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Neurofeedback gaming for wellbeing

Aart, J. v., Klaver, E., Bartneck, C., Feijs, L., & Peters, P. (2007). Neurofeedback Gaming for Wellbeing. Proceedings of the Brain-Computer Interfaces and Games Workshop at the International Conference on Advances in Computer Entertainment Technology, Salzburg, pp. 3-4 Neurofeedback Gaming for Wellbeing
Joran van Aart, Eelco Klaver, Christoph Bartneck, Loe Feijs, Peter Peters Department of Industrial Design, Eindhoven University of Technology Den Dolech 2, P.O. Box 513, 5600 MB Eindhoven, The Netherlands,, {c.bartneck, l.m.g.feijs; p.j.f.peters} @ ABSTRACT
For neurofeedback to be integrated in society, there is a need for In this paper we discuss our vision on future neurofeedback neurofeedback to be accepted. However, another problem might therapy. We analyze problems of the current situation and debate be that neurofeedback therapy is based on a ‘mind over matter’ for a change in focus towards a vision in which neurofeedback perspective, implying that not only the physical and mental therapy will ultimately be as easy as taking an aspirin. wellbeing are interconnected [3, 5] but also that the physical Furthermore we argue for a gaming approach as training, for wellbeing can actually be a result of the mental one. Although this separation between neurofeedback therapy and gaming has statement has been proven in various studies [3], people may become noticeably smaller after recent development in brain experience problems with acceptance. Ungrounded conservative manipulated interfaces. We conclude by providing suggestions of opinions have been formed, perhaps as a result of the natural fear of the unknown. Still, although neurofeedback therapy has shown to have a positive influence [6] on numerous disorders, absolute Categories and Subject Descriptors
and undeniable proof of absence of possible side-effects has not been supplied yet. Whether this is a potential issue for the therapy H5.2 [Information Interfaces and Presentation (e.g. HCI)]:
not to be accepted, remains open for debate. However, it has been User Interfaces - Input devices and strategies (e.g., mouse, said that if some or another medication could be as broadly and effectively applicable as neurofeedback therapy, it would already be available at every pharmacy in the world. [11] General Terms
More practical problems with neurofeedback therapy (compared with for example medication) include its expensive and time Keywords
consuming aspects. Currently, a regular therapy exists of approximately 40 sessions of 1 hour each, preferably one or two Neurofeedback therapy, neurofeedback training, gaming, EEG, sessions a week. However, this hour includes only 30 minutes of mental and physical wellbeing, prevention as healthcare actual contact time, since existing EEG products simply take a lot of time to prepare. A closer look at the method: In most cases, 1. INTRODUCTION
EEG products involve placing an elastic cap on the head, with 19 Neurofeedback [2], as therapy of the future, may realize the vision sensors held in place on the scalp. To optimize scalp contact, dead of fighting the cause rather than the symptoms. It treats health cells are removed and hair is parted out of the way to place problems like attention deficit disorders, hyperactivity disorders sensors with gel on the scalp. The ElectroCap (figure 1) [1] is the and sleeping problems, formerly all suppressed with medication. far most used example of this category. Other cases include the Based on EEG measurements, the user’s mind is trained to bridge use of a 2-channel EEG measurement, involving only 2 sensors new connections and to either increase or decrease the use of and clips on each earlobe. In those cases, the sensors are placed specific brain functions. And best of all: it is achieved by simply on the scalp directly (without the elastic cap), for the cap mainly undergoing a number of non-intrusive sessions, which we propose functions for defining the location of scalp electrodes. to improve by interconnecting with gaming appliances. However, if it is such a promising concept, why hasn’t this therapy been adopted by the general public and health companies yet? 2. REVIEW
The results of research in the field of neurofeedback seem very promising, but various aspects like discrepancy in society focus, general acceptance and practical issues (time and money) form Figure 1. ElectroCaps [1]
challenges that have yet to be overcome. Besides the extensive preparation, these sessions take place at a In present day society, people only consult a doctor when clinic, therefore waiting time and obviously travelling time should experiencing physical complaints. In other words: the focus is too be counted as well. Besides the time aspect, neurofeedback much on the physical aspect of health and on curing the therapy is very expensive and not refunded by health insurances. symptoms. In contrast, the main focus of neurofeedback is on mental issues, e.g. concentration or sleeping disorders and on The identified issues, varying from practical to emotional, might fighting the cause of these disorders, rather than the symptoms. all slow down the development of neurofeedback therapy and its The gap between the health focus of society and neurofeedback therapy is noticeable, which may be one of the reasons that neurofeedback is not applied to its full potential yet. Aart, J. v., Klaver, E., Bartneck, C., Feijs, L., & Peters, P. (2007). Neurofeedback Gaming for Wellbeing. Proceedings of the Brain-Computer Interfaces and Games Workshop at the International Conference on Advances in Computer Entertainment Technology, Salzburg, pp. 3-4 recommended to undergo a medical investigation, to exclude We suggest a change in the focus of neurofeedback in two ways, certain causes of possible complaints and to check for counter- both the aim as well as the practical realisation. Furthermore we emphasize the importance of intrinsic motivation (gaming) [9] in Our second suggestion is that a user should be able to conduct a therapy session independently. This implies the need to be able to As applied for health-related training systems, current aims of easily locate the necessary contact-points and applying the sensors. It can be assumed that most of the households already have a computer which can calculate sensor input and provide feedback. This means that in principle, only an EEG measurement - training to alleviate attention and hyperactivity disorders, e.g. device and a software package needs to be applied, which would greatly reduce costs. As a final demand, the training software - training for specific sports such as rowing, cycling etc.; should be easy to operate and perhaps even more important: the software should be intrinsically motivating (playful). - training for relaxation and meditation to cope with mental Based on observations, the following assumptions are formulated, which could be advisable to keep in mind when designing for - training muscular tonicity recovery for cardiovascular playful neurofeedback training sessions: - A1: that it is helpful to give the user rewards based on - training and eating schemes to maintain proper weight or - A2: that it is helpful to simulate elements from an assumed Aims described above, include therapies applied in the medical area, focusing on people with mental disorders. Using neurofeedback training they are able to improve their quality of - A3: that it is helpful to provide the user with quantitative life and bring their wellbeing level up to a regular standard. But what if we would apply this therapy before any disorder has Similarities between gaming and neurofeedback training software occurred? Given the fact that both mental and physical health are are identified, for example: reward schemes with levels, credits, interconnected [3], neurofeedback therapy could function as bonuses, etc. (A1), sound generation and rendering of high- prevention rather than a cure. This insight brings closer the resolution real-time environments (A2), statistics and graphs etc. European dream, emphasising quality of life over accumulation of (A3). Given the fact that intrinsic motivation is found in gaming [7] and that it provides positive influences on concentration and Imagine the possibilities of using neurofeedback training as tool motivation, we suggest to focus on gaming when creating to improve the quality of our lives; consequences on a macro scale neurofeedback training software (e.g. ‘Brainball’ of Hjelm [4] is would be immense, ranging from a decrease in diseases to a considered to be an interesting example). Imagine neurofeedback, reduction of health insurance fees. As a matter of fact, this shift of applied as a treatment, being perceived as fun and enjoyable. In focus from cure to prevention is already taking place in this case a shift from ‘treatment’ to ‘play’ could be both desirable healthcare; a Dutch health insurance company actually stimulates and achievable. It should be kept in mind however, that gamers the use of low-cholesterol margarine by partly refunding it [8]. might not be satisfied with any rewards, contexts and data that are Using neurofeedback training as tool to improve life would be a much more naïve and low-tech than their media experience; or in big step in healthcare. It could be argued that healthcare uses other words: neurofeedback training might have to keep pace with neurofeedback to elevate wellbeing to certain standards, while professional athletes use neurofeedback to enhance their already exceptional performances; the so-called field of peak- 4. APPROACH
performance. With neurofeedback therapy, athletes are able to In this section, issues that are possibly slowing down the teach themselves to consciously enter a state of ‘relaxed focus’, development of neurofeedback will be addressed. Suggestions for resulting in an optimal performance also known as the winning realising the proposed aims of neurofeedback gaming will be mood. Now imagine that everyone could consciously evoke this discussed as well, starting with the acceptance. feeling; neurofeedback could be used to not only cure or prevent It is likely that, before society can accept neurofeedback, there is a diseases but to elevate our entire standard of living. need for awareness about the system and its functioning. This However, before neurofeedback training is accepted, there’s a would imply that before society can exploit the various need to cope with multiple challenges neurofeedback is facing, for opportunities of neurofeedback training, such as improving example the practical issues described before. Neurofeedback personal capabilities, people need to be made aware of the therapy currently involves a lot of time, money and other practical possibility called neurofeedback training. For this to be reached, issues which can obstruct the acceptance of neurofeedback we should realize that neurofeedback therapy (as applied at the therapy. We suggest a world in which neurofeedback training is as moment) is the frontier of neurofeedback training. Early adopters like athletes and people with mental disorders presumably have a bigger drive to look further, which resulted into neurofeedback To realise this vision, we suggest home-use should be enabled. therapy. More might follow and neurofeedback could become For this to happen, first of all the involvement of a medical expert more and more accepted when positive media attention keeps on should be decreased (e.g. only for guidance in defining the goals going. Furthermore, part of this acceptance probably has to be and keeping an eye on the progress). Of course, it is still strongly achieved by means of scientific proof, especially regarding the Aart, J. v., Klaver, E., Bartneck, C., Feijs, L., & Peters, P. (2007). Neurofeedback Gaming for Wellbeing. Proceedings of the Brain-Computer Interfaces and Games Workshop at the International Conference on Advances in Computer Entertainment Technology, Salzburg, pp. 3-4 governmental and health insurance area. Therefore we debate for shift (in healthcare) from cure to prevention, 2) increasing the large scale research proving the positive influence of focus on mental wellbeing in healthcare, 3) elevating the standard neurofeedback therapy and the absence of negative side-effects. of living by enabling users to consciously train brain signals 4) However, increasing acceptance of neurofeedback therapy would implementing gaming approaches in neurofeedback to increase only be the first step. We also propose to enable neurofeedback intrinsic motivation. In general, we propose to make training controllable by the user in home context, which could be neurofeedback training more accessible by designing single-user achieved by designing products according to specific user products for the home environment and thereby achieving our requirements. These requirements are based on the aim of idea of using neurofeedback to its full potential. Furthermore we shortening and simplifying the training methodology and would argue the use of gaming as motivational tool and to support society adopting neurofeedback training. 6. ACKNOWLEDGMENTS
- easily apply sensors (including conducting gel) to one’s head We would like to thank our colleagues at the Department of - have access to training software and the ability to control it Industrial Design, Eindhoven University of Technology, who - receive feedback on electrode impedance and act accordingly raised our interest and helped shaping our thoughts. Furthermore we would like to thank Pierre Cluitmans and Frans Tomeij for - easily clean the sensors and reuse the system sharing their knowledge and insights on the matter. With these suggestions, time and money issues are addressed. Additionally, it is likely that neurofeedback would become 7. REFERENCES
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