'Computer game therapy': A treatment for depression

“Six years ago my life fell apart because of unmanaged and untreated panic and anxiety,” says Simon Fox, Founding Director of PlayLab London. “Three quarters of the people like me who experience chronic mental health conditions – one in four of us ­– never see treatment because it’s too frightening, too difficult or too expensive,” he adds.

Fox, who is a developer and interaction designer, decided to create a computer game to help people manage their anxiety through breathing exercises. His app Flowy, which is currently in beta and does stick a little (it crashed my phone twice, although this was before today's upgrade), aims “to give people something accessible, fun and available - because in this era, they should not have to suffer alone,” he explains.

The reason developments like this are important is because many health professionals agree there is a massive overreliance on drugs in the treatment of depression and other mental health complaints. These usually have side-effects and are not necessarily the best long-term solution. The trouble is it takes a long time for other alternate forms medicine – such as arts therapy  – to get recognised, and while the space seems ripe for other innovative new ideas, it can be tricky to see them put to clinical use.

“In plenty of spaces ‘computer game therapy’ is already normal,” suggests Fox. “Re-mission is already showing great efficacy keeping people on their chemotherapy and games like Bejewelled are showing convincing results in reducing depression.”

The benefits of computer games may be starting to become apparent, but it is likely to take a long while before they receive any large-scale government-level medical approval. This is partly because their use falls into two distinct categories. The first are the specific clinical apps designed to help people who have been diagnosed with depression – these require a lot of trial and error to be practically applied. The second, are the various general benefits of casual gaming to decrease stress and improve wellbeing. These are fairly well understood but harder to formalise.

Jane McGonigal, a designer of games “to improve real lives and solve real problems” and author of ‘Reality Is Broken: Why Games Make Us Better and How They Can Change the World’, has aggregated a lot of research around this subject.

She is also Chief Creative Officer of SuperBetter a game “backed by science to help build personal resilience: the ability to stay strong, motivated and optimistic even in the face of difficulty”. A small randomised trial of this game in 2013 [PDF] showed this delivered a marked overall reduction in depression and anxiety.

“Anxiety is very linked to depression,” says Siobhán Thomas Senior Lecturer and Course Director of the Game Cultures degree course at London South Bank University. “I think there are a lot of things computer games can do to help”. One of these is helping others to understand the perspective of people who are depressed through games such as Depression Quest and Actual Sunlight.

Andy Payne, owner of the Mastertronic Group and chairman of UK trade body UKIE who was awarded an OBE in 2011 for services to the UK games industry, agrees. He doesn’t have any specific experience of depression and gaming but is very conscious of the wellbeing it can bring. He highlights the sense of community that many online gamers feel as “there is no judgement” in this environment.

“When you see the gaming communities coming together, they are incredibly diverse,” he adds. This help promote “understanding and empathy” and he remains impressed by how many people describe fellow players as “friends” when they have “never met in real life”.   

When it comes to concerted clinical use though, SPARX might be the poster-child app. Yet this is still only available in New Zealand and none of the UK experts we consulted had even heard of it.

SPARX, is a pneumonic which stands for ‘Smart, Positive, Active, Realistic, X-factor thoughts’ and although it might all sound a bit naff and ‘new agey’, it has been proven to help teens deal with negative feelings through gameplay. In fact, in 2012 the British Medical Journal published a study that showed that out of 187 adolescents with mild to moderate depression 44% underwent remission through SPARX treatment compared to 26% who improved through traditional counselling.

The rise in these bespoke depression apps is only likely to escalate in number over the next few years. MyCognition is one example of an organisation which is involved in games for improving cognitive health. Chief Medical Officer Dr. Raj Kumar who is neuroscientist and psychiatrist for the organisation says: “We will start to exercise the mind like we did the body in the 80s and 90s.” He adds the team is conducting bespoke research on adult depression in Amsterdam at the moment.

“Games are effective feedback systems and we'll see them interacting with wearable sensors in the near term to create powerful effects,” says Fox. These could include brain wave (EEG), heart rate (ECG) or eye movement trackers - although Thomas does warn these devices can take “a bit of getting used to” which makes them less accessible.

The Muse headset and its accompanying Calm app is a good example of an EEG mindfulness device, while MyndPlay offers Thought Field Therapy games which are also played in conjunction with brain monitoring. Then there is Nevermind. This is “a biofeedback-enhanced adventure horror game that takes you into the dark and twisted world of the subconscious” and measures your stress levels as it does it.

“Gaming is changing very rapidly,” explains Thomas. “It is hard to predict the future as today is not the same as six months ago.” Fox concurs with this: “Research is changing and the way we do science is now struggling to keep up with the speed and quality of learning we can do during a development process.”

The benefits are far reaching though. Not least because this form of treatment could be pan-cultural. So, as smartphones become more commonplace, therapies could become available in parts of the world where mental health conditions are not properly recognised [excellent audio series on the BBC World Service]. This would put more control back into the hands of patients.

Kumar adds that this type of treatment is non-invasive, while “no drug is free from side-effects for everyone”. The cost of healthcare can be reduced and people can “go at their own pace. And take part in the security of their own home without worry”.

While Fox concludes: “People want to use games. They can access them easily. They’'re cheap. We already expect to be able to access music, film, news and our friends anywhere in the world. Why is our health lagging behind? It’s on the way, I’d say well within the next decade for sure.”


Related articles:

New technology vs. ‘untreatable’ depression

How a placebo pill and app could help fight anxiety


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