Can we Gamify Therapy?

This week, students return to the school in Florida where recently, 17 people were killed by a former fellow high school student, Nikolas Cruz.

Nikolas had an extremely difficult childhood and had a history of explosive anger, depression, and violence towards animals. Could games have helped Nikolas? How can games play a role in managing depression and improving mental health? I began doing some research into how psychologists and therapists are currently using games.

Games are being used in many ways to tackle many different areas of therapy, from speech therapy, to managing Parkinson’s [1] , treat Bulimia [2], and reduce anxiety [4]. Both games developed specifically for therapy, and games meant originally for entertainment, are used to great effect in therapy — but I had a difficult time finding research conducted on the efficacy of games (developed originally for entertainment purposes) used to treat teenagers with depression, suicidal thoughts and violent predilections.

A recent mainstream game (not AAA, but close) helped in shining a spotlight on mental illness.

Hellblade: Senua’s Sacrifice is a critically acclaimed game where the emotional state of the protagonist takes center stage. Senua suffers from PTSD, depression and psychosis, and the game deftly and sensitively portrays the challenges that people with mental illness face. This is a giant step for mainstream games.

Hellblade takes the player through Senua’s life after a Viking invasion leaves her world in ruins.

Games can play a major role in young people’s lives. Teenagers spend significant amounts of time online and playing games. In the near future, can games recognize depression in players, based on their activity?

Can games act as a therapist, allowing for the player to communicate openly about their feelings, without being judged, or feeling like the data will be sent somewhere else?

If we envision a future where players have their own avatar — their own virtual companion who they would talk to like a close companion (as Jesse Schell would argue), can this virtual avatar take on this role of not just confidante, but counselor?

Virtual reality is also a very promising avenue for game-based therapy (including exposure therapy).

Game designers should design games with this lens in mind. Games meant for therapeutic purposes shouldn’t be in their own bucket — mainstream games dedicated to ‘fun’ should also look to improving player’s mental health, in overt or covert ways.

References:

1. Rocha, R. S. B., De Oliveira Rocha, L. S., Pena, E. S. M., Caldas, L. C. P. and Moreno, M. A. (2018), Analysis of autonomic modulation of heart rate in patients with Parkinson’s disease and elderly individuals submitted to game therapy training. Geriatr Gerontol Int, 18: 20–25. doi:10.1111/ggi.13130
2. Fagundo, A. B., Santamaría, J. J., Forcano, L., Giner-Bartolomé, C., Jiménez-Murcia, S., Sánchez, I., Granero, R., Ben-Moussa, M., Magnenat-Thalmann, N., Konstantas, D., Lam, T., Lucas, M., Nielsen, J., Bults, R. G. A., Tarrega, S., Menchón, J. M., de la Torre, R., Cardi, V., Treasure, J. and Fernández-Aranda, F. (2013), Video Game Therapy for Emotional Regulation and Impulsivity Control in a Series of Treated Cases with Bulimia Nervosa. Eur. Eat. Disorders Rev., 21: 493–499. doi:10.1002/erv.2259
3. Horne-Moyer, H.L., Moyer, B.H., Messer, D.C. et al., The Use of Electronic Games in Therapy: a Review with Clinical Implications. Curr Psychiatry Rep (2014) 16: 520. https://doi.org/10.1007/s11920-014-0520-6
4. Malbos, E., Rapee, R. M., & Kavakli, M. (2013). Creation of Interactive Virtual Environments for Exposure Therapy Through Game-Level Editors: Comparison and Tests on Presence and Anxiety. International Journal Of Human-Computer Interaction, 29(12), 827–837. doi:10.1080/10447318.2013.796438