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

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

doi:10.2196/16066

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

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

Authors

Rineke Bossenbroek¹, Aniek Wols¹, Joanneke Weerdmeester¹, Anna Lichtwarck-Aschoff¹, Isabela Granic¹, Marieke M J W van Rooij¹

Affiliation

¹ Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.

PMID: 32207697
PMCID: PMC7139423
DOI: 10.2196/16066

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.

©Rineke Bossenbroek, Aniek Wols, Joanneke Weerdmeester, Anna Lichtwarck-Aschoff, Isabela Granic, Marieke M J W van Rooij. Originally published in JMIR Mental Health (http://mental.jmir.org), 24.03.2020.