Could Video Games Help Improve Our Mental Health?

A nice discussion of the promise – and challenges – of using video game to promote health.

 

Could Video Games Help Improve our Mental Health?

Can Digital Mental Health Tools Save Psychology?

After decades of research on mental health treatments for conditions ranging from schizophrenia to depression, from anxiety to autism, our track record remains poor. For example, anxiety disorders alone will affect over 90 million people in the lifetime – in the U.S. alone. That’s approaching a third of our population. Yet, only a small fraction of us receive effective, long-lasting treatment. Thus, while we mental health professionals do much good and have some excellent, evidence-based treatments, we also know that, on balance, we are far from doing enough. We are failing.

I believe that there are many reasons for this failure. Psychological disorders are incredibly complex, with diverse and wide-ranging causes and manifestations that vary extremely from person to person. So we have an unbelievably tough problem to solve. But in addition, I believe that there is a two-part “recipe for disaster” that has put up additional barriers to the development of effective treatments:

  1. The stigma of mental illness
  2. Professionals minimize the importance of making treatments acceptable to the individual

The Stigma of Mental Illness

If you type “stigma definition” into Google, here is what comes up:

noun: stigma; plural noun: stigmata; plural noun: stigmas

  1. a mark of disgrace associated with a particular circumstance, quality, or person.

“the stigma of mental disorder”

synonyms: shamedisgracedishonorignominyopprobriumhumiliation, (bad) reputation
antonyms: honorcredit

It is no coincidence that mental illness is the paradigmatic example given by the dictionary. It is one of the most pervasive and persistent of the social stigmas. If we think about other sources of stigma – like the stigma suffered by those diagnosed with HIV/AIDS in the 80’s and 90’s and beyond – the stigma of mental illness is especially striking because mental illness is not contagious. But we fear it as if it were. The mentally ill are NOT more likely to commit violence, and yet, this is what many people fear. Take the media frenzy following the Sandy Hook Elementary School tragedy as an example of this type of assumption.

As long as mental illness remains a sign of disgrace and dishonor, people will avoid seeking professional help because it makes them feel broken – perhaps beyond repair.

Professionals Minimize the Importance of Making Treatments Acceptable to the Individual

There is another issue exacerbating the barrier represented by the stigma of mental illness. This barrier is that we scientists and practitioners, in our education, are socialized away from figuring out how to provide individuals with services they need in a way that they want – something that is obvious to any product- or service-oriented industry. Instead, we are taught to believe that we know best because we use the tools of science to develop the most efficacious treatments. The implicit narrative is: “We are the experts! We have figured out the best “medicine” for you, now take it!” This arrogance often keeps us from seeing that if we develop treatments that are too onerous or if treatments are embedded in a culture of disgrace and stigma, then we have failed to solve the problem. We have failed to meet “consumer needs.”

This is of course an overstatement and many mental health professionals actively fight against these attitudes. But there is a grain of truth here. Anyone on either side of the mental health fence – both professionals and patients – is familiar with this feeling, whether it’s acknowledged or swept under the rug.

How Digital Mental Health Tools Can Disrupt Stigma and Increase Acceptability of Treatmentspersonal zen achievement

In addition to breaking down barriers to effective, affordable, and accessible mental health treatment, I believe that digital – in particular mobile – mental health tools can be harnessed to have profound and lasting disruptive effects on the stigma of mental illness and on our failure to make acceptability of treatments a top priority. Here are five ways I believe digital mental health tools might just save Psychology:

If treatments are administered on a device, they are normalized 

If we are successful in attempts to embed evidence-based treatments into mobile and gamified formats, I believe we can profoundly reduce the experience of and appearance of stigma. Devices have become our filters of information, our gateways to the world, sources of fun, and our hubs of connection. The actions we perform on our devices, by association, feel more “normal,” more connected to every aspect of our lives and to others. This creates a process of validation rather than shaming. By putting mental health treatments on devices, we might just be normalizing these treatments and creating positive emotional contagion – treatments become “good” by association with the devices we love. And if we gamify interventions, these effects could be strengthened even further.

Self-curating our mental health

With digital mental health tools, accessibility is exponentially increased. For example, with mobile mental health apps, you have affordable help “in the palm of your hand.” This ability to curate creates a sense of empowerment. This is “self-help” in a very real sense. With this high level of accessibility and empowerment, many of us will avail ourselves of interventions to reduce negative experiences and states.  In addition, with the proliferation of digital tools to PROMOTE positive outcomes and to reach our fullest potential, we may find on the societal level that this positive focus is just as helpful – if not more so – as the focus on preventing negative outcomes. This attitude of promoting the positive is an excellent antidote to stigma. Who couldn’t benefit from promoting more of what is positive about oneself and how one lives life?

Digital health technology provides powerful platforms for community building

This is readily apparent. With greater community building comes a sense of belonging and a reduction of isolation. But digital community building also provides opportunities for effective advocacy. Of course, many such groups exist, but excellent digital mental health tools with a social media component could accelerate the creation of such systems, leveraging all the power of an individual’s full social network.

The profit motive will fuel innovation and valuing of consumer perspectives

Once interventions enter the digital and mobile technology world, the accompanying consumer focus (read $$$) will force the development of consumer-oriented products. Users have power in this domain. So, if interventions are onerous, boring, or non-intuitive, people will simply not use them. User stats will do the rest – no one will put resources into a product that people won’t use. Better ones WILL be developed.

Digital mental health increases opportunities for gamification

The gamification of mental health is beginning. At this point, we are taking baby steps, since we have an absence of a strong empirical base; in other words, there is precious little research showing that computerized games have a direct, positive influence on mental illness or on the promotion of mental wellness. But we are only in the earliest, exciting stages of this revolution. As I’ve written elsewhere, I don’t think all treatments should be computerized or gamified, nor do I think face-to-face therapy is obsolete – far from it. But I believe that if fun can be combined with powerful treatment technologies, then we can in a single step make profound progress in erasing the stigma of mental illness and creating treatments that people will truly want to use.

Cropping Out the Sadness

An interesting thought piece by Glynnis MacNicol on what might happen when the life you are living online diverges sharply from your real life.  Ms. MacNicol alludes to some of the potential costs, which I imagine are indeed a risk. At the same time, I can’t help but wonder if we could use technology to create a “highlight-reel self” not to hide or be in denial, but to forge a new story of our lives in an attempt to break out of old, stuck ways of feeling about ourselves. It could be an act of “re-visioning” if we do it right.

 

 

Reducing Anxiety with a Smartphone App

Some great coverage on our hot-off-the-presses study on reducing anxiety with a smartphone app. You can find the scientific paper here. And you can learn a little bit more here.

This is a picture of a smartphone.

Mental Health on the Go

My forthcoming research paper reporting on a mobile app that gamifies an emerging treatment for anxiety and stress  – a paper that hopefully will be officially out in the next month or so – is starting to be discussed in the media, including the Huffington Post. Thank you Wray Herbert for such great coverage of the study.

 

 

Focus and Distraction: Two Sides of the Same Coin?

Two recent posts by Stowe Boyd on GigaOm Research cover some really interesting research and ideas on how distraction can help us focus our decision making abilities, and how allowing our minds to wander via internet surfing (as long as it remains under 20% of your total time!) may boost productivity in the office. Thanks, Mr. Boyd.

It’s interesting to think about these ideas in the context of the debate that I am sure everyone has weighed in on at some point: Is the mobile device preoccupation many of us seem to have “good” or “bad” for us? Does it reflect some sort of obsessive multitasking, or the desire to escape our current moment? I think research findings like the ones discussed by Stowe Boyd point to the possibility that by asking this, we’re probably asking the wrong questions. Being on a device frequently is neither innately good nor bad – its effects depend upon when, why, and how much we use the device, and on whether it becomes a barrier to other ways of communicating, thinking, and learning.  This research also suggests that one of the factors that could influence our desire to be on mobile devices is that we all feel the (healthy?) need for distraction. The trick here is to make sure the power of distraction is harnessed for our well-being, and doesn’t just serve the desire to tune out or escape the present moment.

Our Avatars, Ourselves

laura croft

After a little hiatus from blogging, this article about how digital avatars influence our beliefs got me back on the wagon. In particular, it got me thinking about the amazing, good ol’ fashioned power of storytelling – that the stories we tell shape our beliefs about who we are, what we can become, and what is possible or impossible.  This idea is an old one, but its prosaicness lulls us into thinking that the power of stories is an abstraction, not a reality.

This article highlights the very real power of stories – in the form of digital avatars. An avatar, from the Sanskrit word origin, means an incarnation. More commonly, we think of avatars as representations of ourselves in virtual environments. When we represent ourselves digitally we are expressing some aspect of ourselves. That is, we are telling a self-story, real or imagined, that we want to explore. This psychological experience of an embodiment or “incarnation” of self goes a long way in explaining the research findings described in this article.

The research shows that using a “sexy avatar” in a video game influences women – and not for the better.  For example, women who played a game using sexualized avatars – especially those that looked like them – were more accepting of the rape myth (rape is a woman’s fault) and more likely to objectify themselves sexually in an essay. Other studies document the “Proteus effect” in which embodying a character in virtual environments like a game influences behaviors in  in the real world, such as eating patterns, brand preference, and physiological arousal. This effect is strongest when people actively engage with an avatar as compared to passively watching the character. While many of these studies have flaws (e.g., small sample size which makes it hard to generalize that these findings actually apply to people in general) they also have strengths such as strong experimental methods. So, these studies should be given serious consideration.

This article might lead some to demonize video games; but I think that is a mistake. We can bash video games all we want, but this black and white view misses the point that one can tell stories that sexualize women to the exclusion of individuality, intelligence, or competence in all sorts of media: books, movies, cosplay, the news we follow, and the conversations we have. It also misses the point that if avatars are so powerful, they can be used in positive ways.

So, is there something special about video games besides the fact that a single game can make billions of dollars in two weeks? Is actively engaging in a story rather than passively watching it the key to the effects that avatars can have on us? As a society, we need to have this conversation. But it will be crucial for science to weigh in and help interpret whether and how the stories we tell in virtual worlds transform what we do, believe, and become.

My Personal Zen

iPhone Screenshot 1

To follow up on my posts about gamifying mental health, I’m excited to announce that Personal Zen, my science-based (but still fun) stress-reduction game, is ready to share with the world! It’s free in the App Store, so please download it and check it out.

Research from my lab supports its efficacy to prevent and reduce stress and anxiety. Yet, as a game, it’s a beta version and our goal is to get any and all feedback to make it more fun, user-friendly, and effective. So please try it and let me know what you think (either via this blog or the app, which has a “send feedback” button in the menu).

My larger goal is to develop a suite of mobile games for health based on sound scientific principles. As we increasingly curate our own emotional and mental wellness, I think it’s crucial that we have scientifically-supported options to chose among. Because stress reduction is key to wellness, that’s where I’m starting with Personal Zen.

Here’s how it works (as I wrote in the App Store): When we get anxious or stressed, we pay too much attention to the negatives and have less ability to see the positives in life. These habits of attention reduce our ability to cope effectively with stress and can create a vicious cycle of anxiety. Personal Zen helps to short-circuit these habits and frees you up to develop a more flexible and positive focus. You can reduce your stress and anxiety in as little as one sitting, and the more you play, the more you strengthen well-being and vaccinate yourself against the negative effects of stress.

Essentially, the app works by helping people build new habits of paying attention to the world. But building new habits takes some practice, so we recommend spending time with it every week. I love using it on the NYC subways, and it’s truly “snackable” in that using it a few minutes at a time reaps benefits.

If you’re interested in any of the scientific background on the app, I’m happy to share both specific take-home messages and data.

Laying down a social marker

Psyche's Circuitry:

Another thought-provoking piece by Gareth Price about how the pressure to share via social media may be influencing the quality and quantity of our ideas.

Originally posted on DisCoverage:

frustrated_writer_by_photonerd88-d3gobx6BrainJuicer’s Tom Ewing wrote a blog post today about how the way we listen to music could change.

He envisioned people will soon have “attention regimes, in the way they follow dietary regimes and exercise regimes, and will have them in public: a proclamation of one’s listening regime will become a kind of social marker”; adding:

Demonstrating you can pay attention in a world of instant clicks will be a mark of presumed character (and bragging rights) in the same way demonstrating you keep fit in a world of chairs and screens is among white-collar workers now.”

Ephemerality is built into the internet.

If you don’t update your website Google will punish you by pushing you down its search rankings.

Fail to tweet for any extended period and people will unfollow you.

Don’t update your status and friends will accuse you of being a ‘Facebook…

View original 229 more words

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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