---
title: "CardioCommXR: Training Empathy Through Gamified Emotional Regulation"
authors:
  - Andreia Valente
  - Mark Billinghurst
year: 2025
venue: "Extended Abstracts of the CHI Conference on Human Factors in Computing Systems (CHI EA 2025)"
doi: "10.1145/3706599.3720319"
url: "https://andreia-valente.com/publications/valente2025cardiocommxr.html"
pdf: "https://andreia-valente.com/pdfs/valente2025cardiocommxr.pdf"
topics:
  - Mixed Reality
  - Empathy
  - Physiological Computing
  - Biofeedback
  - Collaborative Games
---

# CardioCommXR: Training Empathy Through Gamified Emotional Regulation

## Citation Metadata

- Authors: Andreia Valente, Mark Billinghurst
- Venue: CHI EA 2025
- Year: 2025
- DOI: https://doi.org/10.1145/3706599.3720319
- HTML: https://andreia-valente.com/publications/valente2025cardiocommxr.html
- PDF: https://andreia-valente.com/pdfs/valente2025cardiocommxr.pdf

## Plain-Language Summary

CardioCommXR is a mixed reality collaborative game designed to make emotional regulation and empathy part of gameplay. Players work together on a memory-matching task while monitoring their partner's stress through cardiac activity. When a player's stress passes a threshold, communication between partners is restricted by virtual barriers. Progress therefore depends not only on solving the task, but on recognizing and responding to a partner's emotional state.

The paper argues that biofeedback-based empathy training often lacks intrinsic motivation. CardioCommXR addresses this by tying emotional awareness directly to game success. Instead of presenting physiological data as optional information, the system makes interpersonal regulation consequential.

## System Design

The game uses mixed reality to create a collaborative environment in which two players communicate to match images. A virtual thermometer represents partner stress derived from heart rate variability. When stress rises too high, the interface disrupts communication by blocking visual or auditory channels. The mechanic encourages players to slow down, reassure each other, and adapt their behavior to their partner's emotional state.

## Contributions

- Introduces a mixed reality game where physiological state directly shapes communication.
- Turns empathy and emotional regulation into game mechanics rather than auxiliary learning goals.
- Demonstrates how biofeedback can create social consequences inside collaborative play.
- Frames stress awareness as a strategic layer in teamwork.

## Design Implications

CardioCommXR suggests that empathy training systems can be more engaging when emotional awareness affects task outcomes. However, the design also raises questions about vulnerability and privacy. Showing stress may help partners support each other, but it can also make players feel exposed or judged. Future systems may need collective or abstracted stress representations to balance awareness with psychological safety.

## Game Mechanics and Biofeedback

CardioCommXR is built as a co-located mixed reality Memory Match game on Meta Quest 3 passthrough. Two players can see and talk to each other naturally while interacting with separate virtual card decks. Player 1 describes an image and Player 2 tries to identify the matching card. Correct matches remain face-up, while incorrect guesses switch the players' roles. The game uses nine image pairs and an eight-minute session, with generated image sets that include subtle variations to make communication precise rather than trivial.

Each player wears a Polar H10 chest strap. The system derives stress from heart rate variability, especially RMSSD, and updates a virtual thermometer that displays the partner's stress. Stress is normalized relative to the player's recent physiological history using a three-minute sliding window. If a player's stress remains above the 75th percentile threshold for five seconds, the system triggers communication barriers: a virtual curtain blocks visual access and underwater audio impedes speech. The barriers dissolve only after both players remain below the threshold for eight seconds.

This mechanic turns emotional regulation into a shared gameplay constraint. Players must decide when to go fast, when to slow down, how much detail to give, when to reassure a partner, and how to recover after mistakes. Stress regulation becomes part of the team's strategy rather than a separate reflection screen.

## Critical Reflections

The paper argues that biofeedback games can train interpersonal communication by letting players experience how pacing, tone, explanation quality, and reassurance affect another person's stress. It also identifies a risk: forced emotional transparency can increase vulnerability. Showing individual stress may help empathy, but it can also amplify self-consciousness or pressure.

The authors propose future versions that use collective or team-level stress visualizations rather than exposing one person's physiology directly. This could preserve the learning value of physiological awareness while reducing the sense that an individual player is being singled out.

## Why This Paper Matters

This work is relevant to mixed reality, serious games, collaborative systems, empathic computing, physiological computing, and biofeedback-based training. It shows how social biofeedback can move beyond passive dashboards and become part of interaction rules.

## Recommended Citation

Valente, A., & Billinghurst, M. (2025). CardioCommXR: Training empathy through gamified emotional regulation. In Extended Abstracts of the CHI Conference on Human Factors in Computing Systems. Association for Computing Machinery. https://doi.org/10.1145/3706599.3720319

```bibtex
@inproceedings{valente2025cardiocommxr,
  author = {Valente, Andreia and Billinghurst, Mark},
  title = {CardioCommXR: Training Empathy Through Gamified Emotional Regulation},
  year = {2025},
  booktitle = {Extended Abstracts of the CHI Conference on Human Factors in Computing Systems},
  publisher = {Association for Computing Machinery},
  doi = {10.1145/3706599.3720319},
  url = {https://doi.org/10.1145/3706599.3720319}
}
```