Gamification in Mental Healthcare: Benefits and Challenges

Introduction

There is no doubt that decades of research have been devoted to developing new and more effective treatments for mental conditions ranging from autism to anxiety, and from schizophrenia to depression. What is rather worrying, however, is that we have very little to show for it. Mental disorders such as these continue to impact the quality of life of a significant proportion of the population, costing taxpayers millions of dollars every year. Currently, approximately 90 million Americans — roughly one-third of the population — suffer from some form of anxiety disorder, yet a majority of these individuals fail to seek treatment owing to the stigma, burden, and cost associated with evidence-based care.

Mental health professionals are therefore focusing their attention on the development of low-burden, effective interventions for mental illness. Gamification — the introduction of game-like elements into mental health interventions — is one of the newest trends in that direction, and one that experts regard as having significant potential. This paper examines the various ways in which gamification has been used to impact mental health outcomes among members of the Millennial Generation, who are also the greatest users of smartphones and other mobile devices. It argues that, if properly regulated and controlled, gamification could contribute significantly to improved mental health outcomes.

Overview of Gamification in Mental Healthcare

Gamification in mental health refers broadly to the strategy of translating or embedding interventions into game formats that may range from animated graphics to software applications and game-like interfaces accessible through mobile devices. A report by the Pew Research Center estimates that approximately 61% of young persons between the ages of 12 and 30 own a smartphone or some form of mobile device (Chan, Torous, Hinton, & Yellowlees, 2014). Of these, 31% use their devices to obtain health information from online platforms or psychiatric patient networks (Chan et al., 2014).

Today, numerous apps are available to both patients and healthcare practitioners. These tools assist with patient record-keeping, decision support systems, patient monitoring and surveillance, health promotion, community mobilization, appointment reminders, and treatment adherence and monitoring. The overriding aim of gamifying mental health treatments is to increase patient engagement and reduce the stigma associated with seeking care. Its use, however, remains limited owing to challenges of accessibility and patient privacy.

Examples of Mental Health Apps and Software

Numerous software applications have been developed to improve population mental health. With the help of mobile apps and wearable devices, individuals can track nearly every aspect of their mental health just as they track their physical health. The Recover Record app, for instance, is designed to send reminders and notifications to patients to help them cope with psychological disorders. For people with eating disorders, the app sends a notification at 5 a.m. each day reminding them of the need to eat breakfast (Arthur, 2015). After eating, the patient records on their phone what they ate and how they felt. The procedure is repeated throughout the day, and the app functions like an online diary, prompting users in regular intervals to log their meals or snacks (Arthur, 2015). By recording dietary habits and tendencies, patients are helped to cope more effectively with their disorders.

Beyond Recover Record, numerous other apps address a range of mental health issues: some tackle anxiety through breathing or meditation techniques, others track mood swings, and still others are specific to bipolar disorder, depression, or phobias. Several of the most prominent apps and their functions are described below.

StudentLife

The StudentLife Android app, developed by researchers at Dartmouth College, collects location, audio, and motion data from a user's smartphone sensors. It draws patterns from that data and uses them to predict and alert users to changes in their mental health (Bolluyt, 2014). Algorithms within the app process the collected data to build a picture of the user's sleeping patterns, communication patterns, the places they visit, and their level of physical activity. If the user begins to show changes in any of these patterns — changes that correlate with shifts in stress, loneliness, or depression — the app notifies the user or their registered caregivers that their mental health may be changing (Bolluyt, 2014).

SelfEcho

In addition to apps designed to help users manage their own disorders, other software has been developed to furnish practitioners with information about their patients. One such tool is SelfEcho, which allows mental health practitioners to enroll patients in a system that uses smartphone sensors and self-reports to record data about their daily lives. The software provides mechanisms for practitioners to assess patient progress and determine which elements of a treatment plan are working and which are not (Bolluyt, 2014). The metrics tracked include base models for restfulness, worry, anxiety, guilt, physical activity, pleasure, hopefulness, and positivity (Bolluyt, 2014). Practitioners can use this information not only to track progress, but also to identify triggers and make more accurate diagnoses.

My M3

My M3 is one of the few apps that can be used by both healthcare providers and consumers. It provides a simple screening test that can detect post-traumatic stress disorder, bipolar disorder, anxiety, and depression. Users take the test to help both themselves and their practitioners understand whether they are suffering from, or are likely to develop, a mood disorder (Bolluyt, 2014). This places practitioners in a better position to make accurate diagnoses and administer effective treatments.

MindShift

MindShift is an Android app designed to help teenagers and young people deal with anxiety. It focuses on changing the perceptions users hold about anxiety so that they become more willing to confront it (Simon Fraser University, n.d.). The app provides tips on developing helpful thinking patterns, techniques for relaxation, and strategies for coping with everyday anxiety — all of which help users manage their symptoms (Simon Fraser University, n.d.).

SPARX

SPARX is an interactive fantasy game designed to help adolescents deal with depression and anxiety (Sarasohn-Khan, 2012). Users select an avatar and take part in a range of challenges aimed at restoring balance in a world dominated by GNAT — Gloomy Negative Automatic Thoughts (Sarasohn-Khan, 2012). The game is available on CD-ROM. Research has shown SPARX to be effective in reducing levels of depression and anxiety among adolescent users (Sarasohn-Khan, 2012).

Additional Apps and Software

Other popular mental health tools include the Therapy Outcome Management System, which provides feedback to practitioners on the outcomes of therapy and counseling; the Sleep Well Be Well app; Headspace; Thought Diary Pro; and My Mood Tracker. All of these function in a broadly similar way — tracking users' emotional well-being in correlation with their behavioral patterns (Bolluyt, 2014).

Conclusion

Gamification is a relatively new phenomenon in the medical field, particularly in mental health settings. Its effectiveness in helping patients and practitioners achieve better mental health outcomes has nonetheless been demonstrated by multiple researchers. Its promise stems from its capacity for timely, technology-assisted diagnosis and ongoing self-monitoring. Despite its inherent benefits, gamification is not without its limitations. Its principal weakness is that it does not guarantee the privacy and security of user information as reliably as traditional methods do. Furthermore, not all practitioners are technologically literate, and mobile devices are not accessible to all prospective users, particularly those in rural areas. These disadvantages have made it difficult for mental health gaming programs to diffuse effectively among users. To increase engagement, stakeholders will need to take concrete steps to make such platforms HIPAA-compliant and to expand the technological awareness of mental health care providers.

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