Doctoral thesis submitted to the Faculty of Behavioural and Cultural Studies, Heidelberg University in Cooperation with the Pontificia Universidad Católica de Chile and the Universidad de Chile in partial fulfillment of the requirements of the degree of Doctor of Philosophy (Dr. phil.) in Psychology Title of the thesis DESIGN AND PILOT STUDY OF AN ADVENTURE VIDEO GAME AS A TOOL IN PSYCHOTHERAPEUTIC PROCESSES OF ADOLESCENT WOMEN WITH SYMPTOMS OF DEPRESSION presented by ÁLVARO ERNESTO CARRASCO GUZMÁN year of submission 2015 Dean: Prof. Dr. Klaus Fiedler (Heidelberg University) Prof. Dr. Pedro Morandé Court (Pontificia Universidad Católica de Chile) Prof. Dr. Cecilia Sepúlveda Carvajal Universidad de Chile) Advisors: Prof. Dr. Matthias Backenstrass (Heidelberg University) Prof. Dr. Mariane Krause (Pontificia Universidad Católica de Chile) Prof. Dr. Juan Pablo Jiménez (Universidad de Chile) 1 Table of Contents Dedication ............................................................................................................................ 1 Acknowledgments ............................................................................................................... 2 Abstract ................................................................................................................................ 4 Introduction.......................................................................................................................... 5 1. Theoretical and empirical background. ....................................................................... 6 1.1. Depression. ........................................................................................................... 6 1.1.1. Psychotherapy and prevention of depression. ............................................... 7 1.1.1.1. Efficacy of psychotherapy for depression. ................................................ 7 1.1.1.2. Prevention of depression ........................................................................... 9 1.1.2. Computer based interventions for the treatment and prevention of depression 10 1.1.3. Treatment and prevention models of depression ........................................ 11 1.2. Play. .................................................................................................................... 13 1.3. Games and video games. .................................................................................... 14 1.3.1. The video game experience ........................................................................ 16 1.3.2. Video games for learning and psychotherapy. ............................................ 18 1.3.2.1. Commercial videogames in psychotherapy ............................................ 21 1.3.2.2. Videogames specifically designed for psychotherapy and health .......... 22 1.3.2.3. The potential of adventure video games for learning ............................. 25 1.4. Interactive Narratives ......................................................................................... 28 2. Problem approach ...................................................................................................... 34 3. Research questions and objectives. ........................................................................... 35 3.1. Questions. ........................................................................................................... 35 3.2. Objectives ........................................................................................................... 36 3.2.1. Design phase: .............................................................................................. 36 3.2.2. Research phase ............................................................................................ 36 4. Method ....................................................................................................................... 38 4.1. General research design ..................................................................................... 38 4.1.1. Video game design phase. ........................................................................... 38 4.1.2. Pilot study ................................................................................................... 39 4.2. Procedure. ........................................................................................................... 39 4.2.1. Video game design phase. ........................................................................... 39 4.2.1.1. Web page design. .................................................................................... 39 4.2.1.2. Focus groups ........................................................................................... 40 4.2.1.3. Process of creating and writing the story ................................................ 40 4.2.1.4. Prototype test .......................................................................................... 41 4.2.1.5. Video-game design process .................................................................... 41 4.2.1.6. Psychotherapists’ participation in the game design ................................ 42 4.2.1.7. Playability test ......................................................................................... 43 4.2.2. Pilot test ...................................................................................................... 43 4.3. Subjects. ............................................................................................................. 44 4.3.1. Design phase ............................................................................................... 44 4.3.1.1. Focus groups ........................................................................................... 44 4.3.1.2. Prototype test .......................................................................................... 44 4.3.1.3. Video-game design process .................................................................... 45 4.3.1.4. Playability test ......................................................................................... 45 4.3.2. Pilot test ...................................................................................................... 45 4.3.2.1. Psychotherapists ...................................................................................... 46 4.3.2.2. Patients .................................................................................................... 46 4.4. Instruments ......................................................................................................... 47 4.4.1. Video game design phase ............................................................................ 47 4.4.1.1. Focus group guide ................................................................................... 47 4.4.1.2. Prototype test interview guide................................................................. 48 4.4.1.3. Playability test interview guide ............................................................... 48 4.4.2. Pilot test. ..................................................................................................... 48 4.4.2.1. Post-game questionnaire. ........................................................................ 48 4.4.2.1.1. Post-game affect scale .......................................................................... 49 4.4.2.1.2. Acceptability scale ............................................................................... 49 4.4.2.1.3. Game experience scale ......................................................................... 49 4.4.2.2. Therapist interview guide........................................................................ 50 4.5. Data analysis procedure ..................................................................................... 51 4.5.1. Video game design phase ............................................................................ 51 4.5.1.1. Focus group ............................................................................................. 51 4.5.1.2. Prototype and playability tests ................................................................ 51 4.5.2. Pilot test ...................................................................................................... 51 4.5.2.1. Patients .................................................................................................... 51 4.5.2.2. Psychotherapists ...................................................................................... 52 5. Results ....................................................................................................................... 53 5.1. Web page and video game ................................................................................. 53 5.1.1. Web page. ................................................................................................... 53 5.1.1.1. Integration of post-game questionnaires. ................................................ 55 5.1.2. Focus Groups .............................................................................................. 56 5.1.2.1. Conflicts. ................................................................................................. 56 5.1.2.2. Feeling down ........................................................................................... 57 5.1.2.3. Forms of entertainment ........................................................................... 57 5.1.3. Game story .................................................................................................