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Post-traumatic stress disorder is said to be one of the signature wounds of military deployment to Afghanistan and Iraq. While Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have officially ended, the psychological consequences of trauma will continue for many Service members. There is a significant need for mental health professionals both in the government and private sectors who are well trained in assessing and treating PTSD with military cultural competence. Operation AVATAR is first-person role-playing game in Second Life that aims to help mental health professionals better understand the underlying theory and assessment of PTSD in an interactive environment that supports learning by doing. This presentation will review the process of design and development of this serious game including lessons learned and next steps for developing other serious games for mental health education.
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Training Mental Health Providers in PTSD Assessment and Theory Kevin M. Holloway, PhD Director of Training and Education, HJF
Operation Enduring Freedom (OEF) & Operation Iraqi Freedom (OIF) 3
Mental Health Consequences < 50% Post-Traumatic Stress Disorder Major Depressive Disorder Traumatic Brain Injury Insomnia Suicide 4
By Unknown or not provided (U.S. National Archives and Records Administration) [Public domain], via Wikimedia Commons No photographer listed. https://creativecommons.org/licenses/by/2.0/ Photo by Sgt. Matthew Moeller. https://creativecommons.org/licenses/by/2.0/ Photo by U.S.Army Pfc. Andrya Hill https://creativecommons.org/licenses/by/2.0/ By AllenS (Own work) [Public domain], via Wikimedia Commons 5 DoD photo by Mass Communication Specialist 2ndClass Michael C. Barton, U.S. Navy/released. https://creativecommons.org/licenses/by-nc-nd/2.0/
PE for PTSD CPT for PTSD CBT-Insomnia CBT-Depression CBT-Suicide Ideation Evidence-Based Psychotherapies 6
849 Mental Health Providers Trained in PE and CPT in Second Life since April 2014 Live, Instructor-led Workshops 7
• Better knowledge gain Better knowledge gain Program Evaluation Results • Higher self Higher self- -reported readiness reported readiness to use PE or CPT • Attendee satisfaction Attendee satisfaction similar • Improved roleplay Improved roleplay participation participation Workshops in Second Life compared to Face-to-Face Workshops • Synergistic Learning Synergistic Learning • Self Self- -selection bias selection bias 8
• Vast majority reported never accessing CDP consultation accessing CDP consultation (though about half getting consultation elsewhere) never Program Evaluation Results half reported • Only around half implementing EBP with 1+ patient implementing EBP with 1+ patient since their training half report BUT… • Only about half protocol with fidelity half reported using full fidelity • Significant segment reported using counter counter- -theoretical modifications modifications theoretical 9 According to CDP Surveys 1 year after attendance at any EBP workshop, of which online workshops account for 10%
Barriers to Implementing EBPs Lack of Adequate Training Lack of Sufficient Consultation post-training Unsupported Modifications Understanding of Underlying Theory Lack of Motivation to Do Something New Insufficient Institutional Support Borah, Elisa V., Edward C. Wright, D. Allen Donahue, Elizabeth M. Cedillos, David S. Riggs, William C. Isler, and Alan L. Peterson, "Implementation Outcomes of Military Provider Training in Cognitive Processing Therapy and Prolonged Exposure Therapy for PostTraumatic Stress Disorder," Military Medicine, Vol. 178, No. 9, September 2013, pp. 939-944. Wilk, Joshua E., Joyce C. West, Farifteh F. Duffy, Richard K. Herrell, Donald S. Rae, and Charles W. Hoge, "Use of Evidence-Based Treatment for Posttraumatic Stress Disorder in Army Behavioral Healthcare," Psychiatry, Vol. 76, No. 4, Winter, 2013, pp. 336-348. 10
Experiential Learning • Personally Meaningful • Easier to Remember Experience • Increased Engagement—staying engaged or motivated to return when interrupted • Repetition and Review • Emotion vs Data driven decisions 11
Why Second Life? Free Accounts!! User-Generated Content Interactive Extension of CDP’s SL Training Workshops 12
LEVERAGING GAMING MOTIVATION 14
Total Engagement 1. Self representation by an avatar 2. 3D immersive environments 3. Narrative context 4. Instant feedback 5. Reputations, ranks and levels 6. Marketplace and economies 7. Competition with rules that are explicit and enforced 8. Teams 9. Parallel Communication Systems 10. Time Parameters Reeves, B., Read, J. Total Engagement; How Games and Virtual Worlds are Changing the Way People Work and Businesses Compete. Harvard Business Press. November 3, 2009 15
Leveraging Gaming Motivation CREATING EXPERIENTIAL LEARNING Operation AVATAR Snoozeum vs BIG GAME SMALL MUSEUM BIG MUSEUM SMALL GAME 16
Lessons Learned • Collaboration Collaboration between subject matter experts and technology experts • Don’t just create a 3D world place to see 2D stuff • Gaming Gaming, even mini-games, enhance application learning and engagement • “If you build it, they will come” isn’t true—create a reason to be there • Validate Validate, Validate, Validate 3D world to be a 20
Future Directions • Validation studies investigating learning outcomes: • Stand alone virtual environments • Attending virtual workshops • Virtual workshops with asynchronous virtual environments augmenting • Standard face-to-face workshops • Consultation vs. no consultation 21
Center for Deployment Psychology Center for Deployment Psychology Department of Medical & Clinical Psychology Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Executive Office: Bldg. 11300-602 Bethesda, MD 20813-4768 Contact Us Website: DeploymentPsych.org Website: DeploymentPsych.org 22
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