discovered that having a sense of ambiguity is sometimes the best thing to do for this kind of genre. This is important because if you make things too explanative and easy it then removes the challenge from the game. I want the players to explore the maps provided, and solve the puzzles based on their initiative. I want the threats to be, somewhat in view, but not too overt. The player should be asking themselves; am I safe here? Is it okay to walk out into the open right now? Can I make it across without being noticed? If I use this item will it make noise and draw attention to me, or will it benefit me? Forcing the player into making these crucial decisions puts a lot of pressure on them and helps build the kind of experience I want for my game. 

 

Another really important aspect that I took away from this was consistency. The HUD, UI, art and even sounds should all stay consistent to the theme of the game, as even UI design and sound effects can impact how the player feels and helps to set the mood of the game. Especially when it comes to the sound effects and music of the game. Even keeping a consistent colour theme is important. Perhaps enemies have a theme of being red and purple colours, while rewards are green or gold. This helps the player to identify new and upcoming features with very minimal frustrations. Regardless of what you do, consistency in these areas is essential to cut out unnecessary confusion for the player, as confusion can lead to frustration and kills the enjoyment of the game. Being reminded of this was extremely helpful and has helped to structure and redesign these particular elements in my game that I had previously overlooked. 

 

Conclusion

In conclusion, I have discovered that aiming to create suspense and tension for the player is a very positive thing when executed correctly. Despite this, it is very easy to mess it up and simply create a negative experience for the player instead. I’ll summarise some key areas to target and how not to go overboard.

 

Firstly the challenge and mystery should all be arising from the story and the gameplay. It’s important for building up that sense of danger for the player as they walk down a dark corridor not knowing what's lurking beyond, or as they are gripped by the story not knowing what action a certain character is going to take next. However when it comes to the other areas such as the actual mechanics of the game, you want them to be clear and easy to understand, you want the gameplay to be efficient and responsive, for example having bad controls that make it harder for the players will only cause frustration, not the intended suspense you're aiming for (bad controls are not a replacement for difficulty). You also want to make it clear what is and what's not a threat. After all, being killed by something that you weren’t expecting to be dangerous is also frustrating and kills your enjoyment. The player should be on edge, but only when it makes logical sense. I was already somewhat aware of this, but it was a great and healthy reminder to keep me on track. But incorporated correctly, this tension and suspense should create a gripping game for players that keeps them enthralled and unable to put it down, without first finding out what the outcome is. The story is also a good place to build some of this tension in suspense. Like I stated earlier, Until Dawn suggested that there was a killer amongst the group of playable characters, this lack of knowing and not being able to trust certain characters fully through the use of the story narrative is also extremely powerful.

 

Secondly is that you should not overdo constantly trying to scare the player with jumpscares. Sometimes less is more. An effective way of doing this is the rollercoaster theory of tension and by creating tension cycles (refer to Figure 1). You want there to be extended periods where there are no jumpscares, if you add too many it becomes predictable and boring. Instead, you want the players' mind to do all the work for you. Say you’re walking through a dark abandoned house, you know there is going to be something scary inside, but you're not sure what it is or when it's going to happen, you can let the player go from room to room with nothing overtly scary happening, but all the while their mind bathes in the suspense, and works itself into a scared frenzy just waiting and anticipating when and where the next threat is going to come from, then bam you can hit them with the jumpscare that relieves all of that suspense and fear, which then gives the player almost a sense of relief that it happened. If this is implemented correctly, then there should be a cooldown period. You can think of it as peaks and valleys. You climb to the top of the mountain, but after you reach the top, you need to make your way back down before climbing up the next one.

 

There’s a lot to get wrong when working with this kind of genre of game. However, incorporated correctly, this tension and suspense should create a gripping game for players that keeps them enthralled and unable to put it down, without finding out the outcome, while all the time giving them a sense of adrenaline and excitement.

 

 

References 

Amanda Roy Christopher J.Ferguson (March 2016) Computers in Human Behavior, Volume 56, Pages 14-20 Available at: https://www.sciencedirect.com/science/article/pii/S0747563215302351#abs0010

(Accessed 25th January 2020)

Celia Hodent (2017) The Gamer’s Brain: How Neuroscience and UX Can Impact Video Game Design 

Chris Pruett (2016) Gamasutra Available at: https://www.gamasutra.com/blogs/ChrisPruett/20160115/263292/The_Mechanics_of_Tension.php

(Accessed 2nd February 2020)

Desi Quintans (2013) GameDevelopment Available at: https://gamedevelopment.tutsplus.com/tutorials/game-ui-by-example-a-crash-course-in-the-good-and-the-bad--gamedev-3943

(Accessed 27 January 2020)

M.A Bezdek, R.J. Gerring, W.G. Wenzel, J.Shin, K.Pirog Revill, E.H Schumacher (2015) Sciencedirect Available at:

https://www.sciencedirect.com/science/article/abs/pii/S0306452215005965

(Accessed 27 January 2020)

Mortiz Lehne and Stefan Koelsch (2015) Frontiersin Available at:

https://www.frontiersin.org/articles/10.3389/fpsyg.2015.00079/full

(Accessed 22 January 2020)

O’Doherty, J. P. (2004) ScienceDirect Available at:

https://www.sciencedirect.com/science/article/abs/pii/S0959438804001680?via%3Dihub (Accessed 24th January 2020)

Ortony, A., Clore, G. L., and Collins, A. (1988). Cambridge Available at: https://www.cambridge.org/core/books/cognitive-structure-of-emotions/33FBA9FA0A8A86143DD86D84088F289B

(Accessed 24th January 2020)

Rudolph Kremers. (2009) Level Design: Concept, Theory, and Practice. Taylor & Francis.

 

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