The Game Doesn’t Care: Why the Gamification of Mental Health Isn’t Working (Yet)

Games that are not games. There is a serious barrier to the effective gamification of mental health. This barrier is that the games we psychologists and health professionals are coming up with are not fun. In fact, they are totally uncool, border on the condescending, and wouldn’t motivate anyone to play for more than 30 seconds. This is the case even though the bar is set quite low because these “games” address things that people really want, like boosting our intelligence and memory, reducing depression and stress, quitting smoking, … fill in the blank. boring gameI’ve been fascinated with this disconnect between Psychology’s view and real-world acceptability. This disconnect is plaguing other fields as well, such as in the development of “serious games” for education. In this larger context, I’ve been working on the development of an app that takes a scientifically proven approach to reducing stress and anxiety, and embeds the “active ingredient” of this intervention into a game that is fun – fun enough, we hope, for someone to want to play for much more than 30 seconds.

Fun versus health goals. In the midst of  this ongoing development process, I had the pleasure of speaking with Nick Fortugno, co-founder of the game design company Playmatics. In addition to creating really fun games, like Diner Dash, he has created games to promote positive social change and is one of the visionary and forward-thinking advocates for the idea that serious games can and should be fun. So, he has a deep understanding of the barriers facing the gamification of mental health. As we were talking about these barriers, Nick said something that really got me thinking. He said, when we design games for education or health, we have to remember that “the game doesn’t care” about whether we’re making progress towards our goal. This elegant idea highlights the fact that a game isn’t fun because it meets some criterion we have for success – like boosting our ability to remember, reducing symptoms of anxiety, or losing 5 pounds. A game is fun because it creates an aesthetic experience and facilitates game play that we want to come back to again and again. Therefore, I would argue that a “serious” goal embedded in a truly fun game is reached almost as a by-product of the fun.

The need for backward engineering. I think I am accurate in saying that very few people, myself included, who are trying to create serious games for wellness think like this – i.e., like a game designer – about the process of gamification. From what I can tell, game designers think very deeply about the experience they want the game to promote, and then they work through the pragmatics of the game play that will facilitate this experience. This backward engineering from the point of view of the aesthetic/experiential goal to the pragmatics of the game is the opposite of what psychologists do when they think about gamification. Instead, we have parallel streams of development in which (a) we know that our “game” (read scientific protocol) is truly boring, and (b) we have to somehow decrease the snore factor. We think: “Hm, here is my very rigid experimental protocol/computerized intervention. I must overlay this protocol with some cute little animated guys, perhaps with a fun back-story (wizards? aliens?) and then make sure users get points when they conform to the requirements of the protocol.” Sounds thrilling, huh? So fun? Exactly the recipe for the next Dots? Right…. So, we have a lot to learn from game designers, and I believe that crucial to the future of the endeavor of gamifying mental health is partnering with people who know how to create fun and understand the process of game design.

Pocket rituals. What would it be like if we created mental wellness tools, or even interventions for serious mental health problems, that were truly fun and that could become part of our array of habits and strategies for feeling better, reducing symptoms, performing more efficiently, or dealing with stress?  These games, if “snackable” would become our pocket rituals, our chill pills. We could take out our device for 5, 10, or 15 minutes and be empowered to bring about a targeted, appreciable positive impact. The barriers to use should be minimal, the experience intrinsically rewarding – that is, it feels good to play – as well as reinforcing because it helps us meet our health goals. I think many psychologists feel that this approach is not easily conducive to a rigorous scientific approach. But if we fail to find a way to do this – good science and giving people tools they want to use – then the whole endeavor is dead in the water.

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85 Comments

  1. Carol Wuenschell

     /  July 11, 2013

    I applaud the concept, but it sounds like a tall order. I think I would have to see a successful example. It’s a little bit like healthy food that tastes so good you want to eat more of it but at the same time discourages you from overeating. How exactly would that work? Put another way, if a game is that much fun, wouldn’t it become addictive?

    Reply
    • It is a tall order, I agree. But I think it is also eminently possible if we (I mean psychologists like myself) succeed in partnering with people who actually know what they’re doing when it comes to game design. I also think that unless you’re trying to reduce game addiction or addictive tendencies in general, making something incredibly fun and compelling has few downsides.

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  2. TY Psyche ;-)

    Reply
  3. George Rim

     /  July 13, 2013

    How boring could the current games be? Is there too much information being displayed?
    Are the controls clunky? Is it too hard to understand what you have to do? Are the graphics boring? Is there no music or boring sound effects? Too short or too long? Is the interface confusing? Too much story when it isn’t needed? Boring characters? Does it not ‘feel’ like a game? Maybe the game needs better marketing so people know about it? I think there are many factors to consider and feedback is crucial for why people don’t like the games. This is the first time I hear about games like this and I would be interested to know where I can find some of them.

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    • All of the above. However, I don’t want to say there are NO good games out there. Everyone has to judge for himself or herself. But I do believe that there are very few good and effective games for wellness out there.

      Lumosity is one of the most popular companies that sell games for health – theirs focus on building cognitive skills (like focus or memory). The problem with Lumosity and other companies like it is that data suggest playing their games help you get better at playing their games, but doesn’t generalize to the real world very well. I also don’t consider them terribly fun or intrinsically motivating, but perhaps that is just me. As a field we need to do some good groundwork research on what game-like tasks actually work to help people, and then be clever enough to work that active ingredient into a game or interface that people will enjoy and thus be motivated to use.

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  4. The most ubiquitous and hilarious game I’ve noticed in the health care industry is Plug It and Drug It. The rules are very simple and easy to remember because they are backed by the social reinforcement of billions of people…and commercials.

    RULES
    1. Someone else knows more about you and your health than you do.
    2. Thus, you cannot be trusted to make your own decisions about what it best for you.
    3. It is okay to place your safety and happiness in the hands of a total stranger as long as they have a degree in some sort of acknowledged medical field.
    4. A medically degreed individual is automatically right about you, even if they haven’t kept abreast of cutting edge medical research or new scientific findings about your condition.
    5. There is only one way to fix you and that way is the one the AMA and your insurance company approves of. Anything else is unscientific, dangerous, and downright quackery.
    6. If you get worse despite a medical professional’s care, it’s out of their hands or “the will of God.” If you get better on your own, it’s an anomaly or “the will of God.” (Neither incidence will show up in any medical journals, thus protecting and entrenching the established medical belief system.)

    To play the game, all you have to do is feel unwell in some way and then go to someone else to “fix you.” Once you’re in a medical professional’s care, you no longer have control, the game runs itself. To earn points, you must be a “good patient” and simply do whatever anyone tells you to do. “Bad patients” who question decisions being made about them run the risk of being ejected from the game and any pain and suffering they incur before, during, or after that is automatically their fault.

    Sometimes the game is over quickly and sometimes it drags on for decades but eventually, the goal is to get a medical professional to attach a label to you and your condition (Plug It) so that your insurance company will agree to fund your treatment, usually drugs (Drug It). If you do not fit neatly into any particular category, you are essentially screwed and your choices are to start another game all over again with another physician or give up and just be unhappy and in pain for the rest of your life.

    Winning the game means inculcating the label into your very identity, accepting that you are not a well person and never will be, and allowing your body to be chemically altered so that your symptoms seem to disappear but the actual condition–the label–never really does. You will receive positive social reinforcement and the endless sympathy of others as your prize.

    I played this game for a long time with the support of my family, friends, and colleagues–who were also all playing the game. Then, I got fed up and struck out on my own…and healed pretty much everything I had to complain about in very short order (and for free). Much of my family thinks I’m “out there,” I’ve recycled most of my friends, and my colleagues are gone because I left the traditional work force. Let me tell you: feeling fantastic and looking younger than my years was worth it.

    Reply
    • It sounds like it was worth it many times over. As a clinical psychologist by training, although I do research and have never had a clinical practice, I have to say I also am very familiar with this hilarious game. I see the gamification of mental health as a way to start short-circuiting this vicious cycle because it turns the game around so that the tools become increasingly in the hands of the “user.” I’m not saying everyone’s path should be through games or digital media. But I think there are many ways to jump start positive change and the building of new habits of thought and action, and that games and mobile apps could be one of them for some people. Thank you for your comment.

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      • I agree. The best research is the experimentation one does on the self and these games are a new, modern way to do just that.

        Regarding the boredom factor, I wonder how the computer games could be combined with a sort of real life, almost role playing game, sort of Dungeons and Dragons-esque, where people could test out new ideas and coping mechanisms under the guise a “game” with points or an individual-based rewards system. The world is the “game.”

        I think I just heard a second-year philosophy student squeal….

      • Ha! and wouldn’t that be fantastic, if someone could figure out a really fun role-playing game for health. In some ways, virtual reality therapies that are out there are starting to do this – but not in as natural and engaging a way as D&D. The issue is that when the game is not designed with the goal of fun and a certain target “aesthetic” experience in mind, it ends up being cheesy. I’ve heard some game designers talk about basketball as one of the greatest games ever created because it, although it was created by a teacher to help kids stay physically fit during the winter, it was created with the primary goal of making something fun that kids want to do. It wasn’t approached as an “intervention” that was packaged in a game. It was a fun game, pure and simple. And the game of basketball “doesn’t care” whether you’ve lost weight or met a fitness goal. It’s rewarding because it’s fun and feels good.

      • Actually, you just answered your own query: the ultimate goal is feeling good.

        As I’m sure you’ve noticed, people keep on doing what they’re doing until the pain becomes unbearable, then they make changes. Unfortunate, but true. But they only do it this way because they are unaware that feeling better is much simpler than altering their entire life. It rests within the frame of mind of the individual, not their physical actions.

        Teach a person to shift their focus at will–shift their thoughts–and they become literally indestructible.

        A game that slyly incorporates a biofeedback mechanism into the controls and plot, a way for the gamer to monitor their own brain’s frequencies at the same time they are learning to register and recognize their own emotions in relation to their thoughts would put them squarely in the driver’s seat. And it’s not such a long step from the characters on a monitor to the players in one’s own life.

        Intriguing.

      • Are there examples of new communications technology helping mental health treatment? Don’t think so. The phone, fax, email, computers did not help treatment much. Why should this tech be any more useful? The same can be said of “educational” approaches.

        Remember, mental illness, by definition, means people are severely impaired in “helping themselves.”

        These are organic brain malfunctions and not just a matter of “words.” If words alone worked, there would be no need for medical treatment of brain disorders – fun, empowering, game-like, words and experiences not withstanding.

      • I think the mobile revolution is a new beast in terms of what these apps – from games to utilities – provide us with in terms of access, how rewarding the immediacy of these tools are, and how integrated they are in our lives. Many of us clutch our devices like a lifeline, don’t want it out of our sight. For this reason, I think games and tools capitalizing on this can be useful – that is, they could be integrated into our daily lives seamlessly.

        I disagree strongly with your characterization of the mentally ill as people who can’t “help themselves” and chalking mental illness up to a brain malfunctions that “words alone” can’t alleviate. I won’t argue those points here, because I’m sure each of our viewpoints reflect deeply held beliefs and philosophies. But I will say that these games/tools I’m thinking about could be developed for all sorts of people, with all sorts of struggles – which captures all of us. They are just another technology (i.e., an application of scientific knowledge for practical purposes), like psychotropic medication, or talk-based therapy, or deep brain stimulation. The brain is changed by everything we do and everything we experience, with some routes more direct than others and some routes more long-lasting than others. Medical treatments might directly change brain neurochemistry, for example, but “words alone” very likely over time change neural pathways in ways that can last a lifetime. I think it’s worthwhile exploring all potential sources of positive change, especially those that people might actually want to do.

      • Self-harming behavior is the primary symptom of a brain disorder and mental illness, by definition. If individuals could stop self-harming symptoms, they wouldn’t have a mental illness, by definition.

        No out claims are supported by research and data, not beliefs. What about yours?

        Again if words or games or self-talk could stop harmful symptoms – there would be no need for medical treatment of brain disorders – at all. Humanity tried that for 0ver 2K years. It did not work.

        Ok to exploration, but how will the effectiveness of those activities be determined? It must be by measurable change – science. Not positive words, hopes and promises. “Hope is not a strategy.”

        Please provide citations on “change that will last a lifetime.”

      • I’m not sure why you think I’m arguing from a non-scientific view or that I need to be educated about the scientific method. You might not have caught this but I am a scientist. So while I am not writing a blog with scientific citations as I would in my scientific papers, I am basing my views and beliefs on scientific findings, including those from my lab.

        I’m also not sure what kind of citation you’re looking for regarding my statement that changing the functioning of neural pathways could result in longterm behavioral change (i.e., last a lifetime). Given your neurocentric views I would have thought you agreed with this idea.

  5. Games like this only will succeed in their goals when you can bring the gamer on board. I have a sister suffering from depression. I gave her a calendar, not as a device to plan her days – but to note down three things each day that she liked.
    She gave up after some time.
    It was not a video game – or a board game – rather like one of those games you play on car trips with children. But it did not work as it could not trigger her each day to look at positive things. You have to get an immediate reward out of the game. Her reward in the long run would have been to proof herself she has good things in her life on a daily basis. The small things-variety. But there was no immediate reward – that was what stopped her on days the disease controlled her outlook on life.

    Reply
    • You make such an astute point. I think your emphasis on the need for immediate reward – immediate signs that something is getting better in your life – is at the crux of all of this. Thank you for your comment.

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  6. Already some pocket “snacks” of gamefication do exist for motivation to help a person stay on course and to keep alert. It exists in sport and not all sports needs to be a game. Example a bicycle computer that anyone can mount on their handlebar, allows to person to choose whether or not they want the candy/carrot of their mileage or speed or whatever.

    In the area of mental health, rather than use “game”, it’s better to use mental health snacks ..and this exists in yoga where a person can be taught easily to use short yoga meditation techniques to relax in any life situation.

    I don’t like the term “game” for mental health wellness…it suggests more negatively, the person needs to “figure out” something to get better. Good mental health should not be a road to create additional mental health burden or pressure on the person to figure out a winning strategy/tactic. Good mental health is a combination of several things: healthier relationships with people who you care, to community, your daily diet, exercise, hobbies that you love to do, knowing your own roots (know thy self first before you figure out your future/ways to get better), etc.

    Reply
    • That’s an interesting idea – to use the term mental health snacks instead of games. Really, these games are somewhere between a game and a utility. But I think one idea is to actually embed things that work to promote positive well-being into real games. Not to just turn a boring health intervention into a slightly less boring “game.”

      I agree with you wholeheartedly that there are no short cuts to well being or mental health in the long run. However, I do believe – and as a scientist, there are more and more data to back this up – that some of these techniques that could be turned into a game/snack/tool (pick your term) could help set an individual on the road to a whole set of better habits, better choices, richer lives, more connection, etc,…. Sometimes, when we’re emotionally or mentally stuck – whether we have a diagnosed condition or just are experiencing stress or distress – we need something to kick start new habits, recalibrate how we think or interpret or pay attention. This recalibration, even if subtle, could help foster a virtuous rather than vicious cycle. That is my personal goal in working on the development of games for mental health.

      Reply
    • Tug Brice

       /  August 6, 2013

      Jean: actually, by most definitions I’ve seen in the game design industry, all sports ARE games. Not all games are sports, but all sports are games. We can get into quibbling about definitions, but as far as I’ve seen, that seems to be the rule. Perhaps the sports you are thinking about (solo cycling and running, etc.) are better classified as exercise and not sports in their own right.

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  7. I don’t know if the Gamification of Mental Health will ever work?

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  8. My understanding of the current literature, and I am a marketer, not a brain guy, is that behavior is unconsciously driven in 150 ms and that feelings and other higher order concepts and subjective experiences are most likely epiphenomenal. In fact, it seems safer, parsimonious and less culturally determined to assume subjective experience is pretty much uninformative about anything to do with brain physiology and behavior.

    Is changing the subjective (really just verbally reported, using everyday language) experience the goal of mental health or any other medical practice? No. The subjective experiences are symptoms of the problem. Symptom management is fine. Symptom chasing can be harmful.

    Businesses however, by definition, are always just “symptom chasing.” Big difference.

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    • Some behavior is driven by bottom-up emotional judgments (the 150 ms you refer to) but these same behaviors can also be driven by top-down decision-making and control processes. Many roads lead to Rome – if Rome stands for what we actually end up doing or choosing.

      I’m not sure I agree – or completely follow – why subjective experience is uninformative about brain activity or behavior. Patterns of neural response signify the subjective as much as they signify the objective. Neuroscience just doesn’t have as much data on the subjective.

      I think games based on scientific principles and “active ingredients” for treatment can be effective on the subjective and objective level. Data on techniques such as attention bias modification for anxiety and cognitive bias modification for mood problems suggest just this. This is my primary field of interest.

      We also should be careful to distinguish between folks with clinical diagnoses and the “worried well” (which is just about all of us some argue). A gamification approach may not be most appropriate for people in the most distress; or alternatively, it might be exactly what they need to start recalibrating their system to benefit from other treatments, and possibly to feel less stigmatized and disempowered if they struggle with that. That is a question for research and for the individual who experiences these current and future games.

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      • Disagree, subjective experience and words have little that is informative of any physiological process – especially neuronal.

        Refusing to accept medical facts and an insistence on cultural ideas and beliefs about the medical conditions of a brain disorder will just continue false and misleading beliefs.

      • Tug Brice

         /  July 28, 2013

        “Disagree, subjective experience and words have little that is informative of any physiological process – especially neuronal.”

        Not entirely true. A trained observer, that is, one who is aware of the facts of their disorder and is well trained in mindfulness can often yield quite a but of useful information about processes, especially when paired with a physical reading like an fMRI or PET scan.

        While it is true that the brain runs on physiological and physical processes, we do not understand anything about how those those processes relate to actual human experience. We have some rough theories and we can do some neat tricks, but we aren’t even close to anything resembling a complete picture of how the physical brain correlates to the subjective mind. (Sorry Doc, not trying to knock neuropsych. It’s just a young field)

        We’re putting together a puzzle without a picture of what it looks like. We’ve got some pieces that fit together, but no idea where those pieces go. The only way we can get a look at the box is by comparing objective to subjective, and the only way we can do THAT is self report.

        “Refusing to accept medical facts and an insistence on cultural ideas and beliefs about the medical conditions of a brain disorder will just continue false and misleading beliefs.”

        Speaking as both someone studying psychology and suffering from a medical brain disorder, the subjective matters. A lot. It’s like treating pain. In fact, it’s exactly like treating pain. Even if there is nothing wrong with the body, the distress is still real to the patient. Leaving it untreated, even though nothing is physiologically WRONG, is not doing your job as a caregiver. Not all problems with the brain are the result of neurochemical medical disorders. Sometimes they are bad cognitive patterns in people with perfectly healthy (physiologically speaking) brains. It’s not how the brain is doing things, it’s the things that the brain is doing. That is one group games can be built to target.

        They can also be designed to target people who are,. for whatever reason, reluctant to get psychological help directly. Some people see a stigma attached to therapy or psychological treatment. While you are right in that no amount of talk therapy will cure a brain disorder, it might help a reluctant patient get to a point where they can get treatment. That is what I interpreted the blogger as saying.

      • I agree with you 100%, Tug. Nicely put.

  9. This is the future. Whoever connects Garmin running watches to the PS3 trophy will be rich.

    Reply
  10. An important post!
    I think psychologist have a huge responsibilty to use our knowledge not just for our patients that we see everyday, but to contribute to society! Thanks for being innovative and sharing this:)

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  11. What is interesting to one, will be boring to another. Exercise, sunshine and artistic endeavors along with a healthy diet, restful sleep and periods of meditation will always win over any ‘pocket’ game. Medications are the other winning half to the scenario. Mental Illness has no idea what a scorecard is.

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    • I agree with you and at the same time also believe that for some, meditation and changing deeply-held habits are difficult as a first step. What if these games could be used as tools to get people to more effectively use these other tools? What if they could help to recalibrate the way they think or feel even a little so that they could benefit more from doing other healthy things in their lives and create new habits?

      I also disagree that mental illness doesn’t know what a scorecard is. For better or for worse, our brains are sensitive to signs of reward, signs of progress. It feels good to get points or improve from one session to the other – whether that’s yoga or a game. Many people are not highly motivated by the “scorecard” but many are.

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      • I wrote this specifically from my own experience with bi-polar illness. It began after the birth of my first born and an episode of post-part psychosis. I’ve been under the care of psychiatrists for almost thirty years. I experienced two specific doctors that were eager to try training and gaming exercises. In both instances I encountered debilitating setbacks. Both times I chose to excuse myself from their care and actively sought therapists who relied upon conventional methodologies. (The most heinous experience was based in Cognitive therapy exercises consisting of xeroxed pages and countless written exercises. I was told that if I would simply change the way I thought and reacted, I could alter my brain chemistry. I would conclude this as effective as snapping my fingers and ‘snapping’ myself back into a ‘normal’ reality…I still cannot believe there’s a school of thought that values such an absurd assumption.
        Sincerely, I did not intend to offend in my earlier comment. Your dedication to work towards devising new techniques is encouraging. At my age ( 60), I’m set in my ways and find myself within a comfort zone that utilizes talk therapy and medication evaluations/changes dialoged between myself and a physician I’ve trusted for 14 years.

      • I really appreciate your sharing your experiences about this. I don’t think games/exercises and the like are for everyone. It has to fit the individual and the problem or challenge. And it is far, far from simple to “change how you think and react.” That’s exactly the most challenging part of the human condition. But, there is reason to believe that for some people, there are techniques that can help make some of these changes little by little. And sometimes, the individual – particularly the most remarkable people – have to carve out their own path. I didn’t take any offense in your comment and really appreciate you taking the time to read the post and share your thoughts!

      • Tug Brice

         /  August 6, 2013

        Coffeegrounded: Blame the therapist, not the therapy. CBT therapy is not designed to deal with brain chemistry issues, but the things that form around those brain chemistry issues. I mean no disrespect when I say this, but if biological or chemical issues are involved in the problem, they need to be involved in the cure. CBT is a talk therapy designed to deal with the maladaptive and non-reality based thought and behavior patterns that “build up” while living your life with those chemistry issues. I’m also bipolar, and it took years for me to get rid of the 20 years of bad learning that happened once my biology was under control. CBT was a part of how I did that.

        …Granted, written exercises are a HORRIBLE way to implement CBT, but the therapy itself works very well when properly applied to what it is supposed to work on.

  12. It’ll definitely be a hard road to take but at the same time a great channel if you can make it. Gotta agree with you on the part of backwards engineering. But integrating mental health with fun gaming kind of feels like mixing oil and water to me considering how many times i’ve been told that games will rot my brain. But all power to you if you can accomplish it!

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    • Thanks for the comment. It is indeed interesting to be working in a medium that, to many people, is supposed to as you say rot our brains. But I think with the mobile revolution, in which we’re so used to using mobile utilities, these apps could fall somewhere between a game and a utility – and therefore be perceived differently.

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  13. cerrosolo

     /  July 15, 2013

    So the goal is a mobile game, which is very different from an immersive platform game, correct? In that case, I think you should choose a single behavioral change that you want to focus on rather than mental health writ large. Think about the ones you play and the ones that are popular. Angry Birds, Cut the Rope, Words with Friends, etc. What do they have in common? Cheap or free, fast, very easy, very limited goals in the game, very addictive. If you can choose one small change you think will be essential to mental health, focus in on something as simple as possible to help drive that lesson home.

    Jane McGonigal talks about this in relation to Words with Friends. Its key mental health related outcome is it helps you stay connected to people who you otherwise wouldn’t communicate with. It’s not its sole purpose, but it helps to achieve it by making it very easy and purposeful to socialize with your wider social network.

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    • Yes a mobile platform. I agree 100%. Thanks for this helpful comment. It’s interesting because people have a reaction to the idea of creating something “addictive” for the purposes of positive health because addictive connotes illness. But I agree that the intrinsic motivation for the game is a necessary ingredient – call it addictive or call it good game design!

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  14. Hello
    My name is Abigail, I am currently a psychology student, studying at Grand Canyon University. I think that the reason this has been such a tall order, is because by the time you reach the level of psychologist you have some what of a disconnect from your average Joe. You have to have a certain mental capacity to pursue and enjoy the study of psychology. By trying to create a game for mental health, you are in a way trying to bottle sunshine. I really dont know much about creating games, but i do enjoy playing them. I also enjoy making difficult life subjects, relationships, personal development, etc., more understandable to the average Joe. One thing i would suggest, if i may, is to make different gaming platforms. The platforms could be individualized to the type of mental/physical problem. Once the user has chosen a platform, for example stress management, the game could become a quest with visible progress. It could be something as complex as world of war craft, or as simple as candy crush saga. But it boils down to the fact that when people can visibly see the progress they are making as well as have fun, it motivates them to continue playing. The objective should be to give people their daily dose of mental health and wellness without them even realizing it.

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    • This is a fantastic and useful point. In the app I’m developing (soon to be released in beta version on the app store) I’ve been trying to figure out just that – how to show progress in a way that is fun and motivating. I think the daily dose without realizing it idea is a good one. At the same time, some recent research coming out on cognitive bias modification techniques, upon which my specific app is based, suggests that awareness of the target goal may boost efficacy. So, maybe a certain level of awareness and targeted use is best? There are a lot of interesting and exciting open questions from the research standpoint. But the feedback from users is, perhaps, more critical at this juncture. People know what they like. Thanks for your comment.

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  15. Oh yes. The same applies to anything that has a primary goal of teaching something, rather than just being fun. I have a five year old. Any ‘educational’ game is dull. Truly, mind-numbing dull. Definitely not designed by a gamer. But he learns a huge amount from the really FUN games.

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    • This is a great point and I am sure that these games can be/are very effective. But the issue I’ve been struggling with in thinking about these “games” is that that I believe we need to develop tools that people and even kids, who have an unerring sense of what is truly fun, will want to come back to again and again. This increases the possibility of these games having a real and lasting positive effect. In terms of mental health, it also makes these games feel like tools rather than chores or a prescription – another important factor for reducing barriers to getting effective treatments and educational aids out there. I don’t think that all treatments or educational tools should be moved to a mobile, digital platform. Quite the opposite. But I think we can capitalize on available technology to provide people with easily accessible and effective options that are also self-empowering because people will choose them – and how and when to use them.

      update: Oops – just realized that I misread your last sentence – you are saying he learns the most from really fun games. So, we are exactly on the same page :-).

      Reply
      • Uh-huh. I remember an exhibit at Dundee Science Museum I think it was. You and an ‘opponent’ were strapped into head bands that measured brain waves. The calmer you were, the more the … Alpha? Gamma? whatever they were waves there were. And the more of *them* there were, the more the ping pong ball moved towards your opponent. So you had to zone out to win. I LOVED it. And it was apparently VERY successful with alcoholics in teaching them ways to meditate without ‘medicating.’ So, yes, things have got to be fun or they won’t be used. We are basically animals – we need random rewards from a game, over short periods of time. And then we are hooked. That’s why slot machines are so successful…

  16. We love/hate teachnology, but it’s here to stay. If you’re not using it you’re missing opportunities to provide support in a world which demands technology. Mr. Rogers said he embraced children’s TV programming simply because others would who would not provide quality programming. Check out my recent post on technology in education. We have a similar struggle finding an appropriate balance with technology. I suggest embracing it, like Mr. Rogers!

    Reply
  17. Ever played Skyrim or Fallout? They are role-playing games that allow the player complete freedom.

    Want to be a sociopath? You can. Want to be a serial killer? Go for it! Want to be an average blacksmith? You can!

    Think about it for a second. A psych-doctor has a program made that’s on this basis. They allow patients access to the game on the condition the patient only uses the character made by the psychologist, meant to represent the patient, and the patient agrees to try to make decisions based purely on what they would do “in real life”. The game keeps track of their choices-good or bad. After every X amount a time, the player is asked why they made certain decisions, and asked to give a reason either by multiple choice or fill in the blank.

    The psy-doc can go back and look at the choices made, the reasons they made them, and have a more “real” look at the way the person thinks.

    Taken further, good decisions are rewarded, bad decisions might be punished somehow, loss of experience or whatever.

    The only trick that I don’t see how to make work is getting people to transfer the “good” behaviors learned in-game into real life choices.

    What do I know about it? I play games. I am bipolar with psychotic features and have memory issues which I blame on Lithium. You know what has helped me with the memory issues? The mini-games in Mass Effect 2. Taken further-what happens when I play as a bipolar on Fallout or Skyrim? I tend to make it so that I have lots of enemies, or I’m poor, or unable to do certain missions because of my choices.

    Give it a think. Please contact me if you want any other thoughts. :)

    Reply
    • Oh, and one more thing-with games of this nature, if you could gain the interest of some of the better “modders” out there, you could probably accomplish this for free-simply by giving them credit, or possibly at a very low cost at least. Check out http://forums.nexusmods.com/index.php?s=e3d8ed4b96fe0ca261d85bea04ad2b36&c=409,411,419,415,569 and similar.

      Reply
    • Your thoughts on this are really fascinating. I think that you could definitely be on to something. In some ways, just making the “right” choices over and over could be enough to start retraining your brain to make helpful choices in real life. Research on cognitiive bias modification techniques suggest exactly that. And if we make these choices in an engaging, realistic, viscerally rooted environment, perhaps this is the most powerful way to do this.

      Thanks for all these ideas!

      Reply
  18. Interesting read. I will bounce around your blog and see what else you are writing about – I like it though! Thanks for sharing.

    Reply
  19. Your arguments ended up as occupational therapy games 50 years ago, overloaded with them on fb. Work from specific behavioural problems backwards, There is no one size fits all solution. Meanwhile, I’m heading for Alzheimers’ and a future of finding things to pass the time, preferably without spending energy or money. I miss the ability to link the sim city spin offs (of all kinds) to the form fonts programs and get rid of the things that annoy me, make my own improvements etc etc. but those things are too fiddly for phones or tablets. You will also have to lose psychiatric technical terminology and any other misunderstandable dialects, preferably from the planning stage right through.

    Also, incorporate the ability to change ones mind into the game.

    Say you decided on a trail, like Candy crush but with different games, say including the Sudoko game I play as one stage, then I am going to need in the future a 2 out of 3 clicks or taps system to get the right number in the right square, (it’s eye hand coordination.) and also, that particular game would be better if all games finished without a hint or wrong number were eliminated from the choice of boards options.

    Reply
  20. When a game ceases being (or never actually becomes) fun, if it doesn’t feel like you’re actually “playing” something, I think it ceases to be a game and becomes a chore. It’s totally possible to have “educational” games that are fun and that people actually want to play, but I think that when the goal of the game developers is to make an educational tool first and a game second, this is very difficult to achieve.

    I still remember, as a kid, playing a science game called “Cosmic Science” or something like that, where you played an alien racing other aliens around a track, and the way you advanced was by solving science problems. It was super goofy and fun, and when I got to high school chemistry and physics classes, I actually still remembered things I had learned in that game years before. It didn’t try to teach me everything about science, just bits and pieces, but it stuck because it was FUN and I couldn’t get enough of it.

    Reply
    • Thanks for your comment! We need more Cosmic Science! It is difficult to achieve but your memory of that game is proof enough that it can work – if only because it was motivating for you and increased your enjoyment of learning.

      Reply
  21. there is no doubt about this all …

    Reply
  22. Tug Brice

     /  July 18, 2013

    This was passed to me from a friend of mine, because she knows I’m working on something very similar. I am a LONG time gamer of all types (Video/computer, pen and paper/tabletop, card/board, live action, etc.) I also have had the pleasure of knowing a few professional game designers, I have quite a bit of experience in computing (and a little programming) and I have personal experience (extremely personal) with mental illness.

    I am working on creating a game that acts as an intervention to depression, using theories of positive psychology (among other things). My target audience are the severely depressed that are an an inpatient hospital environment I intentionally targeted the most resistant audience possible. The key is to make the treatment inherent to the game-play itself. The players cannot think that they are playing any kind of treatment game.

    First, you make a game people want to play. Second, you design the game so that the actions that the player takes inherently creates the desired effect within the patient. I have a good many ideas about how to go about doing that. Positive psychology has a lot of really great theories that work well with gamification. I have a year left in undergrad and I’m planning on making this my PhD dissertation, so I’m still on the ground floor. However I have plan and a good idea of how to get where I’m going. If you want to discuss more, I’d be happy to go into details privately.

    Thanks,
    -Tug Brice

    Reply
  23. Reblogged this on Design and Emotion and commented:
    I’ve run into a few “health” games over the past couple years and feel similarly, that they experience is layered on top of function rather than integrated. The gamification techniques typically employed in the business realm often suffer from the same thing.

    Reply
  24. Reblogged this on Hey, Shall We Talk? and commented:
    Need a chill pill? ‘There’s anApp For That’. Could a smartphone app help with positive mental health? http://www.psyches circuitry.wordpress.com believes so! Check out this article!

    Reply
  25. I will share this interesting piece. My thoughts exactly. My background lies in the games industry and ICT. I was CEO of an international casual game development company for over ten years. Now I have a huge interest in Gamification. I see two approaches:

    -scientific approach
    -game designer approach

    Scientists want an explanation for everything. This costs time. A lot of time. If they find the explanation, something new has come up already. I want the explanation as well. If I find it during the building process, great, if not I will move on. Moving on means: build, test, adjust, test, and so on. The product evolves along the way. That’s the secret, evolve why you are building the game!

    Game designers want result, they want it fast. A result is in their eyes people liking and playing the game. It’s as simple as that. To make games fun is one of the toughest things to do. For a game to be succesful in any field, fun just can’t be a by product. It’s essential! So glad that I found this post, that preaches the same.

    In my opinion we need to collaborate better, much better. We need to accept the field of expertise that the other party brings to the table. Don’t ever step into shoes that don’t fit. Listen and learn from eachother. Then and only then, we can make a step forward.

    My mother language isn’t English, hope I didn’t make to many mistakes writing this down.

    Reply
    • I belated thank you for this very thoughtful comment. I checked out your blog and website – really interesting stuff!

      As a scientist, I feel challenged by the disconnect between the build, test, adjust process of the game design world and the scientific approach. One thought I’ve had along the way is that if we can do a good job of nailing down the science of the basic mechanism of positive change the game is utilizing – and that means basic parameters like how information is displayed, what sort of user responses or interfaces create the right interaction, even the size of different components (stimuli) in the game – then we can engage in a true game design “build, test, rethink, build again” process on top of that. So, as long as you have the mechanism right, and you know the boundary conditions of how you need to embed the mechanism in the game, you can create any game you want around that. That’s what I’m shooting for.

      I agree with you 100% about the need to collaborate better. I’m very excited to start pursuing some of those collaborations!

      Your English is perfect and your points excellent! Thanks for commenting! I’d love to know what you think of our stress reduction app (beta!) once we release it (for free) in the App Store (once the store is back up and running!). We’re hoping to get a lot of user feedback so we can take it to the next level. As it stands now, my lab research suggests it works to reduce stress and feelings of anxiety.

      Reply
  26. Reblogged this on Simone Borsci.

    Reply
  27. The word “game” by definition includes descriptors like “fun” and “entertainment.” If you take the aforementioned adjectives away from the directions given to any individual, you’re giving the person a task – not a game to play.

    I couldn’t agree more with your statement about how reaching a “serious” goal can be a byproduct of the fun at hand when playing a game. Because, essentially, I would say all games have that quality. Whether you need to save a princess or hijack a plane, you have a task that needs to be completed in order for you to get to the other castle or gain access to an enemy’s database.

    Yes, I called it a task; however, when gaming, you may get the opportunity to meet interesting characters in the process; possibly explore vast landscapes; and you might get the chance to experience the thrill of having to make split second decisions to beat your opponent – all shrouded in so many emotionally driven responses and unique challenges that there is no possible way NOT to have fun!

    Lastly, kudos for actually talking to a someone who is a professional in the game design field. Hopefully his input will shred infinite amounts of light to the app you’re developing. I believe that was a exceptionally wise move on your behalf. Again, kudos!

    Reply
    • The potential for deep levels of discovery and exploration in games is so interesting and not something that gamified mental health has really done well yet. That is something I’m going to give a lot more thought to. Thanks!

      Reply
  28. I’ll add my name to the list of those agreeing serious video games for health (G4H) have yet to fully embrace the role of fun. We recently published a review article with some thoughts about G4H and fun based on 15 years of research and $25 million in NIH grant funded G4H behavioral intervention development, mostly targeting childhood obesity prevention (Buday R, Baranowski T, Thompson D. Fun and Games and Boredom. Games for Health Journal. August 2012, 1(4): 257-261. doi:10.1089/g4h.2012.0026). We and others in the field have made remarkable progress over a relatively short period of time in what is essentially a new health modality. Nevertheless, it’s clear much more research is needed.

    Reply
    • Thanks for bringing my attention to the review article! I am a little out of the loop with the field of obesity prevention, but I am aware that a lot of progress has been made in the world of G4H here. You are doing amazing work. The problem of research is one of timescale. Research takes a LOT Of time as you know, but games by their nature need to be designed with a user in mind who might tire of a game relatively quickly. So, a suite of games needs to be available so switching or rotating through is possible. I think in the health field this is a notion we (at least I) forget about. I’d like to see one or two mechanisms targeted in a suite of games (although this is my neuroscience training here – it’s easier said than done), and research track patterns of use across multiple games as well as efficacy. This might allow for a more naturalistic view of how games are actually used.

      Reply
  29. Thanks for posting this, keep posting.

    http://www.india.seawindsolution.com

    Reply
  30. Reblogged this on Assisted Living and commented:
    Awesome post!

    Reply
  31. Lovely topic to read about, please keep writing!

    Reply
  32. Reblogged this on The Kesgar and commented:
    I proposed the extension of this article: “gamification of learning” isn’t working yet, too. There are some smart attempts to games with some learning like math and physics, but the games are mostly “small” compared to hits like Angry Birds or Temple Run.

    Reply
    • I agree 100%. It seems like the field of education is where we started getting a real idea about how challenging gamification can be. Thanks for the reblog and for reading!

      Reply
  1. The Game Doesn’t Care: Why the Gamification of Mental Health Isn’t Working (Yet) | Free psychology
  2. The Game Doesn’t Care: Why the Gamification of Mental Health Isn’t Working (Yet) | Serendipity Planned
  3. My Personal Zen | Psyche's Circuitry

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