A Randomized Controlled Study of the Effects of PopCap Games on Mood and Stress Carmen V. Russoniello, Ph.D, LRT, LPC,

1. A Randomized Controlled Study of the Effects of PopCap Games on Mood and Stress Carmen V. Russoniello, Ph.D, LRT, LPC, BCIAC, Jennifer M. Parks, CTRS Psychophysiology Lab and Biofeedback Clinic East Carolina University The study was underwritten by PopCap games

2. Casual Game Research • Previous studies have primarily focused on the negative aspects of video games. • Studies that have focused on the positive effects include a means to develop social relationships, and to facilitate education, development skills, and multi tasking. • There are a few studies that focus on the health effects of video game play including effects on obesity and cancer treatment. • No previous studies have focused primarily on the mood and stress effects of playing casual video games using both psychological and physiological measures.

3. Investigated Methods That Improve Mood and Decrease Stress Results from surveys indicated that people played PopCap video games because the games reduced their stress and improved their mood. Therapies such as board games, card games, biofeedback, meditation and massage have been useful in helping people change brain and autonomic nervous system activity from areas associated with depression and stress to areas associated with relaxation and alertness.

4. Study Purpose The purpose of the study therefore was to determine whether PopCap games did indeed improve mood and/or decrease stress in players using psychological and physiological measures.

5. Method • Data from 143 Subjects was used in the study. • Subjects: • Completed Informed consent • Completed Profile of Mood States Assessment • Opened envelope to determine control versus experimental group • If experimental then subjects chose one of three games to play. • If control then subjects were instructed to search the internet for journal articles on health conditions. • Subjects were connected to EEG and HRV equipment • Subjects played/surfed the web for 15 minutes.

6. Casual Games • Bejeweled 2 • Bookworm Adventures (BWA) • Peggle

7. Psychological Measurement The Profile of Mood States or POMS is a factor analytically derived inventory that measures six subscales: tension, depression, anger, vigor, fatigue, and confusion. In addition it calculates a “Total Mood Disturbance”. Internal consistency for the POMS has been reported at .90 or above. Test re-test reliability is reported between .68 and .74 for all factors.

8. Physiological Measure of Mood • It is has been shown that left hemisphere frontal alpha brain waves can be correlated with mood and associated behaviors. • Increases in alpha power in the left hemisphere is associated with negative affect, depression and avoidance/withdrawal behaviors. Conversely, decreases in left alpha power improves mood and decreases avoidance/withdrawal behaviors. • Decreases in right hemisphere alpha power has been also been associated with negative mood. Conversely increases in right alpha power improves mood and increases Approach/Engage behaviors • The ratio between right and left brain alpha has been used to measure emotional stability/mental relaxation (Davidson,1988 and Marshall & Fox, 2000).

9. Physiological Measurement of Stress Heart rate variability (HRV) provides an accurate assessment of autonomic nervous system stress based upon variability in the inter-beat interval of heart beats (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996). A robust HRV is associated with balance between the sympathetic and parasympathetic branches of the autonomic nervous system (ANS).HRV was recorded during the entire session using a small ear clip sensor. HRV changes indicated by decreases in very low frequency (sympathetic) norms and high frequency (para-sympathetic) norms were used as specific indicators of stress. HRV Device and Ear Clip Sensor

10. Results The spheres on the following slides list the mean difference and standard error after comparing 5 minutes of baseline with control or game changes. Differences between individual games and the control group are also presented with related confidence intervals. The level of confidence was set at p. <.1 due to the similarity of the control group activity to the game groups and the exploratory nature of the study.

12. Subjects under the age of 25 had a significant reduction in tension after playing Peggle (p=.09).

17. Subjects younger than 25 reported significant reductions in confusion after BWA (p=.04); Bejeweled (p=.002); Peggle (p=.002). Subjects older than 25 did not significantly differ.

22. References Schiesel, S. A Graying Audience Discovers Video Games. The International Herald Tribune. Retrieved July 16, 2007from the Internet www.iht.com Anderson, Craig A. and Brad J. Bushman. “Effects of Violent Video Games On Aggressive Behavior, Aggressive Cognition, Aggressive Affect, Physiological Arousal, and Prosocial Behavior: A Meta-Analytic Review of the Scientific Literature.” American Psychological Society 12 (2001): 353-359. Lee, Joanne E. and Vessey, Judith A. “Violent Video Games Affecting Our Children.” Pediatric Nursing. 26.6 (November/December 2000) 607-610. Marjut Wallenius,  Raija-Leena Punamäki,  Arja Rimpelä. Digital Game Playing and Direct and Indirect Aggression in Early Adolescence: The Roles of Age, Social Intelligence, and Parent-Child Communication. Journal of Youth and Adolescence, (2007): 36(3), 325-336. Retrieved July 6, 2007, from Research Library Core database. Calvert, Clay and Robert D. Richards. “Violence and Video Games 2006: Legislation and Litigation.” Texas Dekanter, Nike. “Gaming Redefines Interactivity for Learning.” TechTrends 49 (2005): 26-31. Funk, J. B. Video games. Adolescent Medicine Clinics, (2005):16(2), 395-411. Hutchison, David. “Video Games and the Pedagogy of Place.” The Social Studies. 98.1 (January/February 2007) 35-40. Simpson, E. S. Evolution in the classroom: What teachers need to know about the video game generation. Tech Trends, (2005): 49(5), 17-22. Agosto, Denise E. “Girls and Gaming: a study of the research with implications for practice.” Teacher Librarian 31. (2004): 8-15 Flores, Alfredo. “Using Computer Games and Other Media to Decrease Child Obesity.” Agricultural Research 54. (2006): 8-10.

23. Monastra, V. Clinical applications of electroencephalographic biofeedback. In Biofeedback: A practitioner’s guide. Schwartz, M. A. & Andrasik, F. (Eds.). 2003;438-470. Hope Lab. Re-Mission™ Outcomes Study: A Research Trial of a Video Game Shows Improvement in Health-Related Outcomes for Young People with Cancer. Retrieved July 14, 2007 fromhttp://www.hopelab.org/docs/HopeLab%20-%20Re-Mission%20Outcomes%20Study.pdf Axelrod, S. Gordon, Ubel, F. A. Shannon, D. C., Berger, A.C. Cohen, R. J. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat to beat cardiovascular control. Science, 1981; 213: 220-22. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Standards of measurement, physiological interpretation, and clinical use. Circulation 1996, 93(5): 1043-1065. Wilkinson, D. J. C., Thompson, J. M., Lambert, G. W., Jennings, G. L., Schwarz, R. G., Jefferys, D., Turner, A. G., and Esler, M. D. Sympathetic activity in patients with panic disorder at rest, under laboratory mental stress and during panic attacks. Arch Gen Psychiatry 1998, 55: 511-520 Mussleman, D. L., Evans, D. L., and Nemeroff, C. B. The relationship of depression to cardiovascular disease. Arch Gen Psychiatry 1998, 55: 580-592 Biocom Technologies. HRV Live Measuring and Monitoring System. Retrieved from www.biocomtech.com July 14, 2007. Nexus 32 Physiological Measuring System. The Stens Corporation. http://www.stens-biofeedback.com/products/nexus32.htm Davidson, R. J. EEG measures of cerebral activation: Conceptual and methodological issues. International Journal of Neuroscience, 1988: 39, 71-89.

24. Marshall PJ, Fox NA: Emotion regulation, depression, and hemispheric asymmetry, in Stress, Coping, and Depression. Edited by Johnson SL, Hayes AM. Mahwah, NJ, Lawrence Erlbaum Associates, 2000, pp 35-50 Field, T., Grizzle, N., Scafidi, F., Abrams, S., Richardson, S., Kuhn, C., & Schanberg, S. Massage therapy for infants of depressed mothers. Infant Behavior and Development, 1996: 19, 107-112. Field, T., Grizzle, N., Scafidi, F., & Schanberg, S. Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence, 1996: 31, 903-911. Field, T., Ironson, G., Scafidi, F., Nawrocki, T., Goncalves, A., Pickens, J., Fox, N. A., Schanberg, S., & Kuhn, C. Massage therapy reduces anxiety and enhances EEG patterns of alertness and math computations. International Journal of Neuroscience, 1996: 56, 197-205. Fox, N. A. If it's not left, it's right: Electroencephalogram asymmetry and the development of emotion. American Psychologist,1991: 46, 863-872. McNair, D. M., Lorr, M. & Droppleman, L. F. Profile of mood states. San Diego: Educational and Testing Industrial Testing Service, 1981. Cohen, S., Kamarck, T., Mermelstein, R. A global measure of perceived stress. Journal of Health and Social Behavior, 1983: 24, 385-396. Cohen, S., & Williamson, G. Perceived stress in a probability sample of the United States. In S. Spacapam & S. Oskamp (Eds.), The social psychology of health: Claremont Symposium on applied social psychology. Newbury Park, CA: Sage, 1988.

25. CONTACT Carmen V. Russoniello, Ph.D., Director Psychophysiology Lab and Biofeedback Clinic East Carolina University Belk Building Suite 2501 Greenville, NC 27858 russonielloc@ecu.edu 252-328-0024 www.ecu.edu/biofeedback