There is large amount of research into the positive effects of video games on mental health, and there are now games being designed to directly address mental illness, such as depression. These games, designed for a primary purpose other than simply entertainment, are known as serious games.
In a recent review of serious games designed to directly address depression, researchers have found a great deal of positive evidence, and promise for serious video game design (Fleming et al., 2015). Here is a summary of the games that were examined and what was found.
Think Feel Do
This interactive intervention for children is a CBT-based series of six sessions in which the player is guided through each session by the three game characters (Tom the thinker, Becky the feeler, and Izzy the doer). Music is used as a mechanic within this interactive intervention, and the objective of this game is to learn the difference between positive and negative thinking patterns, and learn the actions that lead to positive outcomes.
But what about the evidence for this approach? In one study, Think Feel Do has been shown to significantly improve symptoms of depression as self-rated by a group of young men. Other measurements such as parent rated scales showed no change in symptoms. In a randomised controlled trial (RCT), adolescents who played Think Feel Do, demonstrated significant improvements in depression as both self-rated and parent-rated.
SPARX and SPARX Rainbow
SPARX is a CBT-based game comprising seven sessions. Players choose an avatar to represent them in the game world, and game play involves navigating through the world, taking on challenges and overcoming gNats (gloomy negative automatic thoughts). The objective of this game is to defeat gNats, and gather SPARX & power gems, in order to restore balance to the game environment. Following each session, the player is encouraged to reflect on how they can apply the lessons learned in game, to their real life.
In terms of evidence to support this game, studies have found that SPARX and SPARX Rainbow are as effective at treatment for depression when compared with traditional clinician only treatment, as rated by a clinician. A large scale RCT determined that self-rated measurements of depression, moods and feelings, were in fact significantly better in the group who took part in the SPARX intervention compared to Clinician provided CBT treatment as usual.
This game is also a CBT-based program comprising seven sessions. Through elements of gaming, players move through a fantasy world on a quest to reach their homeland. Throughout the journey, players are asked to complete a series of lessons based on CBT, and subsequent quizzes. The objective of this game is to earn points by completing quizzes, which are then rewarded with fun mini-games.
Studies evaluating the effectiveness of The Journey have found that participants had significantly greater reductions in depressive symptoms as rated by a clinician, compared with another non-game psycho-educational based intervention.
The Journey to the Wild Divine and Freeze-Framer
These are two biofeedback interactive interventions that are presented in sequential order, and they are delivered in conjunction with psycho-education about the effects of stress on health and wellbeing, both physically and psychologically. This intervention is paired with face-to-face therapy over eight sessions. The objective of these games is to complete tasks and levels in increasing difficulty whilst maintaining a state of calm, which is measured using biofeedback.
Studies evaluating this intervention have found that The Journey to the Wild Divine and Freeze-Framer provided a significant improvement in self-rated depressive and anxiety symptoms when compared with a wait list control group.
If you are sensing a pattern so far, you are right. This game is also grounded in CBT principles, and is conducted over two to four sessions in conjunction with face-to-face therapy. The objective of this game is to traverse a tropical island and avoid being stung by gNats, creatures that represent Negative Automatic Thoughts. The player comes across characters during the game that share different strategies of how to avoid the stings of gNats, while the player carries a notebook within the game so that they can record new strategies as they play.
While gNats Island has been evaluated as part of an open trial, objective outcome data of improvements was limited. The study suggested that the game contributed to an overall improvement, a heightened understanding of CBT concepts in young children, and a positive impact on behaviour.
In contrast to the above games, ReachOut Central is not delivered in modules or sessions. It is however, also grounded in CBT principles. Players take on the role of a new person in a social environment, and the objective of the game is to successfully integrate and settle into a new town. Players have a mood meter which is a reflection on their engagement with particular activities such as homework, sleeping and physical activity. This mood mechanic also determines the success of other in game actions such as successfully engaging with other characters in the game.
In an open trial, ReachOut Central has been shown to be effective at improving resilience for females, but not for males. Studies also suggest that the game is effective at reducing general psychological distress, as measured by a self-rated questionnaire that measures depressive symptoms, as well as stress and anxiety.
So, “Yes, however…” seems to be the preliminary answer to the question of whether or not games can successfully treat depression. There is certainly strong evidence that video games can be part of a successful intervention, as suggested by the research above. However, there are limitations, and as such, caution should be employed when suggesting that video games, or even serious games designed for purpose, can effectively treat mental health concerns. The evidence is growing for some games, and there is a steady stream of new interactive interventions being made. Prescribing play may have seemed far fetched only a few years ago, but as long as research in this young field continues, we may see a lot more games for health, as well as solid evidence to back them up.
Fleming, T. M., Cheek, C., Merry, S. N., Thabrew, H., Bridgman, H., Stasiak, K., . . . Hetrick, S. (2015). Serious games for the treatment or prevention of depression: A systematic review. Revista De Psicopatología Y Psicología Clínica, 19(3), 227.