Full paper · 2022

Keep Calm and Aim for the Head: Biofeedback-Controlled Dynamic Difficulty Adjustment in a Horror Game

Moschovitis, P., & Denisova, A.

JournalIEEE Transactions on Games, 2022

Teaser figure: Keep Calm and Aim for the Head. A screenshot of the horror game “Caroline”, a dark forest graveyard, with heart-rate input and live-adjusted difficulty. When stressed the game gets harder, when calm it gets easier. With 42 players, intrinsic motivation was higher with heart-rate adjustment (120.6 vs 102.6, p = .002); of four challenge types only decision-making changed.
Open full-size image

In short

We built “Caroline”, a horror game that reads the player's heart rate and adjusts its difficulty in real time: stressed players get a harder game and relaxed players an easier one. We compared it with a version of the game without the adjustment.

In games

Related ideas in commercial games

  • Our example

    Nevermind

    2015

    A horror game that uses biofeedback to make the game harder when players get stressed.

  • Our example

    Left 4 Dead

    2008

    Its “AI Director” adjusts the pacing and number of enemies based on how players are doing.

How the study worked

Game
“Caroline”, a horror game made for the study: the player collects ten artifacts while avoiding enemies that cannot be fended off or defeated
Players
42 (21 played with biofeedback-controlled DDA, 21 without)
What players were told
Players with adaptive difficulty were instructed that their heart rate controls certain aspects of the game, making the game more challenging if the heart rate increases
Play time
Around 20 minutes on average, based on playtesting
Measures
Intrinsic motivation (IMI) and perceived challenge (CORGIS)

How the biofeedback loop works

The game uses the player’s heart rate to adjust three parameters in total.

Player’s heart rate Ear-clip sensor and Arduino, read in real time The game adjusts Caroline’s max speed and max acceleration; player’s noise radius Stressed: harder Caroline moves faster and the player can be heard further away Calm: easier Caroline slows down and the player is quieter
Example parameter values at two heart rates
ParameterFormulaAt 75 bpmAt 120 bpm
Caroline’s max speedHeartRate × 2.5187.5 units/s300 units/s
Caroline’s max accelerationHeartRate × 2.5187.5 units/s²300 units/s²
Player’s noise radiusHeartRate ÷ 60 × 22502812.5 units (10 m)4500 units (16 m)

Values from the paper, in Unreal Engine units. The loop diagram is a schematic of the rule the paper describes: “if the player is too stressed, the difficulty increases, and the opposite happens if the player is relaxed.”

Key findings

  • Players of the biofeedback version reported higher intrinsic motivation.
  • Of the four types of challenge measured, only decision-making challenge was affected by the adjustment.
  • Nominated for the IEEE Transactions on Games Outstanding Paper Award.

From the talk

My CoG 2025 talk on this paper

  • This encourages self-regulation and adds a mental layer to gameplay: not just ‘run and hide,’ but ‘breathe and survive.’

    On the heart-rate mechanic

  • The reduced sense of decision-making burden suggests players may attribute some control to the system—almost like it’s co-playing with them.

    On lower decision-making challenge with DDA

Read and cite

APA citation

Moschovitis, P., & Denisova, A. (2022). Keep Calm and Aim for the Head: Biofeedback-Controlled Dynamic Difficulty Adjustment in a Horror Game. IEEE Transactions on Games, 15(3), 368-377.

More on this topic