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To rank or to classify? Annotating stress for reliable PTSD profiling

In this paper we profile the stress responses of patients diagnosed with post-traumatic stress disorder (PTSD) to individual events in the game-based PTSD stress inoculation and exposure virtual environment StartleMart. Thirteen veterans suffering from PTSD play the game while we record their skin conductance. Game logs are used to identify individual events, and continuous decomposition analysis is applied to the skin conductance signals to derive event-related stress responses. The extracted skin conductance features from this analysis are used to profile each individual player in terms of stress response. We observe a large degree of variation across the 13 veterans which further validates the idiosyncratic nature of PTSD physiological manifestations. Further to game data and skin conductance signals we ask PTSD patients to indicate the most stressful event experienced (class-based annotation) and also compare the stress level of all events in a pairwise preference manner (rank-based annotation). We compare the two annotation stress schemes by correlating the self-reports to individual event-based stress manifestations. The self-reports collected through class-based annotation exhibit no correlation to physiological responses, whereas, the pairwise preferences yield significant correlations to all skin conductance features extracted via continuous decomposition analysis. The core findings of the paper suggest that reporting of stress preferences across events yields more reliable data that capture aspects of the stress experienced and that features extracted from skin conductance via continuous decomposition analysis offer appropriate predictors of stress manifestation across PTSD patients.