Could gaming be the answer to the world’s mental health problem?
A therapist and a science writer look at the issues with wellness apps and argue for a radical new approach.
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You may have heard that one in five people will suffer from mental illness in their lifetime. While this stat is already uncomfortable, the fact that it’s a gross underestimation makes it all the worse.
Sadly, data from a two-decade-long study concluded in 2017 found that a whopping 82.7% of subjects met the clinical criteria for a mental health problem at least once during the course of the study.
Other research has shown that the absence of mental illness is not the same as positive mental health. There’s a spectrum of wellbeing — from flourishing to languishing — and most of us, it turns out, fall more towards the languishing side.
In light of this, you’d think that use of therapy, wellness apps, and other mental health maintenance practices would be as common as gym memberships. But of course that’s not the case. Widespread stigma and misunderstanding mean that we tend to wait until we’re at breaking point before seeking psychological help. That is, if we ever seek help at all.
Mental health tech is failing
There are more than 10,000 mental health apps available online, meaning it’s never been easier to get hold of mental wellness resources. Surely tech is the answer to affordable, accessible help. But we need to make some changes first.
The digital world thrives on engagement. Tech companies plough billions into making products sticky and addictive. But most wellness apps are remarkably *un*engaging.
Research has found significant dropout rates in digital Cognitive Behavioural Therapy (cCBT), which is by far the most common form of computerised therapy available. One large UK trial concluded that people simply don’t stick around long enough to get meaningful benefits from these apps.
Why is this? It’s because we treat our mental health differently to other types of health, such as physical or financial. Our thoughts and feelings seem more personal, precious and complex than these other, easily measurable commodities. As a result, tech strategies that work in other domains can backfire when it comes to wellness and self-care.
Gamification hits a bum note
Take gamification, for example. Most gamified experiences rely on design features such as points, badges and achievements. These work well for fitness apps, encouraging people to strive, compete and stick with their new habits. But when it comes to mental health, don’t these things feel a little out of place?
Indeed, a 2013 study revealed that participants found “points, rewards and achievements to be a poor fit in the context of mental wellness and mindfulness.”
It seems that you simply can’t treat deeply personal issues as something to “gamify” without trivialising them.
Artificial Intelligence isn’t ready
Similarly, AI chatbots have promised engaging therapy delivery. But again, with limited success so far.
Despite its enormous potential, current AI can only mimic human conversation on a fairly superficial level. It’s good enough if you want weather updates or an imaginary conversation with Einstein. Not so much if you are pouring your heart out and need to be heard.
As a result, conversations with the many cute AI critters out there can feel shallow and generic. This may sound innocuous, but in a sensitive context like mental health, a small mishap can do real damage.
The future of digital mental health
So, what’s the way forward for mental health tech? How can we design solutions that offer effective help and foster meaningful engagement simultaneously?
My co-founder Ellie — a science writer, published in The Guardian, Aeon and more— and I have been focusing on this question for over three years now.
The conclusion we’ve reached will perhaps surprise some people:
We believe that the niche and somewhat geeky world of narrative gaming offers the answer to online mental health experiences that actually work.
Game, not gamification
Video games are a chief source of entertainment for over 3 billion people on the planet, so we know they can teach us a thing or two about tapping into intrinsic motivation.
But, contrary to popular opinion, our love of make-believe worlds and fantasy battles is about more than mere escapism. For hundreds and thousands of years, play and fiction combined have been how human beings have learned, communicated, connected with each other, and made sense of ourselves.
The world of gaming, in other words, with its inherent focus on story and immersion could be a great fit for mental wellness. Of course, we’re not the first people to stumble upon this idea. Yet, the kind of gamification we tend to see in wellness apps neglects the deeper, richer parts of play that make video games so sticky:
Story, world-building, curious exploration, aesthetics, and a sense of connectedness…
It’s these things that we believe are the missing ingredients.
So, we’re betting on narrative gaming as the future of digital mental health. Here are our top three reasons why.
1. Games create an optimal learning environment
Any skill requires practice and this includes the skills involved in achieving mental wellness. People are not born equipped with the powers of mindfulness, self-awareness, emotional literacy and intelligence… These things need to be learned.
Because games are so engaging, they naturally enable repetition of desired behaviours without the need to push or guilt yourself into doing what you know is good for you.
Furthermore, since failing in a game is not a big deal — in fact, it’s encouraged and necessary to progress — it’s easier, in this context, to both bounce back from setbacks in the learning process, and to adopt a growth mindset that can be beneficial for real-life problems, too.
2. Play simulates reality
In his book The Storytelling Animal, Jonathan Gottschall argues that during development, play is how we practise to prepare ourselves for the demands of life.
“The most common view of play across species is that it helps youngsters rehearse for adult life. From this perspective, children at play are training their bodies and brains for the challenges of adulthood — they are building social and emotional intelligence.”
But of course, it’s not only children who need to develop such skills. As adults, play can help us fine-tune the more mature abilities of effective self-reflection, emotional expression, quality communication, psychological tools such as self-distancing, and so on.
3. Story brings meaning to our lives
In psychology, there’s a concept called “narrative identity” — it’s the idea that we see our lives as evolving stories. An empowering narrative allows us to connect our past, present and future in a meaningful, purposeful way, generating a sense of agency that’s otherwise hard to come by.
The challenge for many people who struggle with their mental health, then, often comes down to this:
How do I rewrite my story if it isn’t serving me?
The road to authorship
People feel empowered by the knowledge that they are the authors of their own stories. This idea has been at the core of our work while building Betwixt: a wellness-focused choose-your-own-adventure game designed to test our theory that narrative gaming is the way forward for mental health tech.
To give people the chance to change their internal narratives, we cast them as the protagonists of an epic story — one they can explore and ultimately transform.
We’ve borrowed heavily from games and we’ve learned from the feedback of thousands of testers so far that when you create a safe, playful, fictional space around problems, something magical happens:
People engage — they brave their inner darkness and approach it courageously. Then they come back and explore it from another angle, broadening their perspective, adding layers of strength, awareness and wisdom.
We’ve found that people feel a sense of play, creativity and even excitement as they learn about themselves in this way. This is a process of meaning-making that, to me, as a therapist and creator, has been truly inspiring to behold.
And, having seen it in action, I am now convinced of one thing: the future of mental health tech can, should and will be an epic adventure.
