AS IF: a VR game for empathy

Version 2.0

[Team Project] AS IF is a VR game designed for nonpatients to experience the living experience of a chronic pain patients. By embodying the players into a grandma virtual avatar and deliver daily tasks in a narrative settings, the game aims to facilitate the players empathy towards the embodied character, who is a chronic pain patients. In the game, the player can direct manipulate the object in a kitchen and bake a cake. However, the player’s physical movement are limited and receives virtual pain “signals”.

We have iterated this game three times according to the user test for each version. In v1.0, we used Microsoft Kinect and in v2.0 and we switched to VR. We changed the interactions from puzzle-solving to direct manipulation in v3.0.

[My Role] Project leader, game designer, developer, and researcher.



Chronic pain affects, by conservative estimates, 1 in 5 people in industrialized countries. Despite this prevalence, public awareness of chronic pain was remarkably low until the recent opioid crisis; as a result, stigma remains a problem frequently faced by people who live with this condition. Many researchers have been evaluating how digital media may impact the emotional and perspective taking aspects of empathy in both clinical and nonclinical settings. Despite the growing interest in using virtual reality (VR) and VR games to motivate empathy, few studies have focused on empathy for people who live with chronic pain. To address this, the VR game AS IF was developed to increase non-patients’ empathy toward the growing number of people who live with long-term chronic pain. On the basis of our prior work, we overhauled our approach, designed and built a VR prototype and evaluated it, and offered design suggestions for future research.


We adopted a mixed methods approach to compare the empathy-related outcomes in both pre- and posttesting and evaluate its effectiveness. A total of 19 participants were recruited in this study. Adapted Empathy Scale, the Willingness to Help Scale, and the Emotional Wheel instruments were used. In addition, participants were given a Sense of Embodiment questionnaire to evaluate their perceived level of embodiment in the game. Finally, through a 15-min semistructured interview, participants discussed their experience, provided feedback, and offered researchers their ideas.


The findings of this study suggest that the VR game was effective in improving implicit and explicit empathy as well as its emotional and perspective taking aspects. More specifically, for the Empathy Scale, the total pretest scores (mean 47.33, SD 4.24) and posttest scores (mean 59.22, SD 4.33) did not reach statistical significance (P=.08). However, we did find differences in the subscales. The kindness subscale showed a statistically significant increase in the posttest score (mean 15.61, SD 2.85) compared with the pretest score (mean 17.06, SD 2.65;P=.001). For 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) the gameplay. The effect size for this analysis was large (d=−1.063).


The contributions of this research are as follows: AS IF provides a promising approach for designing VR games to motivate people’s empathy toward patients with chronic pain, the study evaluates the potential effectiveness of such a VR approach, and the general design suggestions devised from this study could shed light on future VR game systems.


Tong X., Gromala, D., Kieai P., and Shaw C., Designing a Virtual Reality Game for Promoting Empathy Toward Patients With Chronic Pain: Feasibility and Usability Study, JMIR Serious Games 2020;8(3):e17354, doi: 10.2196/17354, PMID: 32763883 (impact factor: 3.351).

Tong, X., Ulas, S., Jin, W., Gromala, D., & Shaw, C. (2017, May). The design and evaluation of a body-sensing video game to foster empathy towards chronic pain patients. In Proceedings of the 11th EAI International Conference on Pervasive Computing Technologies for Healthcare (pp. 244-250).

Jin, W., Ulas, S., & Tong, X. (2016, May). AS IF: A Game as an Empathy Tool for Experiencing the Activity Limitations of Chronic Pain Patients. In Proceedings of the 2016 CHI Conference Extended Abstracts on Human Factors in Computing Systems, pp. 172-175.



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