Available online at ScienceDirect. Procedia Computer Science 75 (2015 )

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1 Available online at ScienceDirect Procedia Computer Science 75 (2015 ) International Conference on Virtual and Augmented Reality in Education Virtual Tool for the Development of Strategies to Reduce the Stress in Students Leticia A. Neira Tovar a *, Angélica Quiroga b, Francisco Torres c a Universidad Autónoma de Nuevo León, Av.Alfonso Reyes s/n, San Nicolás NL b Universidad de Monterrey, Centro de Tratamiento e Investigación de la Ansiedad, Ave Mississipi 116, San Pedro Garza Garcia NL, 66220, c Universidad Autónoma de Nuevo león, Av. Alfonso Reyes s/n, San Nicolás NL 66450, Abstract A This paper is based on gamification technique through the use of a gameplay, where computer science and psychology join together to understand the human emotions and the behaviour, looking for issues to manage the stress produced in the students during a new learning program. This tool is a computer game created with the objective of treating anxiety in a fun way, adjusting depending on your level of anxiety in which the user is setting. The Game is focus on developing different strategies that help to confront the anxiety, using psychological tool around the stage, represented by scenarios outside of everyday life and a central character with which the user represented and share his anxiety level. The intervention on the different levels of anxiety is carried out through the different in-game situations that test the user abilities The Authors. Published by by Elsevier Elsevier B.V. B.V. This is an open access article under the CC BY-NC-ND license Peer-review ( under responsibility of organizing committee of the 2015 International Conference on Virtual and Augmented Reality Peer-review in Education under responsibility (VARE 2015). of organizing committee of the 2015 International Conference on Virtual and Augmented Reality in Education (VARE 2015) Keywords: Video Game, Anxiety, Interactive control, Psychology, Computer Science 1. Introduction Stress is directly related to unpleasant or unsatisfactory events that occur in an individual's life, causing a series of emotional maladjustments [1,2], depending on how unpredictable, uncontrollable, and overloaded finds his/her live [3]. For students, entering an institution of higher education, remaining as a regular student and being able to graduate, is often an experience that many students consider stressful, particularly associated with overload and assessments [4,5]. Many problems are related to academic stress in students, such as sleep disorders, chronic fatigue, * Corresponding author. Tel.: address: Leticia.neira@gmail.com The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( Peer-review under responsibility of organizing committee of the 2015 International Conference on Virtual and Augmented Reality in Education (VARE 2015) doi: /j.procs

2 Leticia A. Neira Tovar et al. / Procedia Computer Science 75 ( 2015 ) headaches, digestive problems, anxiety, depression, sadness, concentration, aggressiveness, isolation, among others [6]. It is necessary to buffer the effects of stress on students, if they already have it, or prevent them. We developed a serious game accessible to all people between 12 and 30 years that have access to a computer and internet connection, that in a fun way helps to reduce the stress level in the user and improving their subjective wellbeing. This serious game, was based on the use of psychological techniques introduced into the gameplay. The videogame was built using Unity tools. The user interface consists on Kinect tool interacting with an oculus kit to present a Virtual Reality environment. The gameplay develop different strategies that help to confront the stress. The intervention on the different levels of stress was carried out through the different in-game situations that test the user abilities. The intention was to develop the skills and strategies necessary to confront the stress to affront a test examination at the final scholar period at college. This research aims to get the way to integrate psychology therapies with computer science and videogames, in order to create a virtual world that fosters the development of skills and strategies to deal with the stress during the examination period. Anxiety is considered important process because it has unpleasant consequences that directly harm the lives of sufferers and even from those around them [7, 8, 9]. 2. Methodology To develop this project, there were identified three different stages, which were designed to generate stress in a controlled environment. The first stage put you on an unusual situation in which you have to collect the best objects for a travel throw the hill, with the challenge of time counting down and the limit amount of movements. (Fig.1). Fig. 1. Initial icon stage The second stage tests user s skills and coordination as without the correct combination of momentum and speed your climb up the cliff truncated stay, making you come back again and again, causing Frustration and Anxiety in the user. Fig. 2. Hill and objects The third stage tests user s reflexes, as without them you can not dodge the obstacles and cliffs, the mountain has prepared for you. This with the intention to get the skills and strategies necessary to confront the anxiety

3 336 Leticia A. Neira Tovar et al. / Procedia Computer Science 75 ( 2015 ) Fig. 3. Skip and advance scene to produce stress. A base model was used to integrate the elements of this project. Figure 4. Fig. 4. Base model This base model help us to get the way to integrate psychology therapies with computer science and videogames, in order to create a virtual world that fosters the development of skills and strategies to deal with the anxiety. This model is former by 5 principal elements to integrate the involved areas working to produce the objective gameplay. The central element is the Person, then the selected character, to interact into a virtual world to manage anxiety techniques. 3. Evaluation and metrics A study of stress applying Cohen s Perceived Stress Scale (PSS), adapted and validated in Spanish [10], was conducted in two steps: (1) pretest, a week before applying the interaction with the game, (2) posttest, a week after using the application on a daily basis. The test was conducted with 40 participants, during the last period of school. The instrument used to measure the perception of stress consists of 14 items with a response format from a fivepoint Likert scale (0 = never, 1 = rarely, 2 = occasionally, 3 = often, 4 = very often; [8]. Cronbach s alphas pretest (α =.723) and posttest (α =.714) suggest that the items have relatively acceptable internal consistency. 4. Results In Table 1 we can see differences between the answers of the participants before and after the videogame sessions. We conducted a t-student test to compare this two sets of quantitative data collected independently to see if we could find a statistical significance difference. Table 1. Descriptive measures of responses to PSS

4 Leticia A. Neira Tovar et al. / Procedia Computer Science 75 ( 2015 ) Media Moda Error Std Desviation Variance Pretest Posttest The t-student for independent samples test showed a p =.463, indicating no statistical significance difference between the two measurements. Due to the fact, that posttest media is lower than the pretest media, we decided to calculate the strength of the apparent relationship to see if there had been an effect size of the intervention. The typical benefit from playing the serious videogame is considered to be a relatively large effect size (Cohen's d = 3.679). Furthermore, although the gameplay included moderated stressful situations, such as challenges and an open structure and semi situations board, all participants answered at some point with transient reactions of frustration, however, there were those who persisted in frustration. A couple of participants found the challenge to be an incentive, showing persistence to continue to obstacles given its assurance that there was an achievable solution to every challenge. 5. Discussion The results suggest that even users with no academic stress, self-reported a decreased degree of perceived stress. Although the difference has not statistical significance, the trend towards reduction showed a relatively large size effect. Game mechanics, were strongly supported in challenges that favour analogue sequencing of experiences cognitive and metacognitive processes associated with emotional modulation [8]. It is possible that knowledge about the operation rules refer to everyday experiences, as would be the successful advance in the game and the ability to be in control. This could relate to studies games in which there was an increase in the ability to solve problems [7]. Conducting this study had various limitations that could have influenced the results found. The sample of people without manifestations of academic stress limits the extent of the positive results of the game only applicable to similar population as the exposed to the game. 6. Conclusions In a society in which people interact through cyberspace and in a horizontal communication system asynchronous information could be released through serious games for health that would promote the transference of skills and knowledge developed during the game experiences to daily life. Results in this study provide valuable information about the use of serious games for health to deal with the stress and hopefully affront examination stress in college. We are now proposing to extend the period of exposure to the game to 10 weeks and re-assess the impact on stress

5 338 Leticia A. Neira Tovar et al. / Procedia Computer Science 75 ( 2015 ) management. Acknowledgements Authors want to thank to ENNUI Studios, who develop the prototype to probe the gameplay, using their experience and their equipment to develop the software. Also to Diego A. Flores Perez, a former student who support the animations design. References 1. Lazarus R. Stress and emotion: Management and implications for our health. Spain: Desclée de Brouwer; Williamson A. Manage and overcome stress: how to achieve a more balanced life. Spain: Desclée Brouwer; Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.) The social psychology of health. Newbury Park, CA: Sage; Barraza A. Academic stress in high education students: A case Retreived from: 5. Jaramillo G, Caro H, Gómez Z, Moreno J, Restrepo E, Suárez M. Stress and anxiety triggering devices in dental students of Universidad de Antioquia. Revista Facultad de Odontogía, Universidad de Antioquía 2008; 20(1): Monzón M. Academic stress in college students. Apuntes de Psicología 2007; 25(1): Adachi PJ, Willoughby T. More than just fun and games: The longitudinal relationships between strategic video games, self- reported problem solving skills, and academic grades. Journal of Youth and Adolescence 2013; 42: Guidano VF. Self in process. Barcelona: Paidós; Hoffman L. Family therapy. An intimate history. New York: W. W. Norton & Company, Inc.; Remor E. Psychometric properties of a European Spanish Version of the Perceived Stress Scale (PSS). The Spanish Journal of Psychology 2006; 9(1):