AS IF:  A VR Empathy Game 

VR system created to combat social stigma associated with chronic pain

Weina Jin, Servet Ulas, Xin Tong, Dr.Diane Gromala and Dr. Chris Shaw

Problem: Those suffering from chronic pain are unseen: their experience seems both invisible and incommunicable. This makes it difficult for healthcare professionals, family, friends and co-workers to believe and understand a patient’s suffering, and may negatively affect those who might otherwise want to empathize with and support patients. 

Social stigma 

Not feeling believed and understood can lead patients to confusion, frustration, anger, anxiety, shame and social isolation. Further, gaining an empathetic understanding of a patients’ experience is not an adjunct, but is integral to helping patients to move forward alongside their pain. Therefore, we designed an interactive system called “AS-IF” to help educate the public, raise awareness and enable others to gain a sense of empathy (or perspective-taking in the short run) with patients. 

VR Design. This interactive VR system helps people who don’t live with chronic pain (“the public”) gain a sense of empathy with chronic pain patients by putting them in the shoes — or virtual body (avatar) —of a patient.

VR users co-inhabit a 3D avatar of a patient; “pain” is indicated by red glowing particles that also signal functional limitations. A user simultaneously hears her self-talk — the patient’s fears, struggles and concerns. In these ways, users gain a sense of what it may feel like to try to do everyday tasks with physical impairments and the all-too-common social stigma they face.       

VR Tech. The revised system was developed in Unity3D using an Oculus HMD and Microsoft Kinect Sensor as an input device that detects and tracks the user’s position and movements.

Results. Originally created using game conventions, AS-IF was completely rehauled after studies and demos at CHI and the Canadian Society of Pain’s (CPS) Annual Scientific Conference made it clear that users prefer ‘direct manipulation’. Health professionals at CPS were strongly enthusiastic and said they could benefit from using  AS-IF as “a compelling way to remind us that our recommendations to patients often require more effort than we assume, and may have wide-ranging effects that we unintentionally overlook.” 
Findings of our largest study suggest that the VR game was effective in improving implicit and explicit empathy and its emotional and perspective-taking aspects. For the Empathy Scale, total pretest scores (mean 47.33, SD 4.24) and post-test scores (mean 59.22, SD 4.33) did not reach statistical significance (P=.08). However, we did find differences in subscales: the Kindness subscale showed a statistically significant increase in post-test scores (mean 15.61, SD 2.85) compared to pretest score (mean 17.06, SD 2.65; P=.001). In the Willingness to Help Scale, a significant increase was observed from a t-test analysis (P<.001) of scores before (mean 7.17, SD 2.28) and after (mean 8.33, SD 2.03) gameplay. The effect size for this analysis was large (d=−1.063).

Tong X., Gromala D, Kiaei Ziabari SP, Shaw CD (2020). “Designing a Virtual Reality Game for Promoting Empathy Toward Patients with Chronic Pain: Feasibility and Usability Study.” JMIR Serious Games. 2020 Aug 7;8(3):e17354. DOI: 10.2196/17354. PMID: 32763883; PMCID: PMC7442937.

Tong, Xin & Kiaei Ziabari, Seyedeh Pegah & Gromala, Diane & Shaw, Christopher. (2019). “AS IF You Were Me”: Evaluating a Virtual Reality Game for Promoting Empathy towards Chronic Pain Patients. JMIR Serious Games. 8. 10.2196/17354.

Servet Ulas, Weina Jin, Xin Tong, Diane Gromala, and Chris Shaw. 2017. “Frustrating Interaction Design of AS IF, an Embodied Interaction Game for Perspective Taking Towards Physical Limitations.” In SpringerLink, pp.192–198. http://doi.org/10.1007/978‐3‐319‐58753‐0_30

Tong, X., Jin, W., Ulas, S., Gromala, D. (2017). “Evaluating AS IF, an Interactive Body-sensing Game to Foster Empathy Towards Chronic Pain Patients,” Canadian Pain Society Annual Conference 2017.

Jin, W., Ulas, S. Tong, X., Gromala, D., and Shaw C. (2016). “AS IF You Are Suffering in Silence An Interactive Installation as Empathy Tool for Chronic Pain,” ISEA2016, May, Hong Kong.

Jin, W., Ulas, S. Tong, X., (2016). “AS IF: A Game as an Empathy Tool for Experiencing the Activity Limitations of Chronic Pain Patients.” Peer-reviewed paper presented at the ACM CHI Conference May 7-12, San Jose, CA. Peer-reviewed paper published in ACM CHI’16 Extended Abstracts, pp.172-175, NYC: ACM (Association for Computing Machinery).