Overview

Challenge

For children: People with OCD, particularly students, often face social stigma and unkind treatment, which can exacerbate their symptoms and hinder their mental well-being. While gradual exposure to challenges is crucial for building resilience, maintaining a balance between progress and emotional stability can be difficult. Additionally, parents play a vital role in supporting their children by confronting and understanding their OCD behaviors, which can be emotionally taxing. Moreover, the recovery process may feel burdensome for children due to repetitive and boring training methods, especially when professional guidance is lacking, further reducing the effectiveness of rehabilitation.

Competitors: Competitors provide a relaxing and visually appealing user experience with educational value, but their offerings are often limited by insufficient personalization features and inadequate parent interaction functionalities. While free downloads enhance accessibility and attract users, the high production costs associated with maintaining quality and innovation pose a significant financial challenge.

The Solution

A game to help relieve the symptoms of children with OCD through scientifically effective breathing exercises as well as promote relationship between children and parents. By transforming repetitive drills into playful exercises, Bubble Cargo allows children to engage in long-term therapy without realizing it.

Liyi Xu, Shurong Han, Chenwei Ye, Yijuan Li

Timeline

My Roles

Teammates

2 Months (Sep.2023 - Nov.2023)

Product Manager, Hardware Developer, Product Designer

Background

Characteristics

Severity
OCD is ranked by the World Health Organization in the to 10 of the most disabling illnesses by lost income and decreased quality of life.

Universalization
OCD is that the condition affects as many as 12 in every 1,000 people (1.2% of the population) from young children to adults, regardless of gender, social or cultural background. There are also at least 1 in 200 –– kids and teens that have OCD.

Obsessive-compulsive Disorder In Children

Although OCD can occur at any age, one of the two age ranges when OCD tends to first appears is between ages 8 and 12.

Bring behavioral and social impacts in life and at school

Executive Functioning Defecits

School Refusal

Social Difficulties

Disrupted Sleep

Mindfulness-Based Cognitive Therapy for OCD

Mindfulness- an effective way to promote awareness and attention to one's inner experience, a way to see one's inner experience from the standpoint of a spectator.

Goal

Trainer helps the patient to shift from focusing on the past and the future (as determined by memory and regurgitated thinking) to focusing on the present moment, thus creating a process of decentering and de-identification of the individual's experience.
Integrate "positive thinking" into daily life to help patients deal with negative emotions in daily life.

Demonstration from several studies

Effective in the treatment of OCD
Experienced therapists who can provide targeted mindfulness-based exercises according to the characteristics of different obsessive-compulsive individuals can achieve even more significant results.

Anapanasati-Regular breathing

Regular breathing is also an essential part of a Mindfulness-Based Cognitive Therapy
Has more Control Over Your Thoughts
Stress Reduction
Improved Mood

Research

Competitor Research

Conclusion from the map:

They provide a relaxing and visually appealing user experience with educational value, but there is room for improvement in areas like personalization and parent interaction.
The accessibility of free downloads is a strong point, but high production costs may pose a challenge.

Participants

Children Age: 8
Casue: Severe OCD
Current Treatment: Medication, CBTY-BOCS Score: 26

Children B Age: 12
Casue: Moderate OCD
Current Treatment: ERP, CBTY-BOCS
Score: 19

Interview

To get some background information about the children, I asked their parents to describe their children (e.g., personality) and whether they faced any problems in recovering from OCD.

Q1: Describe your child's current situation

Q2: How do you deal with your child's various situations after getting OCD?

Q3: Do you know if breathing exercises in Positive Thinking Cognitive Training are helpful in relieving OCD symptoms? Will you try it with your child?

Observation

After having each of the two parents record their child's behavior and interactions with them during mindfulness training especially on breathing, I summarized their individual experiences into the following user experience map.

Insights

1. Need positive feedback
Positive encouragement and understanding from others is extremely important for people with OCD. However, for OCD patients who are attending school, they are more likely to encounter being treated unkindly.

2. Gradually challenge the symptoms
Children with OCD need to be gradually challenged to help them reduce their symptoms over time and become more resilient.

3. Need support from parents
Parents need to confront and understand their children and work with them to overcome difficulties.

4. Scientific mindfulness training guidance is needed
Boring and repetitive training can make OCD children feel that rehabilitation is a burden, and the lack of professional guidance can reduce the effectiveness of rehabilitation.

Game Concept

Game Direction

Game Background Story

Cargo's room has sunk to the bottom of the water and many of his beloved toys are trapped in the water. Every day, Cargo tries to find a way to bring these toys to shore. One day he realizes that his breath turns into bubbles and he uses these bubbles to load his toys!In the game you will play as Cargo and control the size and movement of the bubbles through positive breathing to transport the toys in the underwater house to shore.

Game Flow

Modeling

Game on Unity & BGM Production on REAPER & Hardware on Rhino

Game Devices

Module

Breathing Cues

How to play?

Step1: In the game you will play as ‘Cargo’ and control the size and movement of the bubbles through positive breathing to transport the toys in the underwater house to shore.

Step2: Move the bubble, until you think the bubble is big enough to carry the toy you want, you can catch it.

Step3: Be careful not to get swept away by the vortex.Otherwise the bubble is destroyed and returns to the starting point at the initial size.

Step4: Go and collect some golden coins for bonus!

Step7: Transport the toys to the white bubbles on the shore.

Step6: Transport the toys to the white bubbles on the shore.

Step8: After bringing them ashore, the lighthouse lit up, guiding distant ships to discover Cargo and take it to a new island for a new life!

Step9: Congrats! You successfully complete this turn.

Step5: Use the force of the water column to make the bubbles rise.

Unity Coding
-Using Uduino

Obtain data received from the port, and split it into key and exhalation volume.

Bubble controller: movement, water column interaction, vortex interaction, etc.change.

Breathing indication progress bar display/color control, bubble movement and enlargement, and breathing ring color change.

Scene Design

Cooperative treatment

Game design

(1) On Board
Log in to the user's own account so that the system recognizes the doctor or child.

(1) Home Page
Mouse over for a 360 degree view of the island.

(2) Doctors’ Side
The doctor assigns his patients different stages of the game, checks the completion of the tasks, communicates with the patient and makes an appointment for the next specialized psychotherapy session.

(2) Zen Mode
In this mode, you are free to choose their game time.

(3) Users’ Side
Patients can view the advice given by the doctor, assigned game tasks, communicate with the doctor in real time, etc.

(3) Story Mode
In this mode, players need to complete tasks set within the game in order to win.

Usability Testing

Child 1: Xinqian
Age: 10
Duration of confirmed OCD: 2yrs
Degree of OCD: moderate

We observed that Xinqian was very curious about the game and worked very well with his mom during the game, which went very smoothly overall.

Xinqian: “After the game, I felt much more relaxed and my original anxious thoughts were much reduced.”

Xinqian’s Mom: “I'm usually concerned about his symptoms of illness, and I'm hoping that this game will help ease the obsessive thoughts in his mind a little faster.”

Child 2: Zijun
Age: 8
Duration of confirmed OCD: 1yr
Degree of OCD: Severe

Zijun was initially resistant to participating in the game, but after careful guidance from us and his parents, he gradually became engaged and enthusiastic. After the game was over, he even dragged one of the other children to participate with him.

Zijun: “I think the game is great and more fun than any MBCT therapy I've tried.”

Zijun’s Mom: “I hope that in the future there will be more features to go along with the counseling to visualize the effects a bit more.”

Child 3: Jiaye
Age: 9.5
Duration of confirmed OCD: 5 months
Degree of OCD: Slight

We've noticed that Jiaye often struggles to control himself from cleaning his fingernails when he's supposed to be focused, but in the game, we've found that he can control this compulsive behavior.

Jiaye: “In the game, I will fully focus on my breathing, and it feels much better.”

Jiaye’s Mom: “I think it's okay, but I'm somewhat concerned if this will make the child addicted to video games.”

Challenges during testing

In conducting user experiments, our teammate who is primarily responsible for program development and I have been following up to resolve bugs.

1. At the beginning the children needed adult guidance to know the breathing sequence.
2. The children would blow several times for a short period of time.

Greatly affected the user experience.

It was not in line with the positive breathing methodconcept we designed.

Solution

Therefore, our team continued to make adjustments to the gameplay in "How to improve the visualization of breathing progress".Specifically, we added a progress bar on top of the existing breathing ring, and used only three colors to differentiate. (The final effect and code are shown in the previous Code section)

Future Work

1. Increasing the number of patients participating in the game experiments.

2. Continuously monitoring the follow-up of patients who have participated in the experiments.

3. Enhancing game functionality.

Bubble Cargo