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

This post is from 5 years ago, July, 2013. I believe we’re all still thinking about and struggling with these same issues today! 

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. In other words, a game isn’t fun because it meets some criterion that we, the developers, 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 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.

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.

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.

Are Video Games the Learning Tools They’re Cracked Up To Be?

I was just included in an interesting “Up For Discussion” feature on Zócalo Public Square about whether video games in education are all they’re cracked up to be.

http://www.zocalopublicsquare.org/2012/12/03/class-i-commend-you-for-your-work-on-resident-evil/ideas/up-for-discussion/

Check out the whole array of viewpoints. Here was mine:

I believe that while many people overrate the benefits of video games in education, just as many underrate them. Video games are tools like any other. Their pros and cons depend on how, why, when, and for whom the video games are used. The use of video games in education should be tailored, not off-the-rack. However, until we have more direct scientific evidence on this topic, we can only do thought experiments. For my thought experiment, I focus on how video games might influence the broader contexts of learning: relationships and motivation.

Relationships. Do video games influence the teacher-student relationship? A recent study hints at the possibility. This study compared mothers playing with their toddlers with traditional toys versus electronic versions of the same toy. Mothers playing with the electronic toys were less responsive, less likely to be educational, and less encouraging. Might the same apply to teachers and students? Could video games, because they “do the teaching” have a negative impact on a teacher’s ability and motivation to engage with students? Could video games disempower teachers?

Motivation. We use incentives all the time to motivate learning (e.g., grades), but video games may be unique in the degree to which incentives, whether points or rewards, are integral to the learning process. If the motivation for learning becomes too closely tied to these external incentives, the pleasure of learning for learning’s sake may be squelched and children may miss opportunities to appreciate that setbacks—not getting a reward—are opportunities to improve. We must think through the subtle ways in which video games can shape children’s motivation for learning and design video games to encourage the learning style we believe will be most productive.

Whether one believes that video games will lead to shorter attention spans and boredom in the classroom or that they are powerful tools for igniting a child’s passion for learning, video games will soon become a central part of the educational landscape. So, let’s figure out how to do it right.

 

The Gamification of Learning

A recent Pew Report polled internet experts and users about the “gamification” of our daily lives, particularly in our networked communications. They write:

The word “gamification” has emerged in recent years as a way to describe interactive online design that plays on people’s competitive instincts and often incorporates the use of rewards to drive action – these include virtual rewards such as points, payments, badges, discounts, and “free” gifts; and status indicators such as friend counts, retweets, leader boards, achievement data, progress bars, and the ability to “level up.”

According to the survey, most believe that the effects of this gamification will be mostly positive, aiding education, health, business, and training. But some fear the potential for “insidious, invisible behavioral manipulation.“

Don’t pooh-pooh the behavioral manipulation point. Do you really want to have your on-line behavior shaped like one of Skinner’s rats by some faceless conglomerate? But that’s actually not what got me going. What got me wondering about where this is all going is that it seems undeniable that gamification will shape how we learn, in particular how kids learn.

Elements that make up this gamification – rewards, competition, status, friend counts – are particularly powerful incentives. Neuroscience had repeatedly documented that these incentives rapidly and intensely “highjack” the reward centers of our brain. So it begins to feel as if we’re addicted to getting that next retweet, higher friend counts, higher scores on fruit ninja, etc.,…. Even the sound that our device makes when a message pops up gives us a rush, makes us tingle with anticipation. We eagerly wait for our next “hit” and are motivated to make that happen.

This gamification could have a powerful impact on how we go about learning. Psychological researchers distinguish between a fixed and a growth mindset – that is, peoples’ beliefs – about intelligence and learning. When people have a fixed mindset, intelligence is viewed as a hard-wired, permanent trait. If intelligence is a fixed trait, then we shouldn’t have to work very hard to do well, and rewards should come easily. In contrast, in a growth mindset, intelligence is viewed as something that can grow and develop through hard work. In this way, a growth mindset promotes learning because mastering a new skill or learning something new is enjoyable for its own sake and is part of the process of intellectual growth. Intelligence is not fixed because it is shaped by hard work and effort. For a nice summary of these distinctions, see a recent post on a wonderful blog called Raising Smarter Kids.

This is where gamification comes in. If children are inundated with incentives and rewards for even the simplest activity or learning goal, motivation for learning becomes increasingly focused on the potential for reward, rather than the process and joy of learning. In addition, when you’re doing things mainly for the reward, the motivation for hard work will peter out after a while. You just move on to the next, perhaps easier way of getting rewards rather than digging in and trying to master something. It also becomes more difficult to appreciate the value of setbacks – not getting a reward – as an opportunity to improve. In these subtle ways, gamification may undermine a child’s ability to develop a growth mindset. Instead, we might have a generation of children who are implicitly taught that everything we do should be immediately rewarded, and that getting external things, rather than the joy of learning, is why we do what we do.

Promoting a growth mindset is not only important for helping our children learn, but for helping them face frustrations and obstacles. Dona Matthews and Joanne Foster, in Raising Smarter Kids, highlight several rules to promote a growth mindset:

1. Learn at all times. This means think deeply and pay attention. When we use technology and social media, we can sometimes err on the side of doing things very quickly and superficially. So, this rule is important to emphasize with children today more than ever. We also have to remind our children (and ourselves) that it’s ok to make mistakes, even if we don’t get rewarded for our efforts.

2. Work hard. This is a skill that of course can be promoted by the presence of incentives – kids will work for hours at a game if they can beat their highest score. But what happens after they get the reward? Are they committed to continue learning? Will they continue struggling and practicing? Sustained hard work is an opportunity for personal growth that external motivation, like that from rewards, may not be able to sustain. Here, the enjoyment of learning and gaining mastery may be the most powerful motivator when it comes to helping children become dedicated learners for the long haul.

3. Confront deficiencies and setbacks. This is about persisting in the face of failure. The increasing role of gamification could both help and hinder this. Gamification will help in the sense that with so many rewards and game dynamics, opportunities for failure are around every corner and children will need to learn to persist. At the same time, what guarantees that a child will persist to obtain these rewards? Rewards are not equally motivating for all individuals. Will those not interested in rewards and games just be left feeling bored, and take part in fewer opportunities for learning?

I’m not saying that we should avoid all rewards – that would too extreme and impossible to boot. But we must maintain our awareness of how, with increasing gamification, the simplest act of using technology, logging onto our favorite website, or using social media might be subtly changing our motivation to learn.