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.

 

 

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.

Connectedness and the Call of Anxiety

A study suggests that more frequent mobile phone use might make you more anxious. This could reflect the burden of constant social connectedness, or even nomophobia –  the “no-mobile-phone phobia” of losing connection. But we shouldn’t forget that this is a clear chicken and the egg question….. Are devices making us anxious, or do people who are already anxious just use devices more frequently?

 

 

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.

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 Happiest iPhone on the Block: Why Managing Your Digital Life is Like Good Parenting

When I started blogging a little over a year ago, I was a true social media skeptic. I drew more inspiration from thinkers like Sherry Turkle than Anil Dash. But my experiences with social media have turned this on its head. I’m still a skeptic in the sense that, as a scientist, I believe we need to know a lot more about how social media affect our lives for better and for worse. But I don’t feel the kind of concern I used to feel. Perhaps I’ve been tempted by the siren song of technology, lulled by a false sense of security engendered by the all-consuming digital embrace… but I don’t think so. I actually feel more in control and less overwhelmed by social media and other digital forms of communication than ever before. I feel they are tools, which I can selectively choose among and harness. I believe that a sense of well-being and balance in social media use is possible if we use some simple practices. The best metaphor I can think of for these practices is that they are the types of things that an effective and sensitive parent does. Here are the top five “parenting strategies” I’ve used to manage my social media burden:

naughty child

  1. Establish rules and set limits. Children thrive when there are consistent limits and structure. In the same way, our technology use needs rules and limits. If I don’t set limits on when and how I use social media, I’m more likely to get sucked into the black hole of keeping up with every tweet/text/email/post/newsfeed. I’m more easily distracted by social media, less present with others, and more likely to waste time and be less efficient because of it. Like all good parents, I try to create structure that is firm but fair. Harsh discipline might work in the short term, but the child usually rebels. So, I try not to be unreasonable or unrealistic about the rules (e.g., “I can only check email once a day, and for no more than 10 minutes” doesn’t work). I’ve tried to find a set of guidelines that work with my life and make me happy.
  2. Monitor communication technology use. It’s 10 o’clock. Do you know how much social media you’ve used today? This is really about being mindful about how we’re using our technology. I prioritize my time – I only have so much time and attention in a day, and so I try to spend my mental and social capital wisely. I keep track and schedule times that I will use these tools, and know the times that they need to be put to bed.
  3. Reinforce good behavior. It’s not only the amount of time we use social media or communication technology. It’s about how we use it and what it brings to our lives. I try to select digital communities that brings something positive to my life and that cultivates a positive peer network.
  4. Selectively ignore. In parenting, the idea here is that if a child is showing a troublesome behavior, as long as it’s not destructive, it can be “extinguished” by just ignoring it. If there is no reaction, and no reward, there ceases to be a reason for the child to act that way. And then the child stops being a nuisance. In the similar vein, when I start to feel that my communication technology use is becoming burdensome and bossy, when I feel the pressure to respond to every message or push notification is too much, I start ignoring it. Most of us like the feeling of being connected, and hope that the dings and rings on our devices will bring something good into our lives or that stressful things can be averted and dealt with quickly. So, we start to check obsessively and end up spending dinner time with our family on a device, or walking into traffic with our eyes glued to our iPhone. When I begin to move in this direction, I reverse course and start to consciously and selectively ignore my devices in order to break the cycle.
  5. Adapt technology use to fit my life. One key to being a good parent, I believe, is structuring your life so that it can accommodate children in support of their well-being and happiness. Some (in my opinion) not-so-great parents do the opposite, they expect not to change their lives at all and that children should just fit in. In contrast to my list of strategies thus far, when it comes to mobile technology and social media I try to follow the inspiration of the questionable parent: I fit technology into my life so that I remain able to do what I want and need to do without being sidetracked. If my life is becoming  more stressful and less organized because of social media burden, then I’m probably doing the opposite.

So remember, when that naughty stream of Facebook status updates are just too much to handle, you’re a week behind on your twitter feed, the pesky email inbox just won’t empty out, and those 10 texts – that are going to go unanswered for another few days – won’t stop bugging you, ask yourself: what would mom do?

The Medium is the Message: On Mindfulness and Digital Mirrors

I recently had the pleasure of doing a talk-back with Congressman Tim Ryan on the role of mindfulness – focusing your awareness on the present moment – in education, as part of the Rubin Museum’s Brainwave Festival in NYC. The film, called “Changing Minds at Concord High School,” followed an entire school as they took part in a mindfulness training program. This school is unique in that it is a transfer school, a last stop for many kids with a history of school failure and discipline problems. The twist here is that the students both filmed the experience and conducted a study – of their classmates! – comparing the effects of mindfulness training with that of a placebo. We also included a science curriculum on the neuroscience of mindfulness – how it can change our brains for the better. I was the lead scientist on this project, so the kids were my “research assistants.” The project was spearheaded and directed by the amazing Susan Finley and filmed by the equally inspiring Peter Barton (with the help of the students). Our outstanding scientific advisors were David Vago and Robert Roeser. There is a lot that was amazing about this project, these kids, and this film. I want to focus on just one aspect, which hinges on the phrase “The medium is the message.”

lake yoga

The medium is the message. This phrase was coined by Marshall McLuhan who put forward the idea that the “form of a medium embeds itself in the message.” That is, the medium in which we experience something influences how we perceive the take-home message. Using movies as an example, he argued that the way in which this medium presents time has transformed our view of time from something that is linear and sequential into something that reflects patterns of connection across people and places. I am obviously no film theorist, but I apply this notion to the idea that different media provide us with an array of tools that can help us create a narrative of ourselves and the world that is unique to that medium.

Film and self-identity. In the case of our film “Changing Minds at Concord High School,” I believe that one way that the medium was the message for our students was that film is able to portray individual identities as being truly flexible and changeable. I think that the teens at Concord High, many of whom have experienced tremendous challenges, stress, and obstacles in life, didn’t believe as a group that change for them was really possible. But what our program strove to do, using converging media – film, scientific readings, mind/body experiences of mindfulness – was to convince these young adults that they really could change their brains, change counterproductive habits of thinking, and find the tools to focus more and let negative feelings go. As we move on to Phase 2 of the project by refining and developing our program, we are asking the fundamental question: How can we best use these tools to teach teens to view themselves and the world differently, creating a narrative in which personal change is possible?

Our digital mirrors. I think these issues are especially important to consider now, in this era of social media and reality television in which we crave to see ourselves reflected back to ourselves. We can criticize this, and analyze this, but the fact of it borders on the irrefutable. We know that it’s easier than ever before to document our lives via pictures and videos on our mobile devices, and share them with our digital networks. And we love to do so. Social media, through which we share our images of ourselves and our lives, are an immeasurably huge and complex array of mirrors into which we can gaze at ourselves. There may be costs and benefits to this, but it simply is. The power of this, however, is that we now have a new set of tools to curate our beliefs about who we are – hopefully for the better. And perhaps we believe this evidence of who we are more strongly because it is concrete, it is documented, it receives “likes” and is seen by others and thus is real. I’m liked therefore I am.

This digital infrastructure also provides a profound opportunity for those trying to support growth and positive change in youth. If we help youth document the possibility of change – like we did in “Changing Minds at Concord High School”- they may start to believe it applies to their own lives. This is particularly important for those of us who aren’t used to feeling that the world is full of possibilities. In this way, social networking may be a medium that gives the message that change is possible and that our limitations are as fluid as the flow of information.

Appily Ever After?

I was very interested to read this funny take  on psychology smartphone apps in the New York Times (by Judith Newman) – or more accurately, how NOT to build a psychology app. I just blogged about this general topic in my last post, and what struck me most about this article was the notion of time.

Image

Art by Emily Flake (published in the New York Times 4/5/2013)

This article seems to suggest that mental health apps should quickly and effortlessly facilitate our relationships, efficiency, and well-being. As Newman writes in the article:  “All of these apps require thought. Lots and lots of thought. Thinking is what I do all day long. I needed something that would turn my mind off, not on.”

Great point. Maybe we don’t want the app to be our shrink – because when we go to a therapist, we tend to have a set of expectations that involve spending a good deal of time and energy (unless we’re just looking for a medication fix). Apps, by their nature, are fast, easy, and mobile. So, most of us expect that a psychology app will be a shortcut to mental health. We shouldn’t have to spend time learning how to use the app or being on it too much – at least not so much that it’s taking away from “having a life.”

This view tells me that there is a potentially deep disconnect here: between what many of us in the mental health field think of as the promise of mobile health technologies and what everyone else thinks. Many psychologists see a future in which apps and computerized therapeutic tools break down barriers to treatment, which can be too expensive and intensive for many. For example, for the most common class of psychiatric disorder, the anxiety disorders, only about 20% of anxious people receive treatment! So, the psychologists are thinking, jeez, mobile technologies offer so many amazing possibilities for integrating mental health treatment into the daily life of people who are suffering.  Let’s create an app for that!

But we need to think through our approach carefully. If we just put the same old (frankly boring) computerized interventions on smartphones, will that actually help us reach more people? How many will choose to use these tools? Maybe some, but perhaps not many. Perhaps what most of us want from an app is the digital and interactive version of the self-help book – you can take it or leave it,  pick it up and put it down after a few minutes and still get something from it, and which doesn’t feel like just another source of techno-burden.

So, what is the take-home message for the mental health professionals? Make it fun, make it fast, and make it effective or get back to work on making traditional treatments better.

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