# Lentis/The Psychology and Technology of Game Immersion

Here, we will discuss the psychology and technology of game immersion and go into possible positive ways to use it and negative effects that may arise. While immersive games began as simply another term for a virtual reality game, it has since been morphed to include all games that cause the player to lose awareness of the world around them and the time spent. This fact can be used in situations such as therapy for helping patients forget the pain they are in or military training so they feel like they are actually on an assignment. This loss of awareness, however, can also lead to game addiction if the player becomes so engrossed in the game that they continue to play to the detriment of their own health.

## Definition of Immersion

Immersion is primarily a state of consciousness, which makes a technical definition difficult. A common definition of immersion is when a person becomes so absorbed in an activity that they lose both temporal and spatial awareness. Immersion is also defined as "the sensation of being surrounded by a completely other reality [...] that takes over all of our attention, our whole perceptual apparatus." In both definitions, the key concept is the transfer of awareness of the physical world to awareness of the virtual one.
Immersion is also the process by which awareness is transferred. This process can be split into three distinct stages: Engagement, Engrossment, and Total Immersion. Each stage can be characterized by the psychological barriers the player must overcome and the degree of awareness transfer.

#### Engagement

Engagement is the initial stage of immersion. It is characterized by an increase in time and effort put towards the game. In physical terms, improvements in reaction time and an increase in eye fixations are indicative of engagement. To achieve engagement, a player must overcome two psychological barriers: Access and investment. Access is the players compatibility with the game - in essence how well the game matches his or her tastes. Investment is the willingness to dedicate time and energy to playing the game. At this stage of immersion, the player is still fully aware of the physical world.

#### Engrossment

Engrossment is the second stage of immersion. It is characterized by the beginning of awareness transfer. Engrossment is physically visible as changes in body posture and facial expression, in addition to improvements in reaction time and eye fixations. To reach engrossment, the player must be willing to surrender their awareness to, and become emotionally connected with, the game. Players often describe engrossment as getting into the "flow" of the game. This sensation of "flow" is normally associated with the loss of awareness of the input device and controls - the player feels as if they are directly interfacing with the game. Flow also involves an innate sense of the reactive difficulty of the game, that the game becomes more difficult the better the player is.

#### Total Immersion

Total immersion is the final stage of the immersion process. At total immersion, the player has temporarily transferred their awareness to the virtual world. Total immersion is seen as the combined effects of three forms of immersion: sensory, challenge-based, and imaginative. Sensory immersion is the loss of sensory awareness, and is affected in part by the input and display devices. Superior devices, such as surround sound or virtual reality equipment help to satisfy the sensory immersion requirement. Challenge-based immersion is the apex of the aforementioned concept of flow. In challenge-based immersion, the difficulty of the game is so responsive and demanding that the player feels that all of their attention is required to continue to succeed. Lastly, imaginative immersion is the peak of the player's emotional attachment to the story and characters. Once the player has achieved total immersion, they lose so much self-awareness that they may even temporarily ignore their physical needs and social responsibilities.

## Technology

The input and output devices associated with playing a video game are key contributors to achieving sensory immersion. Although virtual reality technologies are not required to reach sensory immersion, they accelerate and strengthen immersion. Audio-visual technologies such as the Oculus Rift paired with a surround sound system give the player direct presence within the game while reducing their awareness of the real world. Input devices such as the Virtuix Omni - a harness that translates 3D player motion directly into the game, including walking - further increase this sensation of presence in the virtual world. Input and output devices that correctly translate between the player's physical and virtual presence are required, as a mismatch can give the player cybersickness. Cybersickness has similar symptoms to motion sickness, but is cause by a mismatch between visual sensation of self-motion and physical sensation of self-motion.

## Beneficial Uses of Game Immersion
### Physical Therapy

According to physical therapist Marc Suznovich, geriatric patients can benefit from immersive video games such as the Wii because it enables them to focus on something else by engaging them with the task environment in the game. He claims that it helps patients achieve balance, stand longer, and achieve a greater range of motion. He uses the Wii in physical therapy to help patients increase visual-perceptual processing, postural control, and functional mobility. For example, a patient who has a hard time sitting up in bed can play boxing which moves their arms and helps them work on sitting balance. The system also allows physical therapists to easily track the progress of the patients by storing the game data. The distraction from the immersive game is an example of engrossment because the patient’s awareness is transferred from the menial tasks associated with physical therapy to the virtual environment where the patient plays the game.
Judith Deutsch led a research team on a case study also using the Wii for rehabilitation of an adolescent cerebral palsy patient. Like the geriatric patients, this patient underwent physical therapy sessions using Wii sports in both standing and sitting positions. The researchers claim that "Virtual reality systems offer clinicians the control over exercise duration, intensity, and environments that real-world tasks do not." Use of the Wii is particularly appealing because it is relatively low-cost and easily available compared to alternative virtual reality systems specifically designed for rehabilitation of gait training and upper and lower extremity training. They found the rehab had a positive effect on the patient's impairment and functional levels. By diverting the patient's attention to the task environment, the patient can focus on something else rather than controlling body movements and coping with pain.

### Pain Relief

Psychologists and doctors have begun using game immersion to treat pain for patients undergoing extremely painful treatments.A study in 2011 by Jameson, Trevena, and Swain on the effect of both active distraction (electronic gaming) and passive passive distraction (television) found that participants had a significantly higher pain tolerance with active distraction than both no distraction and passive distraction. This illustrates the benefit of video games in particular as a method to treat pain.
Furthering this notion of video games for pain treatment, NBC chronicled a case study of Lieutenant Sam Brown who suffered third degree burns while in combat during his deployment to Afghanistan. After being flown back to the U.S. for treatment, he had over 24 painful surgeries and underwent physical therapy. Brown was concerned that he would become addicted to pain killers because of his extensive and painful surgeries, so his doctor suggested that he try game immersion to treat the pain. By playing SnowWorld, Brown was able to concentrate on throwing snowballs, and thus divert his brain's attention away from the pain processing signals. According to a military study in 2011, playing SnowWorld was more effective than morphine at treating pain. This is an important discovery because it offers a viable alternative to addictive drugs such as morphine.

### Exercise

The American Heart Association collaborated with think tank Institute for the Future to create Cryptozoo: a game that forces users to be physically active. The idea behind the game is that by taking advantage of online games and social media, virtual reality games can reinvent how people think of physical activity. Users sign up online for a set duration to "play" and follow a set of cryptids (mythical animals with strange animal tracks) on a one mile tour of the city. Users can then meet up with other users in different "packs" to try to out-chase the cryptids. This shows a push for taking advantage of aspects of video games that people like (e.g., narrative) in order to accomplish another goal--in this case, exercise.

## Negative Effects
### Game Immersion and Addiction Correlation

As seen in the Google Ngram, the term "video game addiction" has been around in published works since the early 1980's. To put this into perspective, Pong - one of the first games to reach mainstream popularity - was released in 1972, with the home version coming out in 1975. While many things could contribute to the coining of the term, one explanation of its appearance in literature could be the release of the first video game magazine "Electronic Games". Around 1985 is when Super Mario Bros. came out, which might attribute to the small increase in the usage of the term around that time. Super Mario Bros. became the best selling video game of all time until 2008, when the title was passed on to Wii Sports. The most noticeable spike in "video game addiction" was around 1996. While there is no definitive evidence, one guess for this sudden increase is that it is due to the release of the Nintendo Game Boy. As well as the steadily increasing popularity of home gaming systems such as the NES that allowed for play at home instead of at an arcade, the Game Boy let players take the now-portable games with them wherever they want. This allows children and other gamers to play around the clock, and inevitably could contribute to a rise in game addictions.
The word "immersive" began to be used to describe games around 1992, but this was not due to immersion as defined as a game that captures and holds your attention but specifically as it relates to the emerging technologies of virtual reality at the time. One research project by IBM was a simple, interactive video game where the user could pick up and move flexible geometric shapes or "rubber rocks", and demonstrated both the "tremendous promise of virtual reality and the great effort required to make it work." Others began focusing on how virtual reality could specifically be used to make games more exciting by not seeing anything except the computer-generated images in order to be completely immersed in all senses of the word. Since then, however, the term has been expanded and used in reference to non-virtual reality games in the sense that if someone is immersed in a game, all of their attention in focused on this game and this effect can lead to video game addictions.
Although there is no defined causation between the two terms "immersive game" and "video game addiction", there is definitely a correlation. Both have been steadily increasing in usage since the early 2000s, so the two may be related especially since their definitions overlap. A game that is too immersive to the point where you can't put it away can also be seen as an addicting game.

### DSM-V: Internet Gaming Disorder

Named Internet Gaming Disorder to differentiate it from a gambling addiction, this disorder can be more commonly thought of as form of video game addiction and is currently a "condition for further study" in the DSM-5. This means that based on a large number of studies and severe consequences potentially associated with this condition, the DSM-5 would like more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder. It is a concern for psychologists due to reports of gamers who play constantly to the exclusion of their other interests. The main criteria for Internet Gaming Disorder is the "repetitive use of Internet-based games, often with other players, that leads to significant issues with functioning". Five of the following criteria must also be met to be diagnosed with the disorder.
* Preoccupation or obsession with Internet games.
* Withdrawal symptoms when not playing Internet games.
* A build-up of tolerance – more time needs to be spent playing the games.
* The person has tried to stop or curb playing Internet games, but has failed to do so.
* The person has had a loss of interest in other life activities, such as hobbies.
* A person has had continued overuse of Internet games even with the knowledge of how much they impact a person’s life.
* The person lied to others about his or her Internet game usage.
* The person uses Internet games to relieve anxiety or guilt – it’s a way to escape.
* The person has lost or put at risk and opportunity or relationship because of Internet games.
The APA is a trusted scientific and professional organization that represents psychologists in the United States, so their consideration of Internet Gaming Disorder shows how it is a common and growing problem that they believe may need to be helped in the form of a psychological diagnosis. This may lead to medications and rehabilitation methods specific to video game addiction. This also shows how the APA is could be considered a major participant against the creation of immersive games in terms of making games that capture and hold your attention so well as to create an addictive environment.

### Self Help

Programs such as Computer Gaming Addicts Anonymous (C.G.A.A.) exist to help people who want to "abstain from video gaming and to find freedom from compulsive gaming." C.G.A.A. has adopted their Twelve Traditions from Alcoholics Anonymous to ensure that everyone who is taking part in C.G.A.A. is there to help themselves and others in overcoming the inability to moderate their video game playing.

### Parental Concerns

Parents are especially concerned with video game addiction, as they care deeply about the mental and physical health of their children as they mature. Because of this, there are many resources parents can turn to in order to determine whether or not their child is addicted to video games and to assist them in dealing with and helping an addicted child. One such test by TechAddiction, allows parents to take a quiz in order to assess the extent to which their child needs help by answering questions such as:
My Child neglects his/her hygiene because of excessive video game play:
* Never or rarely (0)
* Occasionally (1)
* Often (2)
* Always (3)
The more points that are accumulated by the end of the test, the more likely their child is addicted to video games. If you score over 61 points, your child has a very high likelihood of being addicted to video games, and the website then directs the parent to a book they can purchase about how to help a child addicted to video games.
Parodies of this nature have also emerged, such as Mothers Against Videogame Addiction and Violence (MAVAV) and the MomsAgainstGaming twitter account. The harsh responses to both show that while some parents are concerned about their children becoming addicted to video games, many others - including gamers themselves - find that there is a very big difference between addiction and immersion.

## References

* 1 2 3 Cheng, M. T., Shet, H., C., Annetta, L., A. (2014) Game immersion experience: its hierarchical structure and impact on game-based science learning. Journal of Computer Assisted Learning. DOI: 10.1111/jcal.12066
* ↑ Murray, J. Hamlet on the Holodeck: The Future of Narrative in Cyberspace. The MIT Press, Cambridge, 1997
* ↑ Virtuix Omni Storefront
* ↑ Lin. J.J, Duh, H. B. L., Parker, D. E., Abi-Rached, H., Furness, T. A. (2002). Effects of field of view on presence, enjoyment, memory, and simulator sickness in a virtual environment. Proceedings of IEEE Virtual Reality 9: 164-171
* ↑ O'Grady, K. (2013, March 28). He's got game. Retrieved from American Physical Therapy Association
* ↑ Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P. Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther. 2008;88:1196-1207
* ↑ Jameson, E., Trevena, J., & Swain, N. (2011). Electronic gaming as pain distraction. Pain Research & Management, 16(1), 27-32.
* ↑ Frank, M., & Carter, N. (2012, October 24). Groundbreaking experiment in virtual reality uses video game to treat pain. Retrieved from NBC News
* ↑ (2009). Come out & play 2009 in New York. Retrieved from Come Out & Play website: http://comeoutandplay.org/2009_cryptozoo.php
* ↑ Peterson, E. (1992). Looking-glass worlds. (Cover story). Science News, 141(1), 8
* ↑ Skurzynski, G. (1993). The best of all (virtual) worlds. School Library Journal, 39(10), 37.
* ↑ American Psychiatric Association (2013). Internet Gaming Disorder Fact Sheet. Retrieved from www.dsm5.org
* ↑ Sarkis, Stephanie (2014, July 18). Internet gaming disorder in DSM-5: a disorder for further study. Retrieved from www.psychologytoday.com
* ↑ American Psychiatric Association (2013). "Internet Gaming Disorder." The Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington, D.C.
* ↑ American Psychiatric Association (2014). About APA. Retrieved from www.apa.org
* ↑ Computer Gaming Addicts Anonymous World Services (2014). What C.G.A.A. is and is not. Retrieved from www.cgaa.info
* ↑ Conrad, Brent (2014). The Video Game Addiction Test for Parents. Retrieved from www.TechAddiction.ca
* ↑ MAVAV (2006). Video Game Addiction and Violence in Underground Video Game Cultures. Retrieved from www.mavav.org
* ↑ Moms Against Gaming. (2014, Sept. 24). MAVAV. (2006). Moms Against Gaming. Retrieved from twitter.com/MomsAgainstGam