Creating Biofeedback-Based Virtual Reality Applications to Enhance Coherence Of

Home , Guided meditation

Creating Biofeedback-Based Virtual Reality Applications to Enhance Coherence of

Mindfulness Practice

Thesis

Presented in Partial Fulfillment of the Requirements for the Degree Master of Fine Arts in the

Graduate School of The Ohio State University

Kevin Bruggeman

Graduate Program in Design

The Ohio State University

2019

Thesis Committee

Susan Melsop

Matthew Lewis

Maria Palazzi

Copyrighted by

Kevin James Bruggeman

Abstract

This MFA thesis paper is an in-depth analysis of the creation of The Hiatus System, a biofeedback-based virtual reality (VR) stress reduction application using mindfulness-based stress reduction (MBSR). This paper introduces key terms and concepts such as MBSR, biofeedback/neurofeedback, and VR simulation training that informed the design decisions made during the creation of this application. The paper also describes three iterative design projects that led to the creation of The Hiatus System. A breakdown of the design process for the creation of The Hiatus System is described in detail, technically and conceptually. This VR application was developed for use in healthcare as a system that can teach patients the concept of mindfulness using mindfulness-based stress reduction (MBSR) training, through a biofeedback- based interactive learning module. While the framework for a pilot study testing the effectiveness of The Hiatus System is described in this paper, the results of this study will be evaluated in a follow-up publication to this MFA thesis paper.

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Dedication

This thesis is dedicated to my mother, Cindy Bruggeman, who fought and struggled through breast cancer and depression. Because of her, I found my passion for helping people in her situation that are struggling to get through the difficult curveballs life throws at them. Her strength motivated me to always strive to become better and persevere.

I also want to dedicate this thesis to my aunt, Linda Hodge, who continuously supported my family and me countless times. Linda always treated me as if I was a son of her own and I am forever grateful for her kindness and compassion.

Finally, I would like to dedicate this thesis to Shantel Swift who has remained by my side throughout my graduate years and supported me along the way. I would not have been able to accomplish everything I have without her and I am excited to start the next chapter in my life with her.

Acknowledgments

I would like to offer my warmest gratefulness to The Ohio State University for their constant and support. Thank you to my advisor Prof. Susan Melsop, for her dedication to me and my work. Susan went above and beyond what is required of professors. She helped me on a weekly basis review, revise, and improve my thesis project and paper and for that I am incredibly lucky and grateful. Susan has been the best advisor I could have asked for so again, thank you.

Thank you, Prof. Maria Palazzi for helping me through my first few years becoming a designer and finding my designer’s voice. Thank you, Dr. Matthew Lewis for walking me through the technical aspects of my thesis paper and project, and for helping me translate technical aspects of my work into an understandable language. Thank you to Dr. Ruchika Prakash and Dr. Marcia

Bockbrader for their collaborative efforts on the pilot study. Thank you to Skylar Wurster, my partner in development whom without, this thesis project would not have been possible. Skylar is one of the most intelligent and hardworking individuals I have ever known, and I am proud to continue working with him in the future. Thank you to the Collaboration for Humane

Technologies, Chronic Brain Injury Association and Innovation Studio at Ohio State University for financially supporting the project for the ACM SIGGRAPH presentation. Finally, thank you

Dr. Jason Stoner for the support and time he provided to generate this thesis direction during my undergraduate studies at Ohio University.

Vita

Jan 2014 - May 2016…………....Mentor, Ohio University Game Developers Association

May - Aug 2018…………………...... 3D Visualization Artist Intern, Chute Gerdeman Inc.

Aug 2016 - Dec 2018………………...Graduate Teaching Assistant, Ohio State University

May 2016 - present……………………………………………...3D Artist, Guesswork VR

Jan 2019 - present………...... Graduate Research Assistant, Design, Ohio State University

Publications

Kevin J. Bruggeman and Skylar W. Wurster. 2018. The Hiatus system: virtual healing spaces: low dose mindfulness-based stress reduction virtual reality application. In ACM SIGGRAPH

2018 Appy Hour (SIGGRAPH '18). ACM, New York, NY, USA, Article 8, 2 pages. DOI: https://doi.org/10.1145/3213779.3213785

Fields of Study Major Field: Design

Concentration: Digital Animation and Interactive Media

Table of Contents

Abstract ...... iii

Dedication ...... iv

Acknowledgments...... v

Vita ...... vi

Publications ...... vi

Fields of Study ...... vi

List of Figures ...... ix

Chapter 1: Introduction ...... 1

1.1: Background ...... 6

Chapter 2: Current Research Background ...... 11

2.1: Introduction: ...... 11

2.2: Mindfulness and Meditation ...... 11

2.3: Virtual Reality Biofeedback/Neurofeedback Based Studies ...... 15

2.4: VR Simulation Training ...... 21

2.5: Conclusion...... 23

Chapter 3: Designing a VR Based MBSR User Experience...... 26

Chapter 3: Introduction ...... 26

3.2: Original Zen Temple ...... 28

3.3: Heartbeat VR ...... 36

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3.4: Tree Flight VR ...... 39

3.5 Conclusion ...... 45

Chapter 4: The Hiatus System ...... 47

4.1: Introduction ...... 47

4.2: Visual Design ...... 48

4.3: User Experience Design ...... 66

4.4: Conclusion...... 69

Chapter 5: Scientific Study and Hypothesis ...... 71

5.1: Background and Rationale ...... 73

5.2: Scientific Premise for Aim #1 ...... 74

5.3: Scientific Premise for Aim #2 ...... 75

5.4: Procedure...... 76

Chapter 6: Conclusion...... 78

Works Cited ...... 81

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List of Figures

Figure 1 Daitoku-Ji rock garden ...... ……………………………………………………………..30

Figure 2 Daitoku-Ji moss garden ...………………………………………………………………30

Figure 3 Diorama Space A ...... …………………………………………………………………...31

Figure 4 Diorama Space B ……………………………………………………………………….32

Figure 5 Diorama Space C ……………………………………………………………………….32

Figure 6 Final in-game render of the Original Zen Temple space C in VR ...…………………...33

Figure 7 Daitoku-Ji rippling rock garden waves…………………………………………………34

Figure 8 Heartbeat VR in-game view ...………………………………………………………….37

Figure 9 Ring at full exhale ……………………………………………………………………...40

Figure 10 Ring at full inhale ……………………….……………………………………………40

Figure 11 Bio-sensory Belt ...…………………………………………………………………….41

Figure 12 The Biofeedback Loop .………………………………………………………………42

Figure 13 Bad Breath Graph ……………………………………………………………………..44

Figure 14 Good Breath Graph …………………………………………………………………...44

Figure 15 Breakdown of Zen temple interior and exterior space ….……………………………50

Figure 16 Breakdown of Zen temple exterior space ……………………….……………………50

Figure 17 Breakdown of an interior and exterior relaxation space ………………………………51

Figure 18 Breakdown of interior relaxation space …………….…………………………………51

Figure 19 Top-down view of Zen temple in the final thesis project …….………………………53

Figure 20 Focal point lines from interior temple ………….…………………………………….54

Figure 21 Audio source placement and user’s starting camera view ………………………….…55

Figure 22 Comparison between real world wood and virtual wood material ……………………58

Figure 23 Hiatus System color palette ……………………………………….………………….60

Figure 24 Direct (left image) vs. Indirect (right image) lighting ………………………………...62

Figure 25 Directional light and shadows ...………………………………………………………65

Figure 26 Exterior point lights …...………………………………………………………………66

Chapter 1: Introduction

This thesis explores the potential of virtual reality (VR) to enhance Mindfulness Based

Stress Reduction (MBSR) practices. Specifically, this thesis paper describes the design process of creating a VR application intended to teach MBSR practices. The main purpose of this research project is to utilize virtual reality technology to elevate MBSR practices for the goal of long-term stress reduction in users. Current research demonstrates that MBSR, which is based on mindfulness meditation training, has the ability to reduce long term stress (Miller J., Fletcher K.,

Kabat-Zinn, J., 1995). MBSR is a method of using mindfulness practices to become more nonjudgmentally aware of the present moment. These methods are learned through the process of meditation, such as breath awareness meditation. The goal of MBSR practice is to enter a relaxed mental state, in which one can frequently return to, where the individual is shedding the worries and concerns of past and future stressors or problems. Over time, this mentality reduces the mental impact of stressful events, and lessens long-term stress by decreasing the negative effects of daily stress.

MBSR was developed in 1979 as a clinical program that attempts to teach an individual how to reduce stress through mindfulness awareness meditation (Center for Mindfulness in

Medicine, Health Care, and Society, University of Massachusetts Medical School, 2017).

Mindfulness meditation is a nonjudgmental awareness of sensation, emotion, cognition and perception that an individual can use as a method towards how they interpret both internal and external experiences in life (Klatt, 2009). Mindfulness meditation requires patience and concentration, making it a challenging task for many individuals. One of the major obstacles with MBSR and achieving a mindful state is that the meditation practices require considerable

time and effort for a novice practitioner to adapt to the mindful mentality. This thesis project aims to develop a VR interactive application to support self-learning of MBSR practices.

The main purpose of developing this digital application is to teach MBSR to patients experiencing high stress through the medium of VR. MBSR uses mindfulness meditation, adapted from ancient wisdom traditions of the East, in order to alter the perspective or lifestyle of the user. Changing an individual’s lifestyle through mindfulness meditation provides a new framework for how they perceive and react to stressful situations, as well as learning how to focus on the present moment, not focusing too much on the past and future. MBSR uses mindfulness techniques to create a participatory educational approach, utilizing internal resources to frame what a person perceives as stressful experiences. Frequent practice of MBSR methods attempt to focus one’s internal struggles towards awareness. In the frame of MBSR, awareness refers to the individual’s ability to be aware of, and delegate their responses and reactions to external events in life. Regardless of whether an event is perceived positively or negatively, or whether or not we have control over the event, the core activity of MBSR is to be aware of our affective responses to these internal and external events (Klatt, 2009). The sense of being mindful according to Kabat-Zinn is the ability to be aware in the present moment, nonjudgmentally (Kabat-Zinn, 2013). The concept of focusing on the present moment, is the ability to be aware of our affective responses towards life's events at the moment they occur, not focusing on past events that we cannot change, or future events that we cannot yet impact.

Responding in a nonjudgmental way refers to a change in perspective that MBSR practices promote: the ability to respond to events without irrational sensation or emotion (Kabat-Zinn,

2013). Simply put, responding nonjudgmentally means that the individual is pausing shortly after

a stressful event occurs to relax and breathe so they can decide how to respond to that situation rationally, in a positive way.

Virtual reality, defined in The VR Book, written by Jason Jerald, is “A computer- generated digital environment that can be experienced and interacted with as if that environment were real” (Jerald, 2016). The qualities of VR technology include a head-mounted display

(HMD) that separates the digital content into two small screens within the VR headset, one for each eye. While in VR, the individual has at least three degrees of freedom, allowing them to rotate their head in any direction to look at the immersive 360-degree environment they are digitally present in. Some VR headsets allow for six degrees of freedom, which includes both rotational, and positional tracking. Six degrees of freedom means that the user can physically walk in the real world, and their positional movement is tracked and translated to the digital space, allowing them to physically walk in the virtual reality environment. The major benefit of

VR over other digital mediums is the ability to fully immerse the user in a digital space, restricting distraction from the real world, and providing a feeling of a physical presence in the virtual environment.

This paper describes the creation of a mobile, standalone android-based, VR meditation application, called The Hiatus System. The Hiatus System is a unique application because it integrates a user-centered design focus supported by specific interactive technology created for this project. It integrates MBSR audio training with a biofeedback system while immersed in a virtual Zen temple-inspired environment. This unique combination aims to help reduce stress and teach MBSR to individuals. The aesthetic design decisions of the VR space are based on the physical attributes and atmospheric elements of a Kyoto style Zen temple. Historically, Zen

temples were specifically designed as spaces for contemplative experiences, meditation, and enlightenment.

As stated before, mindfulness meditation, as well as aspects of the MBSR training model are influenced by Buddhist traditions. Therefore, the development of this thesis project is based on design elements of these traditional spaces in an attempt to create a relaxing space that enhances the mediation experience. This project incorporates various design elements in order to attain and maintain the user’s attention towards the breathing meditation practice.

The question that I attempt to answer in this thesis project is: Can a meditation focused application utilizing immersive technologies teach MBSR techniques to individuals? To answer this question a pilot study testing the effectiveness of this thesis project will be conducted.

However, the results of this study have not been completed and analyzed before the required date for completion of this MFA thesis paper. I intend to publish a follow up paper to this thesis reporting the results of this preliminary study. This thesis paper will discuss the structure and hypothesis of the pilot study based on previously existing relative research. The pilot study is titled the Impact of Virtual Reality on Adherence to Mindfulness Practices. This study is being performed by Dr. Ruchika Prakash, Dr. Marcia Bockbrader, Prof. Susan Melsop, and myself and is funded by the Chronic Brain Injury Discovery Theme at Ohio State University. The study will be performed at the Clinical Neuroscience Laboratory under Dr. Ruchika Prakash. The timeline for this study is to be conducted over two weeks, between April and May 2019. In addition to the study, I will describe the research development phases that led to the completion of the final thesis project.

This paper is structured with the following organizational logic. Chapter two elaborates on the background of research related to this thesis. The chapter is divided into three sections:

meditation and mindfulness, virtual reality biofeedback and neurofeedback precedence studies, and virtual reality simulation training. These sections serve as a brief overview of the necessary knowledge to support the hypothesis of the thesis project.

Chapter three describes the concept development of The Hiatus System. This section analyzes the iterative design process, highlights the challenges I faced leading to the final design, and describes how I learned to collaborate with my project partner, Skylar Wurster, an undergraduate student at Ohio State University in Computer Science and Engineering. Chapter three is in chronological order and starts with pre-design studies and methods. I then transition to the research through three VR projects; this includes the Original Zen Temple project, Heartbeat

VR, and Tree Flight VR. These preliminary design studies were instrumental to my iterative design process and provided design principles utilized for the development of the final project.

Throughout these iterative projects, I learned how to design an immersive VR application utilizing real-time interactive technology. I discovered how to balance stimulation and concentration to create a learning-focused user experience.

Chapter four describes the design process of the final project. The chapter begins with a description of the design goals and the preliminary steps taken to achieve those goals. The process of creation is divided into three sections. The first is the design of the Zen temple. This section includes an analysis of reference material, the conceptual problem of visual distraction, the significance of attention focusing design elements, and material identity. Second is the design of the environment. This section includes the visual reference for the physical materiality of Zen temples and gardens, the concept of biophilia, and designing for immersion and presence.

Additional aesthetic considerations include lighting, color, and material identity. The third and final section is the user experience design. This section includes user interaction, the integration

of the biofeedback breath belt, the guided audio meditation integration, and the biofeedback loop. The biofeedback loop is a process in which the user provides bio-input to the biosensing technology, which provides feedback from the bio-input, allowing the user to adjust based on the feedback. The biofeedback loop is presented in detail in chapter three.

Chapter five describes the future pilot study to be conducted in collaboration with Dr.

Marcia Bockbrader from the department of Neurology, and Dr. Ruchika Prakash from the department of Psychology. This section includes the purpose of the study, specific aims, the methods in which the study will be performed, and the hypothesis for the study.

Finally, chapter six is a synopsis of the thesis paper. This chapter attempts to discover if there is evidence to suggest that the design of this MBSR virtual reality-based training application is effective for teaching users mindfulness techniques and subsequently reducing stress.

1.1: Background

Stress, particularly in the United States of America, is a growing issue leading to numerous psychological and physical disorders including depression, anxiety, heart attacks, stroke, hypertension, obesity, and more. Stress is also linked to immune system disturbances that increase susceptibility to infections, auto immune diseases, and cancer (Kemeny, 2007) (Powell,

2013). As well it can have a direct effect on skin in the form of rashes or hives and can contribute to insomnia and degenerative neurological disorders such as Parkinson’s disease (The

American Institute of Stress, 2017).

In 2011 an American Psychology Association study indicated that roughly 53 percent of

Americans reported personal health problems as a source of stress. This is a six percent increase since 2009. Concurrently, only 26 percent of people reported doing an excellent or very good job at dealing with stressful situations. This failure of attending to stress may stem from a lack of

preparedness for stressful events. The same study indicated that only 29 percent of Americans reported they are doing an excellent or very good job at managing or reducing stress when stress occurs (American Psychological Association, 2017).

High stress and chronic stress mental states can lead to much higher health care costs. A study performed by Goetzel et al. studying The Relationship Between Modifiable Health Risks and Health Care Expenditures, concluded that individuals with frequent high stress levels experience 46 percent higher health care related expenditures. If an elongated state of high stress develops into a chronic stress condition, causing mental conditions such as depression occurs, the increase in stress related expenditures can grow to roughly 70 percent higher than average or low stress individuals (Goetzel et al., 1998). Stress related health issues and health care costs exemplify the need for more self-care practices.

This information portrays a clear need for a system or process that can teach individuals how to reduce stress, prepare for stress, and better react to stressful situations. In order to understand stress, its causes and forms, and the best ways that are currently being used to reduce stress, it is important to understand what causes stress at the psychological level in order to formulate a design for stress reduction.

As a designer working across disciplines, I need to be able to work with experts in different fields such as psychology, neuroscience, and computer science in an efficient and productive way in order to design a solution to this problem. To take on this research project, I knew I needed to learn as much as possible about each of my collaborator’s respective disciplines so I could understand the possibilities each could have towards the design of The

Hiatus System. In this case, my role as the designer in the group was to leverage the skills of the team to formulate a user-centered design solution. I began by guiding the team through the

iterative process. During the iterative process my role was to adjust and access the effectiveness of each change, as well as create the visual content of the experience. During this process it was crucial to understand how stress is created in order to design a solution to reduce it.

Stress is a mental and emotional state of tension that occurs when an individual perceives a circumstance they are facing as overwhelming or demanding (Colligan & Higgins, 2005).

There are two main forms of stress: distress and eustress. Distress is the psychological state most commonly associated with stress. Distress has a negative effect on an individual’s health and only occurs when an individual perceives a task or situation as overwhelmingly difficult

(Colligan & Higgins, 2005). Eustress is a positive form of stress. There are a few determining factors that cause stress and help determine whether the situation or task will be perceived as distress or eustress.

According to Dr. Pierce Howard, author to The Owner’s Manual for The Brain, an emotion is an action resulting from situations that enhance or threaten a goal (Howard, 2006).

Stress, also according to Howard, is an emotional state caused by one's perception of an event or situation as goal-deterring (Howard, 2006). The determinant factor of a situation being perceived as a major stressor is whether or not the individual feels out of control of the situation (Howard,

2006). When individuals feel like they have control over a task, they almost always experience eustress (Collin & Higgins, 2005). When an individual believes that they have limited to no control over a situation, or some other aspects of their life, they begin to experience distress

(Colligan & Higgins, 2005). The reasons as to why an individual perceives if they have control over a situation or not largely stems from their personal locus of control (Colligan & Higgins,

2005). A person’s locus of control can be internal or external and can be changed dependent on the situation. An internal locus of control is when an individual perceives that they have control

over their current situation; while an external locus of control is the perception that other individuals or influences have control over that individual’s situation (MacDonald, 1971).

Usually, once a person starts to routinely experience either an internal or external locus of control, they tend to experience that same internal or external feeling of control for other situations as well (MacDonald, 1971). This further supports the idea that the perception of control is not only situational, but a learned trait. This means that the individual can learn a new trait that positively alters their perspective through methods such as MBSR. According to the book, The Power of Habit, habits are not easily broken, but rather need to be replaced (Duhigg,

2012).

Another possible source of stress is how well a task or situation matches the individual's ability to manage that task. An individual lacking the necessary skills for the requirements of a task is more likely to feel overwhelmed by the situation because they lose that sense of control due to a feeling of lacking sufficient resources to cope with the demands of the situation

(McCarthy, Lambert, Crowe, 2010). When an individual’s skills and personality perfectly match the requirements of the task at hand, the individual has a higher chance of entering a psychological state of mind known as flow (Csikszentmihalyi, 1990). Mihalyi Csikszentmihalyi, the author of the book Flow, defines a flow state as, “A state in which people are so involved in an activity that nothing else seems to matter”. Flow states are powerful assets if achieved during

MBSR meditations. An important issue with flow is that one can’t experience flow if other distractions disrupt the experience (Nakamura & Csikszentmihalyi, 2009). Therefore, the aspect of virtual reality becomes important when considering the minimization of distraction due to its immersive qualities that visually remove the user from their physical location. Flow states are

achieved when there is a balance between the level of skill and the size of the challenge at hand

(Nakamura & Csikszentmihalyi, 2009).

Csikszentmihalyi lists eight characteristics of flow: 1. Complete concentration on the task, 2. Clarity of goals and reward in mind and immediate feedback, 3. Transformation of time,

(speeding up/slowing down of time) 4. The experience is intrinsically rewarding, 5.

Effortlessness and ease, 6. There is a balance between challenge and skills, 7. Actions and awareness are merged, losing self-conscious rumination, 8. There is a feeling of control over the task (Nakamura & Csikszentmihalyi, 2009). These eight characteristics are a core foundation of the design of this virtual reality program. Designing an experience where one can achieve a flow state is beneficial towards the overall goals of the project.

Chapter 2: Current Research Background

2.1: Introduction:

This chapter summarizes the current body of research directly relevant to the design of

The Hiatus System. The goal of this section is to provide a framework of information that supports the design decisions made during the iterative design process. Connections between key theories and the methods referenced in this chapter and how they are utilized in The Hiatus

System are made but are more systematically analyzed in chapter three and four. This chapter is divided into three parts. Part 2.2 provides an analysis of the current research being conducted regarding the mental and physical effects of mindfulness meditation through MBSR. Part 2.3 is a description of the current research being discovered about biofeedback/neurofeedback virtual reality-based studies. Finally, part 2.4 illustrates relevant research using virtual reality as a teaching tool through VR simulation training. Combined, these three areas of research provide a solid foundation to support this thesis project. Chapter two explores the research question: is there statistical evidence that supports the hypothesis that VR-based meditation can allow novice

MBSR practitioners to learn the process of meditation more quickly and with less mental difficulty?

2.2: Mindfulness and Meditation

The mental state of mindfulness is difficult to define and understand. Mindfulness, according to the Merriam Webster Dictionary is, “The practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis (Merriam Webster, 2019). Another definition of mindfulness by Jon

Kabat-Zinn (1994), a researcher of modern-day mindfulness is, “paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally”. The common connection between these two definitions is they both direct focus towards a nonjudgmental present

moment. This concept encourages individuals to limit focus on past or future events and only focus on what is happening at that moment in time. For example, their breath, the wind, ambient sound, smells, and virtually any noticeable attribute of the present moment. This method is used to calm the individual so they can focus on their current emotional state nonjudgmentally. In other words, the individual is aware of their emotions and can observe them as they develop thoughts and opinions in their mind, avoiding rash and emotionally charged reactions.

Mindfulness based stress reduction (MBSR) programs are typically structured as an eight-week long training session that includes various different meditations. This 8-week time period was established originally by Jon Kabat-Zinn in 1979 as an effective amount of time to learn the process of mindfulness though meditation that can show positive results, and provide participants with enough guided practices to continue practicing mindfulness on their own.

Traditionally, these programs include an auditory recording of a narrator guiding the listener through the meditation process. Some examples of meditation that are common to MBSR programs are: breath awareness, awareness training, body scanning, and more physical activities such as walking meditation and yoga. This thesis project focuses on breath awareness meditation.

MBSR programs have been used in various clinical settings for a wide variety of issues such as chronic pain, chronic stress, cardiovascular issues, anxiety disorders and more. Since the early 1980’s, the number of studies utilizing MBSR has significantly increased as more studies and results are published. A research study performed by J. Miller, K. Fletcher, and J. Kabat-

Zinn, called, Three-Year Follow-up and Clinical Implications of a Mindfulness Meditation-

Based Stress Reduction Intervention in the Treatment of Anxiety Disorders demonstrates the long-term positive effects of MBSR. The goal of this study was to discover if a time-limited

group stress reduction intervention based on mindfulness meditation could have long-term beneficial effects in the treatment of people diagnosed with anxiety disorder (Miller, Fletcher,

Kabat-Zinn, 1995).

The method of this study followed a rigorous process. After thorough screening performed by psychologists and psychiatrists trained to administer the Structured Clinical

Interview (SCID) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), twenty-four individuals were selected for the study. The subjects selected met the DSM-III-R criteria for generalized anxiety disorder or panic disorder. Each of the participants was assessed four times: during recruitment, preintervention, postintervention, and at a one-month follow-up.

The MBSR stress reduction intervention lasted eight weeks. The participants practiced different meditations such as body scanning and breath awareness, based on their progression through the program for 45 minutes, six days a week. Of the twenty-four participants, twenty-two finished the program. The conclusion of the three-month period was that there were statistically significant reductions on all measures during the intervention period (Miller et al., 1995). Out of the twenty-two original participants, eighteen of them participated in a three-year follow-up. This follow up included a variety of tests and are thoroughly described in the referenced publication.

The study confirms that significant change in subjective and objective symptoms of anxiety and depression occurred between pretreatment and posttreatment with maintenance of posttreatment levels at a three-year follow-up (Miller et al., 1995).

This study provides strong evidence that an intensive MBSR intervention such as the

Stress Reduction and Relaxation Program (SR&RP) can provide a clinically effective treatment for medical patients who also have anxiety disorders as defined by the DSM-III-R, as well as suggesting the potential to be significantly cost effective.

Another study, Mindfulness-Based Stress Reduction for Older Adults with Worry

Symptoms and Co-occurring Cognitive Dysfunction found that MBSR has the potential to reduce worry and improve cognitive functioning in older adults with co-occurring cognitive dysfunction

(Lenze, et al 2014). This study enrolled 34 elderly participants aged 65 years or older with significant levels of anxiety-related distress and cognitive dysfunction into an eight and twelve session traditional MBSR program. The researchers collected measurements of mindfulness, worry, and neuropsychological battery focused on memory and executive function before and after the MBSR program, as well as a six-month follow-up. The MBSR program consisted of yoga, mindful breathing, and various types of meditation. The results of this study showed that the participants showed improvements in worry severity, an increase in mindfulness, and improvements in memory. MBSR research is highly current and many researchers are exploring how the practice of mindfulness can further contribute to their respective fields.

Studies testing the effectiveness of MBSR have been highly positive. The issue with the current method of MBSR for stress reduction is that mindfulness is a mental state which is difficult to learn and requires dedicated practice over long periods of time in order to have a long-term positive effect. The current popular approach to learning MBSR without participating in a guided class is through guided meditation audio recordings. The issue with this method is that it can be difficult to learn the process of meditation through an auditory only method. There is no aspect of interactive learning, or visual guidance. To solve this problem, this thesis uses VR technology to interactively teach the user the process of breath awareness meditation, while they are listening to a guided meditation audio recording.

2.3: Virtual Reality Biofeedback/Neurofeedback Based Studies

With the rising popularity of VR, many studies across various fields are being conducted in order to see what potential this digital medium can have. The following studies cover two VR based studies in meditation that relate to this thesis.

The first study, The Meditation Chamber: Enacting Autonomic Senses (Shaw, Gromala,

& Seay, 2007) is a VR experience designed for relaxation and mindfulness. This application utilizes a form of biofeedback as an added sensory benefit to the experience. The goal of this project is to design, build, and test an immersive virtual environment that uses biometrically- interactive visuals, audio, and tactile cues to create, guide, and maintain a user’s meditation experience (Shaw et al., 2007). The concept driving the Meditation Chamber is similar to the concept driving The Hiatus System. The similarities are that both applications guide the user through a meditation process with some form of feedback based on performance. However, the visual environment for The Meditation Chamber is different than The Hiatus System. The

Meditation Chamber contains two different virtual environments, neither of which are designed to be fully immersive spaces and experiences, particularly in reference to audio and visual design. One environment contains the Sun, rising and setting over the horizon. The other is a completely black environment with a 3D character model placed below the user’s view in order to give the illusion that the 3D character is the user’s physical body. The difference between these two projects is the attention I have given to the design of the visual environment, user experience, and the biofeedback loop.

To prepare for The Meditation Chamber experience, participants are first fitted with a head-mounted display (HMD) and three biometric sensors that measure galvanic skin response

(GSR), respiration and heart rate (Shaw et al., 2007). GSR and heart rate variability (HRV) are

two accurate and commonly used physiological methods to measure an individual’s stress level.

For this reason, The Meditation Chamber chose these physiological measurements as their sources of biofeedback. The participants are then seated in a comfortable position and begin the

VR experience. Upon entering the VR environment, the user begins the first of three modules. In the first module, the user is introduced to a relaxation activity. In this activity the user is presented with a visual display of the Sun. The experience has a vocal guide that asks the user to relax. At this point, if the user’s GSR declines due to the user being more relaxed, the rate at which the Sun progresses towards sunset increases until it dips below the horizon, transitioning to a night scene. The application is tracking the user’s GSR constantly, and when their GSR level drops, the Sun sets in the VR experience.

The second part of the relaxation phase includes a moonrise scene, functioning in an analogous way as the previous sunset scene. The Moon rises until it is at a high point in the night sky. The point of these experiences is for the user to become visually aware of their level of stress reduction based on their GSR, an internal physical bodily function that is visually represented with the aid of this VR application.

The second phase of the three module system guides users through a set of muscle tension and relaxation exercises. 3D graphics of a human body are displayed from a first-person perspective. A way to think of this experience is that a voice is telling you what muscles or parts of the body to focus on, and a 3D rendering of that body part appears in a similar location as to where the user’s real-life body part would be located. This phase is not interactive, but rather the user is following the instructions provided by the vocal guide and sees the 3D model perform the scripted actions with prerecorded audio. These instructions are walking the user through a body scanning technique that involved the user focusing on specific parts of their body, one at a time

as a meditation technique. The animations of the 3D model take place in the VR space from a first-person perspective, but the 3D body is not reacting to the user’s movement.

The third and final phase of this experience is a guided meditation session. During this experience users are placed in a setting with soothing visual imagery and ambient sound. As participants reach what the study notes as an acceptable biometric approximation of a meditative state, the volume of the audio is decreased, and the visual environment begins to fade to black.

The creators of The Meditation Chamber collected survey data for this study on 411 users during an exposition at SIGGRAPH and the results are worth noting.

The findings collected by The Meditation Chamber team indicated that the majority of the users who tried the experience at the exposition self-reported that their levels of relaxation had increased after experiencing The Meditation Chamber. This increase was even higher with users who had never meditated before (Shaw et al., 2007). Thousands of people from various fields travel to the annual Special Interest Group on Computer Graphics and Interactive

Techniques (SIGGRAPH) conference to discuss and present work on the cutting edge of their respective fields. Established in 1974, (SIGGRAPH) is arguably the world’s largest computer graphics and technology conference.

Experiencing The Meditation Chamber allowed me to formulate a few design principles for how to create a biofeedback-based VR meditation application. First, the principle that VR applications flow more fluidly if the guided meditation audio recording interacts with the user.

Requiring user participation is a significant feature to support interactive learning. In The

Meditation Chamber, the player’s response to the required task is visually represented in the VR environment. For example, in body scanning meditation if the narrator asks the user to place

their hand on their knee, and the player does so, having the 3D digital character model in mimicking that action in the VR application increases the immersive quality of the experience.

The second design principle I formulated from this case study is the idea that the artistic style developed is not a determining factor on immersion experience. A VR application can have a highly stylized artistic environment, and still feel immersive and engaging. In other words, a break in immersion occurs when the virtual environment is not artistically cohesive. A drastic difference in art style can be jarring for the player, thus breaking their feeling of presence and immersion within the space.

Another precedent study for The Hiatus System is the VR neuroadaptive meditation application known as RelaWorld. RelaWorld is a “neuroadaptive virtual reality meditation system that combines virtual reality with neurofeedback to provide a tool that is easy for novices to use yet provides added value even for experienced meditators” (Kosunen et al., 2016). The purpose of this study was to combine proven methods of neurofeedback and virtual reality into one application that allows novice meditators to receive the benefits of meditation. The research designers wanted to accomplish this task by immersing the user in an alternative reality.

The meditation focus of this experiment was on body awareness. The participants of this study included 43 university students, ages 20 to 48. Individuals participated in a two-hour session containing six different ten-minute meditation exercises. Upon arrival for the VR meditation experiment, the participants were comfortably seated, and a wearable EEG headset was placed on their heads. The users were then introduced to six meditation exercises one after the other, each lasting ten minutes. Following each exercise there was a working memory task designed to induce stress. The stressful task was administered to counteract the stress reduction from the previous meditation. The session took roughly two hours to complete.

The neurofeedback presented to the user was delivered in two ways. The EEG was constantly recording and measuring the level of the user’s concentration via the theta and alpha brain waves. This brainwave data was translated and applied to the digital scene in real-time in order to provide visual feedback. For example, the user is surrounded by a fog, with nothing but a few spheres to look at. As the user looks at the sphere, and their concentration levels rise, the fog becomes more transparent, allowing the user to see the virtual environment. The visual environment is a geometrically stylized, non-realistic scene containing trees, a water mass, and rock formations. The theta band, used for measuring concentration, caused an orb to float when the band received more theta brainwave activity. The alpha band, used to detect relaxation, increased the opacity of the orb surrounding the user. Together these two features were used to provide neurofeedback to the user while they were engaged in the meditation exercises.

This study compared the results of three different groups. The first group practiced the meditation exercises on a computer screen without the head-mounted display. The second group practiced the meditation exercises with a head-mounted display, without neurofeedback, while the third group practiced in the head-mounted display with neurofeedback. The results of this study showed that in most ways, the experience of neurofeedback was equal or superior to the group with a head-mounted display without the neurofeedback, and both VR experiences were superior in every way to the screen-based meditation. The neurofeedback group reported fewer negative feelings during the meditation; this is expected since the process of neurofeedback is more engaging than the other two types of arrangements. The neurofeedback group and HMD group both reported a similar feeling of relaxation during the meditation, while the screen-only group reported lower feelings of relaxation; one can assume the factor of immersion provided by the VR headset caused this heightened feeling of relaxation. This source of data is important

because it identifies a factor that is specific to the qualities of immersion, rather than a feedback system. The neurofeedback group experienced a higher sense of concentration and presence than the other groups, as well as a deeper meditative state. Presence is defined as a psychological state or subjective perception in which even though part or all of an individual’s current experience is generated and/or filtered through human-made technology, part or all of the individual’s perception fails to accurately acknowledge the role of the technology in the experience

(International Society for Presence Research, 2000). The head-mounted display only group had similar results in these categories, but consistently lower measurements in each of the previously mentioned categories than the neurofeedback group. This study serves as an example of what qualities of a VR meditation can be enhanced by VR alone, such as a higher sense of presence, and what qualities can be enhanced with a feedback system, such as a more engaging interactive learning process.

RelaWorld and The Hiatus System incorporate a participant feedback system. In both applications feedback is given in some form by user input, as visual information. A major difference between the RelaWorld application and The Hiatus System is the type of feedback performed, neurofeedback verses biofeedback. Neurofeedback is not as easily controlled as biofeedback because biofeedback requires a physical action such as breathing. This means that concentration on biofeedback should be more easily performed than a passive neurological or biological reaction such as GSR or EEG. Another difference between the RelaWorld study and

The Hiatus System is that the RelaWorld study was only performed in one session, whereas The

Hiatus System is designed for the user to use repeatedly over a few weeks as an integral part of an 8-week MBSR program. Finally, RelaWorld focused on the meditation methods of point focus, body scanning, and focused attention, whereas The Hiatus System focuses on breath

awareness training only. The decision behind choosing breath awareness training as the meditation task in The Hiatus System is because it is a core action to mindfulness mediation.

Being aware of the breath, and being able to enter a calming state by focusing on your breath is a skill that is learned though meditation, and is a process that is often an individual’s way to connect to the present moment.

2.4: VR Simulation Training

VR simulation training is a fairly new process that has been studied heavily in the training of healthcare professionals. VR simulation training is the process of placing less experienced professionals into a risk-free virtual reality simulation of a task they need to perform as a part of their profession. For example, heart surgeons can virtually perform heart surgery in order to get familiar with the steps and process of the procedure, before they are asked to assist with a real surgery. This process allows the employee to gain frequent, skill building experiences, thus decreasing training time. The important takeaway from the simulation training process is that it allows a user to learn a skill or trait in an accelerated virtual process. From this, we can hypothesize that MBSR training can be accelerated through VR simulation training, in order to learn the mental traits associated with mindfulness. This section will discuss two studies on the effectiveness of VR simulation training in healthcare.

The first study is Virtual Reality Simulation Training can Improve Inexperienced

Surgeons’ Endovascular Skills, by R. Aggarwal, S.A. Black, J.R. Hance, A., Darzi and N.J.W.

Cheshire (2006). The purpose of this study was to evaluate the effectiveness of virtual reality simulation for endovascular training on inexperienced surgeons.

The study consisted of twenty consultant vascular surgeons that were divided into two groups. Group 1 consisted of surgeons that had performed more than fifty endovascular procedures. Group 2 was a group of surgeons that had performed less than ten endovascular

procedures. All subjects were provided with a test to assess their endovascular skill. The simulation used real tools with an active force feedback to provide a more accurately immersive experience. The visual elements were realistic to further represent the surgical process. Group 1 completed the simulation two times, while Group 2 completed it six times. The time to complete the procedure was recorded as well as the amount of contrast fluid used and total fluoroscopy time.

The results of this study were that initially Group 1 completed the virtual surgery faster and used less contrast fluid than Group 2. After Group 2 completed all six sessions, they were able to achieve similar scores as Group 1. In conclusion, this study identifies that the surgeons with less experience were able to improve their endovascular skills to a similar level as the experienced surgeons during the short VR simulation training.

Another study, Virtual Reality Training Improves Operating Room Performance, by

Seymour et al. (2002) concurs with similar findings, noting that VR has significant advantage for training purposes. This study was performed with the objective to demonstrate that virtual reality can transfer technical skills to the operating room environment (Seymour et al., 2002).

The study was tested on sixteen surgical residents. The participants were divided into a

VR group and a non-VR group. All participants performed a virtual simulation of a gallbladder removal surgery. The results of this training were that the gallbladder dissection was 29 percent faster for the VR-trained residents. The non-VR-trained residents were nine times more likely to transiently fail to make progress and five time more likely to injure the gallbladder or burn non- target tissue. Errors were also six times less likely to occur in the VR-trained group (Seymour et al., 2002). In conclusion, this study showed that the use of VR for surgical simulations significantly improved operating room performance of residents.

2.5: Conclusion A phrase often used in VR simulation training studies is skills transfer. When relating these studies to this thesis project, it is clear that the goals are very similar, although the topics are different. In both scenarios, the VR application is poised as an instrument to teach the user a trait or skill they are previously inexperienced in. The Hiatus System uses a similar method of virtual reality training in order to teach the user mindfulness through MBSR in a more effective and faster process than non-VR-training. The information collected from these studies, as well as various other studies published in the World Journal of Surgery, VR to OR: A Review of the

Evidence that Virtual Reality Simulation Improves Operating Room Performance authored by

Neil E. Seymour (2002) provide a wide body of evidence to suggest that VR simulation training increases the speed at which one can learn a trait or skill.

The lessons learned from these studies helped me create a design for a VR application, one that provides an interactive MBSR learning experience. The research completed on MBSR provided a framework to inform my decision-making process. The MBSR training is the core element that I needed to teach users. MBSR, which has the ability to improve the working memory of older adults, led me to believe that if an interactive VR application could offload the cognitive requirements of a 30-minute MBSR meditation, then individuals with a lower working memory capacity could possibly improve their memory if the VR application is successful at helping them complete the full meditation session.

The guided audio meditation recording process used in The Meditation Chamber and

RelaWorld seemed to be effective in reducing the stress levels of the user while they were inside the VR headset. However, it was unclear if they were effectively learning the process of mindfulness awareness meditation. For the creation of an MBSR teaching tool, these two projects helped me formulate a few design principles to inform my making of a VR application.

In short, my guiding principles include: developing visual and audio cues to guide the user, creating a consistent aesthetic style throughout the design, and engaging the user with an interactive task towards accomplishing a goal. First, the environment must limit distraction from the required task. For example, some VR mediation applications such as Guided Meditation VR, developed by Cubicle Ninjas, allows the user to teleport around during the meditation. This action is accompanied with loud audio cues and visual effects. I found the element of teleportation to be highly distracting to the meditation process. RelaWorld and The Meditation

Chamber provided great examples balancing user actions in order to limit distraction from the mediation, while still maintaining the interactive and immersive quality of the application. A few of these qualities are: consistent artistic style, continuous ambient audio, player visual guidance, an environmental response to a user’s actions, as well as a clear instructional format that provides visual feedback for learning.

The two studies regarding the topic of VR simulation training aided me in developing a few design principles for how to create a positive learning environment within VR. First, and most importantly, the experience needs to be physically and intentionally interactive.

Interactivity not only can increase the user’s feeling of presence within the VR environment, but also establishes an interactive learning module for a skill or task. Secondly, in order to create an effective feedback-based learning system, the feedback needs to be effective in relation to the physical task the user is performing. This aspect of the learning process was evident in both the

VR simulation training studies previously referenced but was lacking in The Meditation

Chamber and RelaWorld. For The Meditation Chamber study, the feedback provided to the player was based on the physiological results of their current reduction in stress levels. The issue with this model is that the user is interacting with the result of the meditation process, rather than

the process of learning meditation. The examples of VR simulation training provided strong evidence for the effectiveness of using VR to guide users through a simulation of the actions required to accomplish the task. The knowledge I gathered from The Meditation Chamber and

RelaWorld, as well as the scientific studies on VR simulation training directed my design towards the current breath-based interactive learning module utilized in The Hiatus System.

Chapter 3: Designing a VR Based MBSR User Experience

Chapter 3: Introduction

This chapter describes the design decisions made during the iterative design process that led to the creation of The Hiatus System. This application was first conceived in 2015 but did not enter the development phase until autumn 2016. This chapter consists of three major projects.

Each project served to advance my concept development of the final thesis project. Each section describes various concepts, such as biofeedback, immersive design, and interactive design. The three VR projects are introduced in chronological order; they are: The Original Zen Temple,

Heartbeat VR, and Tree Flight VR.

The Original Zen Temple project was the first significant VR meditation project completed. It was a VR application operating on the HTC Vive. The HTC Vive is a high end, desktop/laptop computer-based VR hardware that includes world space tracking through wall mounted laser emitters that connect to sensors on the HMD and controllers. For more information, visit the HTC Vive website referenced in the works cited. This application was an introduction to mindfulness meditation taking place in a virtual rendition of a Zen garden. The user was seated in the virtual space and led through a guided meditation lesson facilitated by an auditory recording of Jon Kabat-Zinn.

Heartbeat VR was the second significant project completed, and the first collaborative project developed on the HTC Vive. This application allowed the user to visually experience their own heartbeat in VR by using a pulse oximeter sensor that transmitted data to the VR application in real-time. A pulse oximeter sensor is a small wearable device attached to the index finger that records the wearer’s heartbeat. The purpose of this study was to develop a framework for how biofeedback could be used as an interactive process in VR. I wanted to explore how a user interacts with a passive form of biofeedback, via a bio input they do not willfully control.

This project was the first to implement and test the process of biofeedback from a technological and design perspective.

Tree Flight VR is the third and final project leading to the creation of The Hiatus System.

This application began with development on the HTC Vive, but later transitioned to mobile VR.

Mobile VR refers to VR applications that are developed on mobile devices such as android and

IOS smartphones. This however extends to standalone VR headsets such as the Oculus Go that do not require a smartphone to operate, but still operate using the same android technology internally built into the headset. The largest difference between mobile VR headsets and non- mobile headsets such as the HTC Vive is the visual quality and the processing power of the headsets. Mobile headsets cannot provide as high of a visual quality as what is possible with higher end non-mobile VR headsets. Also, most non-mobile VR headsets include world space tracking via exterior sensors, allowing the user’s real-world position to be tracked and translated into the virtual world as well, allowing them to physically walk in the digital VR space.

Tree Flight VR utilized the user’s breath as the bio-input via a pressure sensor belt strapped around their waist. The concept behind Tree Fight VR was to create an abstract rendition of a walking meditation in VR. In this VR experience the user was slowly flying around a large tree that emitted swirling particles. The slow flying mechanic was intended to represent the slow walking speed common to walking meditations, allowing time for the user to visually explore the environment. The user had the ability to control their direction by centering their view in the direction they wished to travel. The goal for this type of interaction was to give the user a feeling of control over their experience, as well as the ability to indulge their curiosities and explore the VR environment. This iterative project was presented at ACM

SIGGRAPH Vancouver, 2018. The feedback I received was positive, but indicated I needed to

focus more on guiding the user towards the meditation practice, rather than focusing on providing a relaxing experience.

3.2: Original Zen Temple

The Original Zen Temple project contained a VR rendition of a Zen temple based on various locations in the temple complex Diakotu-Ji, located in Kyoto, Japan. This space was selected as a reference based on the reputation of its indescribably relaxing gardens. Diakotu-Ji is famous for its elaborate rock garden exteriors. The VR environment created was based on a few of these rock gardens. The experience included a beginner guided meditation audio tape facilitated by Jon Kabat-Zinn. The goal for this project was to create a relaxing experience based on real world spaces designed for relaxation and meditation.

This chapter provides an analysis of Diakotu-Ji, the various temple gardens, and what design decisions were made for the creation of the VR environment. Information in this section provides insight to why this project was a necessary step in the iterative design process.

Diakotu-Ji is a large walled temple complex in Kyoto, Japan. The temple grounds were first constructed in 1319, with additional sections being added in later years (Lambe, 2019). The interiors of individual temples in the complex that were designed for meditation practice are very similar yet have subtle differences. The gardens, however, are more specifically designed and planned, resulting in a variety of different gardens across the temple grounds. The temples contain indoor sitting meditation rooms with tatami mats and long sitting boards that look into the temple gardens. Individuals sit on the large boards when meditating in front of the garden spaces.

The temples themselves were often made from wood, with openings or doorways that lead to the gardens. The walls are composed of either rice paper or similar materials. The benefit of this material is that it is slightly translucent, allowing light to shine through into the indoor

space. Traditionally, tatami mats are made from layered rice straw (Original Kyoto Tatami,

2019). These materials hold cultural significance as well as add an aesthetic element to the authenticity of the space. A commonality between most Zen temples and gardens is the idea of discovering a deeper connection with nature (Nagatomo, 2015). This element is known in the

West as biophilia, “an innate and genetically determined affinity of human beings with the natural world” according to biologist E. O. Wilson (Oxford Dictionaries, 2019). The design of

Diakotu-Ji, as well as many other Japanese Zen temples, focuses on a biophilic connection through meditation and appreciation of nature both in the temples, and the Zen gardens (Kozak,

2011).

Diakotu-Ji has some of the most revered Zen gardens in Kyoto. They are each designed for a specific purpose. The specifics of each garden and their intended meanings are not essential to this paper, but if you are interested and would like to know more, the Visual Structure of a

Japanese Zen Garden (Van Tonder, Lyons, & Ejima, 2002), is an insightful reference on the subject. A major aspect of the Zen gardens at Diakotu-Ji is the balancing of eye rest verses eye stimulation. When meditating, it is beneficial for an individual to alternate meditation spots in order to get a good balance of eye stimulation and eye rest. Gardens that are visually stimulating are typically intended to promote enlightenment and contemplative thought, whereas gardens that provide eye rest are typically used for relaxation and free flow thought (Sternberg, 2009).

Figure 1 is an example of an eye stimulating garden, and Figure 2 is an example of an eye rest garden. Figure 1 has a white and gray color palette with a high amount of fractal use. Fractals are self-similar patterns that occur repeatedly at increasingly smaller scales (Sternberg, 2009).

Fractals are a common pattern that appear in nature through objects such as trees, moss, rocks, grass, waves, mountain ranges, vines, and even human cells. Fractal patterns have been proven to

be pleasing to the eye, though we are not entirely sure why this is. Many believe that this connection between fractal patterns and the natural world creates a pleasant feeling when viewed

(Sternberg, 2009). Figure 1 utilizes fractals via the small pebbles in the rock garden and is broken up with larger rocks at various focus points. The color palette of this space is mixed between light grays and greens. The focus points in this garden are the light gray rock beds that provide eye stimulation due to their color and form but are seen as relaxing due to their fractal geometric composition.

Figure 2 is an example of an eye rest setting. The color palette for this garden is almost entirely green. Green is the easiest color on the eyes for eye rest (Tilley, 2011). This space utilizes fractals even more so than Figure 1. The moss provides a blanket of green fractal shapes across the majority of the space. This type of garden is ideal for relaxation and soothing eye rest.

Figure 1: Daitoku-Ji Rock Garden Figure 2: Daitoku-Ji Moss Garden

The concepts and information above aided me when creating the Original Zen Temple design. The exterior space was the major focus of this design, rather than the interior space.

During the iterative design process, I created a physical 3D diorama of the virtual environment.

This diorama allowed me to make rapid design changes before committing to a final virtual design. The diorama, shown in Figure 3, 4, & 5, illustrate the outcome of this process. The space

was separated into three different sections, each with a different metaphorical purpose. Spaces A,

B, and C are meant to be experienced in order with different types of meditations. Section A is for self-awareness, B is for self-reflection, and C is designed as an introduction to mindfulness through contemplative thought.

Figure 3: Diorama Space A

Figure 4: Diorama Space B

Figure 5: Diorama Space C

The experience used in the final iteration of this project, however, was reduced to space

C. Figure 6 shows the final outcome of space C. This space was designed in reference to the garden at Diakotu-Ji shown earlier in Figure 1. The space has a large section of light grey in the center view, surrounded by various greens within light grey walls. The intention of this color change was to provide multiple instances of eye rest and eye stimulation depending on where the participant was looking. The central focus point is a large rock located in the rock garden, though there are other points of focus as well, such as the other smaller rocks, the rushing water, and the trees in the background. An issue with this space was that there was too much visual distraction and lack of a strong focal point to draw the user’s attention. The intention of the design was for the user to focus on the large rock in the center, but the rushing water and rustling trees proved too distracting to participants because both were moving and generating noise.

Figure 6: Final in-game render of the Original Zen Temple space C in VR.

The visual design of this experience was focused on the center rock garden. I wanted to enhance the connection between human and nature in order to compensate for the reality that the user was not physically located in the natural scene they were observing. The sense of smell and touch are absent in VR, so I attempted to design ways to address these sensory deprivations.

Before the headset is placed on the participant, they are introduced into a dark space lit by candles. Natural smells of pine and grass filled the air via a wax candle. The sense of touch was stimulated by the user holding a smooth stone and a block of wood while meditating. The fractal rocks in the garden bed were raked in a circular pattern around the center rock. This mimicked the way that waves ripple away from a land mass in a pond. This technique has been used in the creation of rock gardens at Diakotu-Ji as seen in Figure 7. This element attempts to induce a higher feeling of biophilia by designing a manmade structure using natural materials and representing a natural formation such as waves in water. These added sensory experiences were an attempt to increase immersion.

Figure 7: Daitoku-Ji rippling rock garden waves

The positive outcomes of this experience include the knowledge gained about the construction of Zen gardens, the use of green and white colors for eye rest and stimulation, and the use of fractals for relaxation. This project was ultimately the most influential to the final project. However, it proved to have many design flaws that limited its success.

The major issue with this project was that there was too much sensory stimuli demanding attention from the user. The combination of smell, touch, sound, and animation caused the user to become easily distracted from the guided meditation. I observed many users spending considerable time looking around and exploring the space, rather than attempting to quiet their mind in order to meditate. This observation led me to develop the design principle of minimizing sensory elements that are not in some way connected to the required task. How I designed a solution around this design constraint will be discussed further in Chapter 3. Also, the user experience (UX) design needed more spaced-out moments of rest before starting the experience.

When beginning the experience, the user would put on the headset and within seconds would hear Jon Kabat-Zinn speaking, introducing them to the meditation. This did not allow time for the user to first get comfortable with the VR space before being asked to concentrate on the meditation. This resulted in many users wanting to visually explore the space during the meditation. One thing I have noticed after putting hundreds of different people in a VR experience is the first thing newcomers to VR do after putting on the headset is take five to ten minutes to simply look around and visually explore the virtual space. This element enhanced my future designs with the addition of a VR adjustment period at the beginning of the experience.

Finally, the VR application needed some way to actively focus the user’s attention back to the meditative process in order to minimize distraction and reclaim the user’s attention if they become distracted.

The need for a design system that focuses the user attention towards the meditative process inspired the idea for my next project, Heartbeat VR. The intention for this project was to develop a framework for a biofeedback system that could later be used as a tool for physical interaction with the meditation experience for interactive visual learning.

3.3: Heartbeat VR

The second project in my iterative design process was Heartbeat VR. This project was an interactive VR experience that allowed the user to visually experience their own heartbeat. The goal of this project was to develop a method of real-time biofeedback in an immersive VR environment as a tool that could later be used to attain and retain attention towards MBSR practices.

Before the user begins the VR experience, they are instructed to wear a pulse oximeter sensor on their index finger that will be used to visually represent their heartbeat in the VR experience. The user is seated in a comfortable position and puts on the HTC Vive headset. Once the VR experience begins, the user is immediately transported to a medium sized cave. In front of the participant is a large representation of a heart. The environment is designed to vaguely represent the inside of a chest cavity in a non-realistic style in order for the users to feel as if they are able to look inside their own chest. The virtual scene is tinted with red and pink lights and is shown in Figure 8. The information from the pulse oximeter sensor is transferred to the virtual environment in real time, causing the representative heart in front of the user to beat synchronously with their own heart. This beating motion is a quick animation that causes the representative heart to increase and decrease in size according to the data being transmitted from the pulse oximeter. Lights around the heart also increase and decrease in intensity as the pulse oximeter readings increase and decrease numerically. Beyond the technical test to ascertain how

the pulse oximeter data could affect the virtual environment, these artistic decisions were made to be a metaphorically clear representation of the user’s heartbeat.

Figure 8: Heartbeat VR in-game view

This project was the first of mine to introduce technology beyond standard VR equipment. In order to allow the user to visually experience their heartbeat, I first needed to implement a way to translate a heartbeat into a usable data format. This required the use of external technology in the form of an Arduino Uno, and a pulse oximeter sensor. At this point, I began collaboration with a computer science and engineering undergraduate student, Skylar

Wurster at The Ohio State University. Skylar was able to write a script that took the data being generated by the pulse oximeter, through the Arduino board where the information can be translated to the VR application. Once the numbers were remapped to a range from zero to one and regulated so that the Unity game engine could receive the information in an optimized way, we were able to use this data to affect various elements within the VR application.

The process in which the data is used is as follows: the user’s heartbeat causes the pulse oximeter to generate numerical data, the data is sent to the Arduino Uno where it is translated from zero to one and sent to the VR application. The VR application is constantly searching for this data, receives it, and uses it to affect elements in the VR environment such as the size of the

3D modeled heart and the intensity of the lights in the scene. This new numerical value effects the scale of the representative heart and intensity of the lights in the VR experience, making the virtual heart appear to beat. This process happens in real-time.

The outcomes of this project, according to subjective user feedback, were that the users felt a deeper connection to their heartbeat and were able to fully notice it during the experience.

Participants noted that they usually pay no attention to their heartbeat as a normal process in life, but during this application they truly were engaged with their heartbeat and found the experience to be relaxing. The participants’ focus on their heartbeat, provided them with a brief period of time where they were not focusing on their current stressors in life. Some participants stated that the application felt like an out of body experience, and that the aspect of biofeedback, via their heartbeat, attained their attention and interest during the experience.

This project was an interesting experiment accessing individuals’ reactions to the visually immersive experience of their heartbeat, but it was missing the teaching element for the long- term goal of teaching MBSR techniques. This project established a working model for real-time biofeedback that could be used in the next project in the iterative process. Heartbeat VR provided a good foundation for how to design and use biofeedback to attain and maintain a user’s attention, but the next step was to apply this concept to a meditative action. This project instigated the question, how do I utilize this visual biofeedback process as an effective process

for teaching MBSR? The next step in my research and development was to use the biofeedback process to develop an education module for MBSR.

3.4: Tree Flight VR

The third and final iterative project leading up to the final thesis project was Tree Flight

VR. This application was a VR stress reduction application utilizing real-time biofeedback. The goal for this project was to create a breath awareness meditation application utilizing the biofeedback process developed in Heartbeat VR. The reason the breath was the primary focus of this project is due to the importance the breath has in regards to mindfulness meditation as described previously. The player is immersed into a scene with one large tree, and swirling particles of light for an atmospheric effect. I chose a large tree because it served as both an object based in nature, as well as the metaphorical connection between trees and Buddhist beliefs. Trees are often referenced in many teachings of the Buddha as a representation of a human being.

During the experience, the user is slowly floating in the direction they are looking, and when exhaling, a small gust of wind is applied behind them in the digital space, increasing their flying speed temporarily. While slowly flying around the center tree, the user has two slightly transparent rings, or mandalas, layered on top of each other located in front of them. One mandala represents a breath guide, expanding and contracting on pace with a standard breathing meditation technique. The user is provided oral instructions to breath with the breath guide mandala. When the breath guide mandala expands, it is the user’s cue to breathe in, when it contracts, it is instructing the user to exhale (Figure 9, Figure 10). The second ring represents the user's breath in real time, expanding when they breathe in and contracting when they breathe out.

Figure 9: Ring at full exhale Figure 10: Ring at full inhale

This project enhanced the usage of biofeedback as a teaching tool. The breath was traced via the expansion of the user’s stomach when inhaling and exhaling. The process of expanding and contracting your stomach, rather than your chest, when you breathe is diaphragmatic breathing. Evidence has shown that diaphragmatic breathing can improve sustained attention during mind-body training and is used in many breath related meditation practices (Ma et al.,

2017). Participants were orally instructed to use diaphragmatic breathing during the VR meditation. This was done by developing a wearable pressure sensor belt that utilized the same

Arduino technology as Heartbeat VR. This belt, shown in Figure 11, contains a small pressure sensor pad, linked to an Arduino kit inside the project box. The box is fastened around the user’s waist via an adjustable strap. This belt communicates to the VR headset via Bluetooth connection. Originally, this application began development on the HTC Vive, but then was adapted for use on Android-based mobile VR platforms in order to make the project more portable and easily used. My target group for this project during my iterative process was patients in a hospital bed, so realistically the hardware being used needed to be highly portable and intuitive. For this reason, the transition to android-based mobile VR headsets was made.

Figure 11: Bio-sensory Belt

Using the belt, the VR application would react to the user’s breath in real-time. The breath guide mandala and the user breath reactive mandala are slightly transparent and located in the same position in the VR space. The breath guide mandala expands for four seconds, pausing for three seconds, and then contracting for four seconds before repeating. These times were selected in accordance with common breath meditation practices that are used when instructing novice meditation practitioners through breath awareness meditation. The purpose for these two mandalas is for the user to match the expansion and contraction of their bio-reactive mandala with the breath guide mandala so both are moving in synchronicity. This process gives the user a task to accomplish that constantly provides feedback if they are performing the task correctly or not. This method is the foundation for what this project identifies as the biofeedback loop.

The biofeedback loop is a term created for this project. It refers to a system that constantly takes bio-input from the user, and provides feedback in which the user can access and adjust their bio-input based on the required task. In the example of this project, the user is

actively breathing in and out providing the bio input via the pressure sensor belt. This data is then translated to the expansion of the mandala on their screen. Feedback is provided to the user via synchronicity, or lack thereof, between their reactive mandala and the guide mandala. This system allows the user to adjust their breathing pace if necessary, before their next inhale, providing more bio input and repeating the loop. Figure 12 demonstrates this process.

Figure 12: The Biofeedback Loop

During the VR experience, the user hears soothing music as they fly around the large tree. The swirling particles provided a sense of life to the scene. The color palette was slightly dark, containing shades of green, orange, yellow, and brown. These design choices were made to promote a state of calm and curiosity to the VR application. As the user flies around this environment, they are asked to breath with the guide mandala. When exhaling their breath, a small wind force is applied to their back in the virtual environment, increasing their speed temporarily. The purpose of this design decision was to incorporate the feeling of control during the VR experience via their bio input. As stated previously in this paper, one of the largest sources of stress is a lack of perception of control. The Owner’s Manual to the Brain, written by

Dr. Peirce J. Howard, states that, “The critical test for a situation’s having achieved major stress

status is whether the individual feels out of control” (2006). I wanted this application to reduce stress by giving the user a sense of control while actively practicing breath awareness meditation.

I wanted to develop a system that would give the user the ability to have an experience in which they had control, in order to hopefully alter their perception of their locus of control from external to internal.

One of the worries when first creating the movement mechanic for this game was the aspect of player motion in VR. Many people develop motion sickness in VR experiences, but this is often due to the way movement is designed in the VR experience. Movement in VR often causes the user to develop motion sickness if they are subject to forced motion. This means that the user is being forcefully moved in the VR world, but they are neither moving in the real world, nor causing the movement in VR. This feeling of motion sickness however can be reduced or eliminated if the user is given control over their motion. For example, if you put someone in the side car of a bike, and have another force driving the bicycle and moving the player around, it is likely that the user will develop motion sickness. However, if the player is driving the bike, physically pedaling to go faster and leaning with the turns, they do not experience motion sickness in most cases because they are in control of their motion. When the player is physically causing the motion to happen, motion sickness can be avoided. In reference to the Tree Flight VR application, the user is breathing out in order to increase their speed. This intentional action is being used as their movement mechanic. Throughout the iterative testing of this project, very few individuals experienced motion sickness, even though some had stated they frequently develop motion sickness in VR experiences.

Another concept of this design was the idea of gamification of meditation. Gamification, defined by gamification expert and influencer Gabe Zichermann, is “the use of game-thinking

and game mechanics in non-game contexts in order to engage users and solve problems”

(Zichermann, 2011). The use of game-thinking and game mechanics include adding an element of strategy, tactics, aesthetic, narrative, or social. Adding any of these elements to a VR application provides user engagement via gamification. In Tree Flight VR, an element of gamification is implemented by providing a task for the player to accomplish, and feedback if they have completed that task correctly or not. Furthermore, I began to generate graphs for the user to view post-meditation. These graphs show the user the pressure data coming through the pressure sensor belt. This graph would clearly show moments when they became off pace with the guide mandala or became distracted. This meant that after multiple occurrences in the VR meditation, the user would be able to track their progress and attempt to get a smoother, more consistent graph each time.

Figure 13: Bad Breath Graph

Figure 14: Good Breath Graph

Figure 13 and 14 above are examples of graphs that have been exported from users. The bad graph example is a user’s first time in in the Tree Flight VR experience. The good graph

example is a user’s third time in the Tree Flight VR experience. These two graphs show a clear progression in understanding the physical process of breath awareness meditation.

This project was presented at ACM SIGGRAPH Vancouver in 2018. During this time my partner, Skylar Wurster and I were able to observe 200+ people participate in this VR meditation experience. The majority of participant’s subjective oral responses agreed that the application made them feel more relaxed and provided a unique experience. The issues that arose during this presentation were that while people enjoyed the experience and found it relaxing, it was failing to provide them with the knowledge necessary to practice MBSR techniques later on their own.

The teaching portion of this project failed. Another issue with this application was the aspect of flying. Again, while it was unique and enjoyable for most participants, it was distracting them from the meditative practice due to the movement mechanics of the application and the requirement for the user to turn their head in order to stay close to the tree.

After analyzing this project, I concluded that there needed to be more focus on teaching the participants the process of meditation through MBSR practices. In the Tree Flight VR experience, the principle focused on the perception of control was limited as the experience gave the user a short-lived sense of control and a temporary respite from stress; the Tree Flight VR experience did not succeed in learning mindfulness through MBSR for a long-term benefit. The goal of this thesis project is to teach the user how to become mindful through practicing MBSR, which in turn can have a perceptual shift on their sense of control, recognizing that they do have control over many important aspects of their day to day lives.

3.5 Conclusion

In conclusion, these three different studies provided me with the knowledge necessary to create the final thesis project. The successes and failures of each project allowed me to develop a design model that will be discussed in Chapter 4; the purpose of which can effectively teach the

process of MBSR in VR using biofeedback to offload mental fatigue. The Original Zen temple established an effective real-world reference for the virtual environment as well as the benefits of utilizing a guided MBSR audio tape. However, the design of the space and user experience negatively impacted the mediation experience. The Heartbeat VR project was a great stepping stone with the development of a biofeedback system, but the project itself was a technical study, rather than a meditative application. Heartbeat VR also led me to understand that the bio input provided by the player needed to be an intentional, physical action, such as breathing, rather than an internal passive action, such as a heartbeat. The need for an intentional action is so that participants are able to both focus and participate on one specific action, as they do in breathing meditation. The ability to focus on your breath is paramount in MBSR practices and is a good lesson to learn when being introduced to MBSR and meditation. For this reason, many MBSR training programs often begin with breath awareness meditation (Germer, Siegel, Fulton, 2005).

The Tree Flight VR application was an important step in development that tested the breathing- based biofeedback loop. This process is used in the final thesis project.

Chapter 4: The Hiatus System

4.1: Introduction

The Hiatus System is a VR guided breath awareness MBSR meditation experience utilizing biofeedback as an advanced iterative teaching tool. The project is viewed as a complete vertical slice of a larger project that will incorporate multiple meditation experiences. This project consists of an introduction to MBSR meditation in a similar fashion as the first week of an eight-week traditional MBSR training program. Breath awareness training was chosen as the ideal MBSR practice because it is a core method of MBSR meditation practice and is commonly introduced to participants early in the program. Breathing meditation is a tool that individuals can use regardless of where they are, and can be used to help individuals calmly react to stressful situations by briefly entering into a mindful state before responding. The application teaches this early lesson to individuals in an immersive, distraction limiting environment, designed with acute focus on awareness towards the breath. A guided audio track, facilitated by Dr. Ruchika

Prakash, at The Ohio State University is used during the VR experience. This track is used in an

8-week MBSR introductory program at the Clinical Neuroscience Laboratory at Ohio State

University. Dr. Prakash’s MBSR program has been tested in clinical trials previously with positive results, making it a desirable program to use for this project.

The previous projects leading up to The Hiatus System informed me of key design principles that are important elements to incorporate for the project to succeed. The following outlines these requirements. First, the virtual environment needs to focus the participants attention towards the meditative practice at all times. Second, the application needs to attain and maintain the user's attention throughout the experience. Third, the virtual environment needs to be relaxing, and immersive. Fourth, the user’s experience needs to be comfortable, consistent, and clear, minimizing room for confusion or frustration. Fifth, an adjustment time period should

be built in after the user enters the VR experience. Sixth, the user should be presented with engaging interaction via the biofeedback system. Seventh, the environment should avoid motion sickness by limiting movement in VR. Eighth, the system should implement gamification to the

VR experience for the purpose of implementing engaging interactivity and elements of play.

Ninth, the VR application should teach the user lessons that promote long term change through a mindfulness awareness mentality. Finally, the system should successfully incorporate breath awareness guided meditation into the VR experience. This chapter describes the design decisions made, and their results to achieve these design goals, as well as provide an in-depth description of the final thesis project.

This thesis project emphasized an iterative design process, which included: white boxing, mind mapping, flow diagrams, and user feedback. This project was designed from concept to finished product in roughly 18 months. During this time the project underwent significant changes to its visual design, user experience design, and technological platform. This chapter describes the iterative design decisions that led to the creation of the final project. During this description, various theories and studies are be introduced to support the design decisions made.

4.2: Visual Design

The visual design of the virtual environment is a significant element to this application.

The digital space is designed to be immersive, and visually relaxing without distracting the user from the meditative task of breathing. Creating a space that is immersive, but not distracting proved to be a difficult task. The reason for this is because increasing the feeling of presence in a virtual environment is enhanced by increasing the amount of sensory stimulus and interaction with the VR environment (Sliwinski, Katsikitis, & Jones, 2017). However, as discovered in the

Original Zen Temple project, increasing the amount of sensory stimulus also increased the frequency of distraction from the meditation. In order to increase the feeling of presence, while

decreasing distraction, the interactive element of the VR environment needed to be connected to the meditation activity (e.g. the breath). The breath reactive mandala serves as the interactive, breath driven, element in the VR environment for the user to constantly interact with. The visual environment surrounding the mandalas is designed to provide a holistic feeling of presence and immersion but provide less stimulation than the breath mandalas. During the conceptual design stages, I focused on comparing and contrasting reference material to establish an understanding of what elements are consistent with Zen Buddhist temples and gardens. Then, using this knowledge I designed a temple that adhered to the consistencies of real-world temples, but also used design methods to direct the user’s attention towards the meditation practice. Finally, after the temple structure was built, I began the highly iterative process of making the application immersive and functional. This process includes the elements of audio, color, material identity, and lighting.

Reference material for this project is heavily influenced by Zen Buddhism due to its historical influence on the process of mindfulness awareness meditation. The goal was to create a virtual environment that promotes the meditative practice. I began this research by comparing and contrasting different Zen temples located in Japan in order to discover commonalities and anomalies between them. Once these similarities and differences were collected, I compared those elements to more modern relaxation spaces such as spas and vacation retreats. I wanted to discover the difference between a relaxing environment and a space designed for meditation.

Figures 15, and 16, are examples of Zen mediation spaces, and Figures 17 and 18, show a few

Japanese Zen temples.

Figure 15: Breakdown of Zen temple interior and exterior space

Figure 16: Breakdown of Zen temple exterior space

Figure 17: Breakdown of an interior and exterior relaxation space

Figure 18: Breakdown of interior relaxation space

These four images are spaces that I compared when trying to determine the differences and similarities between a Zen space and a relaxation space. The red markers represent the similarities between all the spaces, while the blue markers represent the differences between the spaces. The presence of green and blue color was consistent between all spaces, as well as the inclusion of nature, and naturalistic materials. Both the relaxation and Zen spaces focused on the incorporation of natural lighting. All of the spaces broke up the major color scheme with various different colors, but the Zen spaces typically used warm color tones to do this. Calm water sources were frequent throughout most spaces.

The major difference between a relaxation space and a Zen space is an artificial, organized theme. An example of this is the individual organized seating areas in the relaxation spaces. Figure 18 is a prime example of a space that is meant for relaxation, but not meditation.

The existence of a computer, artificial lights, and manmade furniture take away from the naturalistic theme. The distinction between relaxation spaces and Zen spaces was important early on in my design process.

The interior of the virtual Zen temple is designed to draw attention to specific points based on the individual’s placement in the virtual environment. In the final thesis project, the user is placed on long meditation floor boards located at exterior front of the temple, however, in earlier iterations the user was placed in the back of the interior temple. The temple contains three different spaces, room A, B, and C (Figure 19). The “X” marker in room A is where the user was originally intended to be placed. They would sit in the center of the room with the mandala directing their vision through rooms B and C, towards the exterior environment.

Figure 19: Top-down view of Zen temple in the final thesis project

In the center of the mandala is a tree, which serves as a focal point. The edges of the cube-shaped rooms direct the user’s view towards the center tree due to the focal lines, further encouraging the user to maintain focus on that point (Figure 20). The structural design of the temple is to have a single focal point when located inside the temple. Throughout the iterative process, regardless of where the user was positioned within the virtual environment, their gaze would always be drawn to a single focal point. For the final project, the user is placed outside of the interior temple, on the meditation boards located at the “C” position in Figure 19. The design of the exterior space, not unlike the interior temple, creates focal lines towards where the user’s attention should be focused (Figure 20). These lines use linear perspective to subconsciously draw the user’s attention back towards the two mandalas in the center view. Various other elements such as this were taken into consideration when designing the virtual environment.

Figure 20: Focal point lines from interior temple

Minimizing distraction caused by the virtual environment was a multifaceted design challenge. Movement and sound proved to be two distracting elements in the Original Zen

Temple project and thus were more intently focused on in The Hiatus System. For example, the movement of the water and grass is much slower than the movement of the mandalas. The environment audio is purely ambient and lower in volume than the guided audio track. The position of the audio sources is more relevant in VR due to the use of 3D sound. A 3D sound, in relation to VR applications, is a sound that is emitted from specific coordinates in the virtual environment. This sound is stereoscopically delivered to the player through the internal headphones provided with the Oculus Go. The guided meditation track is emitting from the center of the two breath mandalas. 3D sound is highly important in VR environments because it can effectively direct the user’s attention (Fritz, Elhilali, David, & Shamma, 2007). Figure 21 shows the location of three different 3D sounds. The sound in the center labeled A is the guided audio track, while sounds B and C are ambient sounds specific to the environment. The guided

audio track sound being produced from location A is coming from in-front of the user. If the user turns their head to the right, the sound will pan to their left ear, and if they look to the left, the sound pans to their right ear. Sounds B and C are producing a lower volume and emitting from the left and right of the mandala in order to provide a sense of immersive sound. However, all audio sources are emitting from in-front of the user based on the camera position in the virtual scene, (Figure 21). This was intentional as any sound emitting from behind the individual may persuade them to turn around, away from the mandalas. The user naturally will want to look towards the direction in which the most movement and sound are being emitted, thus always bringing their attention back to the breath mandalas. The mandala that is placed in front of the user demands the most attention in the scene because it is providing the most sensory stimulus via its animation.

Figure 21: Audio source placement and user’s starting camera view

When deciding how the temple should be textured, material identity became supremely important. Given that this project contains a rendition of a Japanese Zen temple, it was essential to discover how these temples were constructed, what materials they were made from, and why.

These questions were significant in order to be ethically respectful to the Japanese and Buddhist culture. When deciding what materials to use for the wood, walls, and tatami mats for example, I wanted to be accurate to the reference materials. The temple needed to feel like a cohesive environment that flowed well together. The materials do not need to look completely realistic, but aesthetic cohesiveness can enhance the feeling of presence in the virtual environment (Jerald,

2016). To achieve visual unison, I wanted to discover what elements are used when constructing a Zen temple.

I began by researching the material components of the walls, ceiling and floor of the temple. The floors were obviously made from wood, but discovering what type of wood was difficult; many temples changed the wood they used for construction based on the available resources around them. A common tree used in the creation of Zen temples is the Japanese pine tree. Pine is very common in Japan and therefore used to create many different structures

(Mathison, 2018). I also sought advice from professionals with knowledge of Japanese culture and material identity at Ohio State University, such as Dr. Christina Matheson. For this reason, I decided to recreate pine wood boards for the construction of the temple. It was important for me that the floor boards have a natural tone to reduce an artificial feeling. The materials used in this project were created in Substance Designer’s physically-based texturing software, allowing complete control over how the object reacts to dynamic lighting. Materials made in this program were also made entirely procedurally, meaning that they can infinitely repeat along the X and Y axis of the texture, with parameters that can be exposed and edited within the Unity game engine.

Procedurally based textures were paramount for the VR environment in order to achieve a higher visual quality, while still optimizing for VR due to the computing restriction involved when developing on mobile VR platforms. In order to save processing power, it was important to

minimize the number of unique assets such as lights, materials, and models in order to reduce the amount of draw calls, thus reducing the processing requirements of the VR headset. A draw call in Unity is the amount of unique assets in the scene at one time. Optimization for mobile VR applications is an extensive process that requires many creative design decisions to overcome.

While this is an important aspect of VR development, it is not imperative to the design of this thesis project. More information on optimization for VR applications can be found at the

Optimizing for VR in Unity page on the Unity 3D website. Information regarding optimization in this thesis will be included when it affects design decisions. In relation to the wood material, the design decision to make a procedurally-based wood material is important because it allowed the same wood material to be used for each of the different wood objects in the temple. Using this process, I was able to achieve a higher visual quality using realistic shaders across all assets in the virtual scene while keeping the draw calls low and balancing the required processing power with the visual quality of the scene. Considering the temple consists predominately of wood, this design decision saved significant processing power. The pine wood chosen is a dark brown with hints of red, and visually resembles wood used in many Japanese Zen temples. An example of the digitally created wood compared to wood used for a real-world Zen temple can be seen in

Figure 22.

Figure 22: Comparison between real world and virtual wood material

Many Zen temples have tatami mats on the floor in meditation rooms. Tatami mats are made from twisted and bound rice grass (Original Kyoto Tatami, 2019). Again, this material was chosen because it is an abundant material in Japan and serves as a comfortable material to kneel or sit on for extended periods of time.

Ideally temples would use rice paper for the walls in order to allow natural light to filter in through the slightly transparent material. Increasing the amount of natural light was important to the design of the temple for reasons that will be further expanded upon later in this chapter.

For this reason, I decided to use rice paper as the material for the wall.

The materials used for the virtual temple were based on materials used in real-world Zen temples, but also were chosen to support the various criteria vital for the user experience. VR

environments do not have to consider random elements such as weather or physical durability, so decisions on material choices can be made to fit the desired scenario, rather than what would be more feasible in reality. These materials were all made in a realistic style in order to enhance the biophilic element. Because the plant life and natural materials in the scene are not real, the decision to make them in the realistic art style was made so the user would have a have a higher chance to view these elements as if they were real.

Another important element when designing the visuals for the virtual environment is the color palette and lighting. Most color tones consist of a natural palette due to the theme of the

VR scene. The colors in the scene consists of a split complementary scheme of green, blue and brown. A color palette for the scene is shown in Figure 23. Color choices were not made solely due to their relationship to natural elements, but also because these colors have an effect on emotions. Wheeler & Birren, in Color and Human Response (1978), describe specific human responses to different colors. In summary, he notes that the color green is useful for productivity and long-term energy. This aligns with the idea of using green colors because it is the easiest color for the eyes to stare at for lengthy periods of time. An issue with many meditations is that the participants often become tired and either lose concentration or fall asleep. For this reason, green is an ideal color choice to aid a novice meditation practitioner through the longevity of a

30-minute MBSR meditation.

Figure 23: Hiatus System color palette

Blue tones, according to Wheeler & Birren, slow down the pulse of the individual and lower their blood pressure. This state provides a conducive mindset for studying, deep thinking, and concentration (Wheeler & Birren, 1978). For The Hiatus System, this color felt important to include in a high volume of the visual real estate in order to calm the user. A lower heart rate and blood pressure are two parasympathetic states that also align with stress reduction (Shaw et al.,

2019). It is arguable that the vast amount of blue tones in the scene could aid the individual in stress reduction. The use of blue tones to relax and calm individuals has been proven to work in many real-world situations. For example, the residents of Alaska have roughly six months of darkness each year due to their geographical location. This causes many of the inhabitants of

Alaska to develop symptoms of depression due to the lack of vitamin D from the Sun’s rays. In order to counteract this, many cities in Alaska installed blue street lights throughout city to calm residents for the dark months.

The temples’ color palette ranges from shades of yellow and brown, to the Sun tinted bright yellow color of the rice paper walls. Mainly, the temple consists of the brown colored wood, broken up by the bright walls and desaturated yellow tatami mats. Brown is not an appealing color for a majority of people (Wheeler & Birren, 1978). However, the dullness of the brown tones contrasts with the encouragement of positive moods provided by the yellow and orange tones in the temple. The temple itself, is dark-brown specifically due to the location of the user during the experience. The participant is seated on the meditation boards facing the exterior environment. I chose to make the wood a dark-brown color to discourage the desire to turn around and look at the temple during the experience. However, the bright yellow tones break up the temple so that if the user decides to turn around, they are not negatively impacted by the darker colors. It is important that the user feels like they have the freedom to choose where to look at all times but are constantly guided back to the mandalas in the center of the screen.

The lighting in the VR scene aligns with the goals of the other sensory elements to direct attention towards the breath mandalas. The lighting process used in this project is global illumination. Global illumination, according to the Unity documentation is, “a system that models how light bounces off of surfaces onto other surfaces (indirect light) rather than being limited to the light that hits a surface directly from the light source (direct light)” (Unity

Technology, 2019). Put more simply, the light sources in the scene use indirect lighting bounces rather than direct lighting with no bounces. This allows for larger gradients of shadows and more dynamic lighting. Figure 24 shows the process of indirect lighting versus direct lighting.

Figure 24: Direct (left image) vs. Indirect (right image) lighting.

Indirect lights use a physics-based system to bounce light from surface to surface, losing intensity based on the distance the light rays travel between bounces. Direct lights will hit whatever surfaces have a direct line of sight to the light source and stop when reaching it.

Indirect lighting is far more realistic because it is how light reacts in the real world but is also computationally more demanding on the hardware of the machine it is being developed on. In the

Unity game engine, it is required to delicately balance the amount of times indirect lights can bounce. The less the light bounces, the more optimized the application becomes. For this reason,

I used a process called light baking for lights that do not need to dynamically change in order to optimize the lighting in the digital scene for a mobile VR application. The thinking behind this decision is similar to the balance between visual quality and optimization discussed previously about procedural shaders. Baking light, according to the Unity documentation, is when, “Unity pre-calculates the illumination from these lights before run-time, and does not include them in any run-time lighting calculations” (Unity Technologies, 2019). This means that all the lights and shadows do not need to be calculated every frame, but rather are calculated once and stored

into light maps that are stored in the project build. These light maps contain the shadows and light information, and are applied to the models in the scene, making them static, non-dynamic lights and shadows. This process is almost required for VR development and is an important design challenge to be aware of when creating VR environments. However, if well optimized, some real-time lights can be used in VR experiences, such as the direction light that is linked to the water in front of the Zen temple. This light computes in real-time and allows the reflections and shadows on the water to move as it ripples. These situations are examples of when it is important to balance the amount of indirect light bounces. Baked lighting does not allow for dynamic light, in the sense that if an object moves within the scene, its shadow will not.

However, there are solutions to this issue. One solution to this issue is to limit moving objects that require dynamic shadows. This limitation was recognized early on in development and is one reason why the user is seated during the experience, and nothing inside the temple moves.

During development, one iteration of the project contained a candle with a flickering flame. The flame was later deleted due to a redesign of the meditation experience. An issue with the flame was that the light caused by the flame had to be real time for the flickering effect to look realistic. This light did not cripple the optimization of the scene but proved to be too computationally taxing for what was being gained from its existence. Optimization balancing is a constant design challenge when creating mobile VR content and small situations like the flame example constantly arise during development.

Light placement in the scene is focused on drawing the user attention to the center of the breath mandalas. There are two yellow lights located inside the center of each room in the temple. This is to provide basic illumination to the interior, however, the overall level of

illumination on the interior of the temple remains darker than the exterior space. The yellow color is to complement the color of the slightly yellow rice paper walls.

The exterior lights are illuminated via a directional light. Directional lights are often used as a “Sun” source in game engines such as Unity. This light blankets the scene in a wall of light from a single direction, Figure 25. This light is used to create the majority of the shadows in the scene. The directional light has a blue tint applied to it. The reason for this blue is because there is evidence that blue colored light can promote a state of calm. Dr. Esther Sternberg references a study in her book, Healing Spaces, which was performed at an architectural conference (2009).

At this conference there were three different lounges for attendees to socialize. Each room was painted with white walls, but had different colored lights, red, blue, and yellow. The lights would tint each room the desired color. The results of this study showed that the blue colored room gave the surrounding participants a feeling of calm, while the yellow and red colored rooms induced a feeling of excitement. However, the physiological measure of heart rate variability was not changed, meaning the different moods people were experiencing are most likely related to the light wavelength (Sternberg, 2009). This information is why I chose to tint the directional light blue. The scene is also partially lit via the skybox, adding shades of green and blue light to the scene.

Figure 25: Directional light and shadows

The remaining lights in the virtual scene are all spherical white-colored point lights

(emitting radially from a singular point). These lights are used to illuminate important assets for the user to look at. One point light is located close to the camera position, illuminating the area around the user and the two breath mandalas. The last three point lights are located near the tree in the center of the pond, Figure 26. The lights illuminate the tree to a higher value than other assets in the scene, drawing attention towards it. From the user’s perspective, the illuminated area on the tree is located directly in the center of the two mandalas.

Figure 26: Exterior point lights

In summary, the virtual environment contains a rendition of a Japanese Zen temple, and an outdoor environment that references the Kinkaku-Ji temple in Kyoto, Japan. The VR experience is designed in many ways to focus the user’s attention to specific locations based on elements such as perspective lines, focal points, 3D audio, light emission, and animation. The virtual environment was created to be accurate to the material culture surrounding Zen temples, while aligning with color choices that promote the intended user experience.

4.3: User Experience Design

User experience design is “the process of creating products that provide meaningful and relevant experiences to the users” according to the Interaction Design Foundation (Interaction

Design Foundation, n.d.). User experience, in relation to The Hiatus System, involves the design of interactive technology and interactive systems developed for the application. This includes the bio-sensory belts, the biofeedback loop, and the step by step process in which the user completes the meditation.

As the first step, before donning the VR headset, the user straps on the bio-sensory belt.

This belt is the same as the bio-sensory belt used in the Tree Flight VR project. It was designed and engineered in collaboration with Skylar Wurster. The bio-sensory belt translates the wearer’s breath into a usable data format in the VR application. It does this by detecting the expansion and contraction of the individual’s stomach when they breathe via a pressure sensor. This sensor personally calibrates itself to the minimum and maximum change in pressure received from the user each time the user begins the meditation. This means that regardless of stomach size, tightness of the belt, or deepness of breath, the program will react to the data from each person the same, providing a more universally consistent experience.

From the perspective of the user, the bio-sensory belt tracks their breath when they inhale and exhale and reflects this action through the user’s reactive mandala. Expanding and contracting the mandala when the user breathes was designed to mimic the expansion and contraction of the diaphragm. How this process works on the design side is unique. The bio- sensory belt has a pressure sensor attached to the exterior lid of the belt. This measures the amount of pressure being placed onto the belt hundreds of times a second. This data is then sent to a microprocessor where the numbers are limited and translated into a usable number format for the VR application. At this point, VR application calibrates the minimum and maximum amounts of pressure being transmitted through the belt while the individual is breathing. These numbers are re-mapped as 0 and 1 for use in the game engine. From this point forward when the user breathes, the belt records that number and sends it to the VR application as a number from

0-1. Once this technical issue was resolved, I was able to use this frequently changing pressure value to affect virtually any quality of the VR scene. In the case of The Hiatus System, the data sent from the bio-sensory belt controls the scale of the breath reactive mandala on a set range.

For example, if the pressure sensor is sending a value of 0, the scale of the mandala is 1, if the pressure sensor is sending a value of 1, the scale of the mandala is 3, and if the pressure sensor is sends a value of 0.5, then the scale of the mandala is 2.

The purpose of the breath-based biofeedback is to allow the user to interact with the meditation process. By providing the user with the ability to visually experience their breath, and compare that to a guide, I have created a constant loop of biofeedback. The goal of this loop is to promote flow states within the user. If a flow state is achieved by the user, it will likely increase the enjoyment and effectiveness of the experience. And, I suspect provide a desire for the user to return to the meditation later on for repeated practice. Traditional mediation, while effective and beneficial, does not provide immediate feedback for the practitioner. Understanding this process is important in order to understand how the user interacts within the virtual application.

As soon as the participant starts the application and is placed in the virtual Buddhist Zen temple, they are given a period of time to get comfortable with their surroundings. The importance of this initial time period became abundantly clear during my previous VR experiments. Previous VR experiences began too soon after the user was placed in the VR environment. The issue with this is that the individual was not well prepared to begin the experience and usually demonstrated a desire to explore the virtual space. Even more so, newcomers to VR technology require time to explore their virtual environments and get comfortable within a VR space. VR technology has the ability to immerse the individual into digital space, but it is this initial period of freedom that helps individuals feel a sense of presence and comfort within the space.

At the beginning of the Hiatus System experience during this free time, there is a user interface that contains a Start, Info, and Exit tab. The Info tab provides the user with the option of

viewing a short description of mindfulness and mindfulness-based stress reduction, while the

Start tab provides a short introduction to the application. Once the user selects Start, they are instructed to breathe deep and slow, while the bio-sensory belt calibrates to their specific stomach expansion. After the ten second calibration phase, the guided meditation audio begins.

This audio track walks the individual through the MBSR meditation. This audio track teaches the individual how to breathe in a meditative way, what they should be focusing on, and directs the participant towards a mindful mindset. While listening to the guided audio track, the individual will be focused on the task of aligning their breath reactive mandala with the guide mandala so they overlap in synchronicity. The guided meditation experience lasts for 30 minutes, upon which the guided audio track concludes, and the user is free to relax in the VR space until they are ready to remove the headset.

4.4: Conclusion

The design of the user experience is focused on keeping the individual engaged at all times without causing confusion or distraction. The digital environment is designed to relax and direct the users though the process of MBSR meditation in a way that allows them to interactively learn how to meditate. This process attempts to offload the mental requirements that are associated with long periods of uninterrupted focus. The goal is to make the process of learning mindfulness meditation easier to perform, and accessible to a wider variety of cognitively capable people. Informal results from subjective user feedback of The Hiatus System was that most users found the experience and visuals to be very relaxing. Breathing with the mandalas proved to be challenging for most participants during their first experience with the application, but became much easier their second, third, and fourth times. The VR environment felt immersive and realistic to most users, though some participants were distracted by the virtual environment during their first time using the application, primarily if it was their first experience

with VR. Finally, most individuals stated that they felt much more relaxed after using the application for even as little as three minutes.

Chapter 5: Scientific Study and Hypothesis

As an integral part of a pilot study at The Ohio State University, The Hiatus System will be used to test the impact of virtual reality on adherence to mindfulness practices. Through the

Chronic Brain Injury Association at The Ohio State University, our research team received a grant to conduct a pilot study, testing the impact of virtual reality on adherence to mindfulness practices. The research team is a collaborative group of psychologists, physicians, design professors and myself. Members of the current research team include: Dr. Ruchika Prakash,

Department of Psychology, Dr. Marcia Bockbrader, Department of Neuroscience, Prof. Susan

Melsop, Department of Design, and myself as an MFA candidate in the Department of Design.

The purpose of this study is to collect preliminary data on the effectiveness of VR on mindfulness-based attention training (MBAT) on mindfulness practitioners based on measurements of heart rate variability (HRV) and galvanic skin response (GSR). The study includes two participatory groups, an MBSR with VR group, and an MBSR only group. The goal of this study is to determine if The Hiatus System can effectively deliver an MBSR experience to individuals who regularly practice meditation. Preliminary data will be used to support a future study to assess if MBSR techniques have a positive result on chronic brain injury (CBI) patients. Finally, the findings of the pilot study will be used to determine whether the VR MBAT results vary from the results of the MBAT program without VR.

The overarching aim of this pilot study is to adapt mindfulness-based interventions that have been successful in improving resilience to stress, reducing depression and anxiety, and improving cognition in the general population to an immersive VR application. Our rationale is to leverage VR to provide a structured, visually engaging, immersive, entertainment-style delivery of mindfulness meditation content. The application aims to attain and retain the user’s

attention towards MBSR activity by utilizing a specifically designed virtual environment and experience, paired with real-time user biofeedback, as described previously in this document.

This program has two specific aims.

Specific aim one is to create user-centered adaptations of Mindfulness-Based Attention

Training (MBAT). The objective of this aim is to adapt audio-only interventions from MBAT into an immersive, attention-focused, audio-visual VR experience using patient-centered design.

The team’s approach will be to apply an iterative design model utilizing stakeholders’ opinions, therapeutic design expertise, and interactive technology to create a VR experience that guides users through a breath awareness mindfulness practice. Our hypothesis with this aim is that the

VR environment can minimize distraction, implicitly focus attention, facilitate visualization, and maintain engagement on mindfulness tasks for the meditation practitioners participating in the study. This aim is intended to support the possibility of this application being effective for patients with low cognitive working memory, based on an attention-focused review of the application on healthy-mind participants.

Specific aim two is to demonstrate acceptance, feasibility of, and adherence to patient- centered, adaptive mindfulness meditation methods within a 1-week MBAT+VR program compared with a MBAT only program. The objective of this aim is to determine whether

MBAT+VR is accepted by individuals and promotes better adherence to home practice than a

MBAT (audio only) program. Our approach will be to compare GSR and HRV results collected from both groups, as well as two standardized MBSR surveys, the Mindfulness Attention

Awareness Scale (MASS) and the Five Facet Mindfulness Questionnaire (FFMQ). Our hypothesis with this aim is that using this intuitive, immersive, visual interface will amplify the healing environment by facilitating engagement in visually-based meditation practices. We

expect to find that participants in the MBAT+VR group will demonstrate lower GSR and higher

HRV responses compared to the MBAT only group.

5.1: Background and Rationale

Our overall scientific premise is that mind-body approaches to healing and well-being offer a powerful way to influence body states by engaging the mind through visual stimulation.

Prior to the current pilot study of which I am now a part, the research team conducted an earlier study. Their primary goal was to investigate the effects of a brief mindfulness training program on a Go/No-Go task of external attention and a continuous performance task (CPT) of internal attention, as well as self-reported mind-wandering during those tasks in 74 older adults

(Whitmoyer et al., n.d.). Results from this trial revealed that there was a marginal effect of 4 weeks of MBAT intervention in reducing mind wandering relative to a control group. This effect remained even after controlling for differences in practice minutes. Although improvements in external attention were observed within both the MBAT group and the control group, effects were not significant for the MBAT group above and beyond the control group. However, working memory capacity (WMC) was identified as a moderator of improvements in external attention in the MBAT group specifically, such that those with higher baseline WMC exhibited greater improvements in external attention following MBAT. The results of this pilot intervention thus provide critical importance for the role of working memory capacities in facilitating gains in attentional control following mindfulness training. The use of an immersive, visual VR method designed to offload the labor of working memory capacities has the potential to make this promising intervention available for populations with impaired cognitive functioning. Increasing engagement by augmenting MBAT with VR is expected to increase rates of practice, amplify focus on breath, and reinforce the mind-body connection inherent in breath awareness. In addition, the VR intervention structure provides implicit, rather than explicit

feedback to help maintain breathing rate within the window thought to induce parasympathetic activation and induce relaxation. The goals of this study, guided by studies previously conducted by the research team, allowed us to establish two specific aims for the current pilot study, as well as the procedure in which the study will be performed.

5.2: Scientific Premise for Aim #1 In order to advance MBAT methods and make them more accessible for individuals with

CBI, the current research team will apply the Therapeutic Design Model utilizing the

Interactivity Mixer (Worthen-Chaudhari & Bockbrader, 2016) on healthy-minded individuals to create experiential, immersive, and engaging VR content that can be enhanced from user feedback post-study. The study includes a guided audio track provided by Dr. Ruchika Prakash used for MBSR training.

Results of a pilot study trial for the Go/No-Go task reported a successful use of VR for various interventions to allow for opportunities to practice different skills while controlling distractors in their environment (Parsons et al., 2015; Rose et al., 2005). The Therapeutic Design

Model recognizes that designing therapeutic interactive applications for individuals with CBI requires some deliberate design thinking around what interactive mechanics the user can engage

– what interactive options are available to the patient seem intuitive without requiring working memory or executive function burden, facilitate focus without sensory overload, and can be repeated to advance the “game.” The Interactivity Mixer defines game mechanics according to the type of interactivity the user performs to engage the game. Engagements in a VR environment can be strategic (e.g., planning two or more steps ahead to achieve a goal), tactical

(e.g., moving a chess piece or gesturing with a leg to trigger an interactive mechanic to occur), aesthetic (e.g., unfolding of visual designs or dynamics), narrative (e.g., unfolding of a story or plot as interactive mechanics are triggered), or social (e.g., interacting with other players). In

these apps, we will use an iterative design approach to create environments that are engaging on a narrative and aesthetic level, avoid potential sensory sensitivities or distractions, while strategic mechanics inherent in the structure will represent the actual mindfulness therapy.

5.3: Scientific Premise for Aim #2

Mindfulness training is a form of mental training that emphasizes the regulation of attention towards present-moment experiences, and it is believed to improve attention control via reducing vulnerability to reactive modes of the mind (Bishop, 2002). Our Mindfulness-Based

Attention Training (MBAT) protocol is modeled after the traditional Mindfulness-Based Stress

Reduction (MBSR) protocol (Kabat-Zinn, 1982), incorporating formal MBSR practices such as breath exercises, directing focus away from free-floating thoughts and emotions and re-orienting toward the breath; body scans, directing attention toward the present sensations of the body; and long sitting meditations, practicing nonjudgmental awareness in response to thoughts and feelings arising moment by moment. Thus, MBAT is an abbreviated version of MBSR, intentionally focused on the cognitive components of MBSR, namely the use of selective attention skills to concentrate on thoughts, emotions, and bodily sensations. We propose to demonstrate the feasibility and acceptability of incorporating MBAT with VR imagery

(MBAT+VR) in a 1-week MBAT.

Potential pitfalls of this research include the possibility that the data could be inconsistent. Often, mindfulness-based research studies can have varying results due to the subjective nature of the willingness and dedication to learn mindfulness by the participants. At the conclusion of this study, we expect to have generated and pilot-tested MBAT VR application designed to strengthen user attention. This approach will apply a patient-centered Therapeutic

Design Model utilizing the Interactivity Mixer (Worthen-Chaudhari & Bockbrader, 2016) to deliver experiential, immersive, engaging and impairment-appropriate therapeutic content. We

will also collect GSR, HRV, and design feedback in a pilot group of five participants. This will have a positive impact by providing an adaptive version of MBAT that can be used for a future study for individuals with CBI to enhance resilience, improve mood, and support cognition, all of which can be expected to impact quality of life.

5.4: Procedure

We will gather information through two groups of MBSR practitioners regarding which interactive visuals they believe would enhance their focus on the breath awareness MBAT practice. The participant pool will consist of five MBSR practitioners currently working in the

Clinical Neuroscience Laboratory. These five participants will be divided into two groups, a

VR+MBAT group, and an MBAT only group. After one week of practicing five days a week for one hour, the two groups will switch roles. GSR and HRV will be measured and evaluated through the Empatica wristwatch. At the end of the study, all five MBSR practitioners will have participated in both the VR+MBAT and MBAT only groups.

Participants will be asked to wear the Empatica wristband for 35 minutes each day. We will collect baseline GSR and HRV readings for five minutes, followed by the MBSR practice for 30 minutes. We will collect HRV data according to protocol from Dr Kiecolt-Glaser (Wilson et al., 2018), to assess whether the intervention induced a parasympathetic state (an increase in

HRV). We will also ask users to rate their pre-/post-intervention subjective states of stress and mindfulness using visual analog scales, the Mindful Attention and Awareness Scale (MAAS) and the Five Facet Mindfulness Questionnaire (FFMQ).

The Empatica wristband is FDA approved, non-invasive and accurate. The VR application has taken the precautions necessary to ensure that nausea due to motion sickness does not occur during the experience. This is done by eliminating the known causes of nausea in virtual reality programs at this point, which include forced motion, low frame rate, camera

filters/effects, and unnatural movement. For this study, there is no aspect of forced motion or unnatural movement because the practice is performed while seated in a still VR environment without being required to physically move or being forced to digitally move within the digital application. The application is constantly being optimized throughout its iterative process to ensure the frame rate does not go below the recommended 90 frames per second rendering for

VR experiences. Finally, no camera filters or effects have been applied to this program.

Data will be collected and organized by Kevin Bruggeman and Joanna Salerno. The data will be stored privately within the computer network at the Clinical Neuroscience Laboratory.

The MASS and FFMQ surveys will be provided for each participant and collected and stored privately within the Clinical Neuroscience Laboratory. No confidential or identifiable information will be included in the information stored in this study. The only personal information collected in this study will be age and gender.

Chapter 6: Conclusion

In conclusion, this thesis project is designed to enhance coherence to mindfulness practice through an interactive, biofeedback-based virtual reality program. The hypothesis that

The Hiatus System could have the ability to teach mindfulness to individuals and reduce their levels of stress is supported by years of mindfulness research, VR simulation training research, and VR neurofeedback/biofeedback research. The outcomes of the informal testing suggest the application will be successful at teaching MBSR to individuals in a stress reducing environment.

MBSR training does not have a flawless success rate and many individuals can struggle to comprehend and benefit from mindfulness practice. Based on studies involving biofeedback- based application and interactive technology, such as VR, the hypothesis is that the biofeedback loop can offload the cognitive requirements of mindfulness training by providing visual and auditory guidance through an interactive learning model in VR, providing a positive visual environment designed for mindfulness meditation practice.

MBSR has proven to be an effective and powerful tool for long term stress reduction.

While this process has proven to be successful, it is also difficult. For many individuals it is challenging to understand the process of meditation and requires long-term commitment and dedication. Furthermore, mindfulness meditation requires the user to sustain long periods of focus and attention. This can be cognitively difficult, especially for individuals with low working cognitive memory, or difficulty maintaining attention. This is why I believe that a VR biofeedback-based MBSR training application can help individuals learn how to become mindful in a way that guides them slowly through the process, at their own pace and convenience, while reducing mental fatigue.

Neurofeedback and biofeedback-based VR applications have proven to help individuals learn a task through an immersive and engaging interactive learning module. This heightened level of engagement can cause flow states that increase the enjoyment and coherence to whatever task is being presented. The biofeedback loop is a process in which the user provides bio-input that is then received by the digital application. The application concurrently provides sensory feedback to the user for them to interact with and adjust their bio-input. The hypothesis is that this higher level of engagement with the breathing process will help individuals maintain attention towards their breath and the meditation practice, while also retaining their attention if distraction occurs.

Learning a new skill or trait in VR has been studied extensively in the medical/hospital environment through simulation training. The process of learning a new skill through simulation- based training, in a controlled environment designed around a task being required of the user allows the user to practice that task in a VR environment in order to learn how to accomplish the task faster and more easily. While the relation to VR meditation is directly comparable, the idea that VR can provide an optimized interactive learning environment is a key factor that has been proven through the effectiveness of VR simulation training.

As much as the design of the technology and user experience is important in this project, the visual and audio design of the VR space is equally crucial. The virtual environment of this application is specifically designed to promote a feeling a calm and relaxation, while also constantly directing attention towards the meditation process. This calming virtual environment was achieved through utilizing the processes of color theory, linear perspective, lighting, 3D audio design, spatial design, material identity, and animation. In order to create an immersive experience, providing the feeling of presence for the user, the virtual environment must feel like

an aesthetically cohesive space that engages the user in the process of breath awareness meditation.

The combination of all these elements has led to the development of the final thesis project, The Hiatus System. The need for an application that can reduce long term and chronic stress is significant. As technology is advancing and the pace of our lives increases, the stress levels of individuals continues to rise. Chronic stress can have severe negative health implications if not reduced. Applications such as The Hiatus System have the ability to help more individuals reduce their stress levels through the process of MBSR.

While the pilot study, which aims to test the effectiveness of The Hiatus System, was not completed in time for the submission of this thesis paper, the research and background that has influenced the development of this application provides a strong hypothesis that the application will have a positive effect on the user’s coherence to the mindfulness practice.

Throughout this thesis paper I have described the need for applications like this, crafted a solution to the problem, supported my hypothesis with current and relevant research, and described the iterative process that led to the final design. I plan on publishing a follow-up to this thesis paper in the future that discusses the results of the aforementioned pilot study. My computer science partner, Skylar Wurster, and I plan on developing more applications in the future and continue our collaborative work in the field of research and development.

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