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. 2020 Mar 24;7(3):e16066.
doi: 10.2196/16066.

Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study

Rineke Bossenbroek  1 , Aniek Wols  1 , Joanneke Weerdmeester  1 , Anna Lichtwarck-Aschoff  1 , Isabela Granic  1 , Marieke M J W van Rooij  1
Affiliations

Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study

Rineke Bossenbroek et al. JMIR Ment Health. .

Abstract

Background: Many adolescents in special education are affected by anxiety in addition to their behavioral problems. Anxiety leads to substantial long-term problems and may underlie disruptive behaviors in the classroom as a result of the individual's inability to tolerate anxiety-provoking situations. Thus, interventions in special needs schools that help adolescents cope with anxiety and, in turn, diminish disruptive classroom behaviors are needed.

Objective: This study aimed to evaluate the effect of a virtual reality biofeedback game, DEEP, on daily levels of state-anxiety and disruptive classroom behavior in a clinical sample. In addition, the study also aimed to examine the duration of the calm or relaxed state after playing DEEP.

Methods: A total of 8 adolescents attending a special secondary school for students with behavioral and psychiatric problems participated in a single-case experimental ABAB study. Over a 4-week period, participants completed 6 DEEP sessions. In addition, momentary assessments (ie, 3 times a day) of self-reported state-anxiety and teacher-reported classroom behavior were collected throughout all A and B phases.

Results: From analyzing the individual profiles, it was found that 6 participants showed reductions in anxiety, and 5 participants showed reductions in disruptive classroom behaviors after the introduction of DEEP. On a group level, results showed a small but significant reduction of anxiety (d=-0.29) and a small, nonsignificant reduction of disruptive classroom behavior (d=-0.16) on days when participants played DEEP. Moreover, it was found that the calm or relaxed state of participants after playing DEEP lasted for about 2 hours on average.

Conclusions: This study demonstrates the potential of the game, DEEP, as an intervention for anxiety and disruptive classroom behavior in a special school setting. Future research is needed to fully optimize and personalize DEEP as an intervention for the heterogeneous special school population.

Keywords: adolescents; anxiety; applied game; attention-deficit/hyperactivity disorder (ADHD); autism spectrum disorder (ASD); disruptive behavior; serious games; single-case study; special education.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Visual circle that is depicted in the players’ visual field corresponding to an inhalation (left) and exhalation peak (right).
Figure 2
Figure 2
The effect of DEEP on anxiety for 8 adolescents. Every 3 data points represent 1 day (measured around 10:00 AM, 12:00 PM, and 2:00 PM). The dashed and stepped lines represent the relatively stable anxiety levels that were identified using recursive partitioning.
Figure 3
Figure 3
The effect of DEEP on disruptive classroom behavior for 8 adolescents. Every 3 data points represent 1 day (measured around 10:20 AM, 12:25 PM, and 2:30 PM). The dashed and stepped lines represent the relatively stable disruptive classroom behavior levels that were identified using recursive partitioning.
See this image and copyright information in PMC

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