Late at night, in the middle of a panic attack, 25-year-old Zoe Quinn used to get out of bed to play video games. By the light of her computer screen, she immersed herself in another universe, and her anxiety slipped away.
Now, the Dorchester woman wants to make gaming for others what it was for her: a therapeutic, purposeful way out of dark times. Her passion makes her part of a growing movement among gamers and doctors alike to use the medium to educate the public and diagnose, and even treat depression or anxiety.
Quinn has created a simple, free, Web game called “DepressionQuest.” Players click through the deeply realistic narrative of a first-person character, making choices for the character about work, friends, and family. The game shows options for dealing with depression, such as seeking therapy or medication, or reaching out to friends.
“DepressionQuest” isn’t clinically tested. (Though she got advice from a therapist, she warns that suicidal people should not play.) But Quinn wanted sufferers of depression to know they’re not alone — and show those who haven’t experienced depression what it’s like. “Games require a certain degree of empathy — from the nature of the interaction, immersing yourself in the experience,” she said. “The world of games is changing. It’s not just Mario or Call of Duty.”
Game developers hope that one day they might supplement therapy and support groups by putting mental health care into patients’ homes or pockets. The demand for therapists far outstrips the supply nationally, and many who most need help with mental health issues can’t afford or reach treatment, or don’t seek it out.
But most of the games have yet to go through rigorous testing to see whether they work — or might inadvertently harm patients — and the makers aren’t yet allowed to make health claims for their products. While drugs must be approved by the federal government and states license many therapists, games are unregulated.
Colin Depp, a psychiatrist at the University of California, San Diego who works on mobile apps for anxiety and bipolar disorder, said the technology has potential, but the market for these games is still “a bit like the Wild West.”
‘Games require a certain degree of empathy — from the nature of the interaction, immersing yourself in the experience.’
The US Food and Drug Administration plans to require approval for only a “small subset” of Web or mobile medical apps “that may present potential harm to consumers,” a spokeswoman for the federal agency said in an e-mail. She said some video games purporting to treat or diagnose mental health conditions could be subject to agency review.
Developers are largely focused on making games that engage our ability to be mindful, aware, alert. People with depression, anxiety, attention deficit disorder, traumatic brain injury, and some elderly people have weaker brain functioning in these areas.
Games can test those abilities — and, researchers hope, train the brain to improve at such tasks.
One benefit of such games might be to encourage patients to stick with treatment. Depressed people may struggle with adhering to a routine of taking pills, seeing a therapist, or even waking up for work. An app that looks and feels like other video games could help patients stay engaged, said David Mohr, a professor of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine.
If there’s one thing game designers know, it’s that building in rewards keeps players coming back, said Matt Omernick, a designer who has worked at Microsoft and LucasArts, designing Star Wars games. There are plenty of games that reward players for “shooting Nazis or chopping people’s heads off with a light saber,” Omernick said, but video games can also harness rewards to encourage positive mental change.
Omernick now works with Boston’s Akili Interactive Labs on a game code-named “Project Evo.” Akili’s game allows players to collect stars, gems, and alien specimens as they explore new worlds like an extraterrestrial Lewis or Clark, with the goal of helping players sharpen their cognitive functions, including being more mindful and engaged.
The innate human desire for rewards is a useful place to start when treating depression, researchers said. But a shared concern among developers of mental health games is making them positive — rewarding good thought patterns and sharp cognitive functions rather than just shooting skills or the ability to steal cars.
While games should be fun, they have to be just “boring enough” so that doctors can use them to diagnose problems such as a player’s inability to focus, said Dr. Monika Heller, a Minnesota child psychiatrist who works with CogCubed, a company developing games for anxiety and depression.
Designers are trying to strike the right balance so that time in front of a screen doesn’t turn harmful. Healthy teens who spend too much time immersed in video games are likely to become depressed, recent studies in Singapore, China, and Japan suggested.
But playing a game for just 10 to 15 minutes a day gets patients to the “sweet spot” when the game is effective but not excessive, said Patricia Areán, a psychiatrist at the University of California, San Francisco who received a National Institute of Mental Health grant to study Akili’s game. The trial, which has just begun, will test the game on 150 depressed and healthy adults. Areán said a larger study will be necessary before the game is proven effective.
For Ashley Malek, a 14-year-old from Ramsey, Minn., health-oriented games might replace her daily regimen of two hours a day of “normal zombie-killing games,” she said. Malek, who struggles with painful and incapacitating facial and body tics, used a Whac-a-mole-style game made by Minnesota’s CogCubed. The game, played on a series of interactive screens, noted her attention lapses and reaction times while playing. The results helped to confirm her psychiatrist’s suspicion that Malek was suffering from anxiety.
CogCubed is developing a version of the Whac-a-mole game that would help patients cope with anxiety. Company CEO Kurt Roots said CogCubed is seeking guidelines from the FDA. Teens would play for 20 minutes twice a day until the game shuts off automatically, Heller said.
Some developers are attempting to build mobile games based on diagnostic and therapeutic tasks long used in therapists’ offices.
For example, Army veterans with multiple mental health issues play Blue Marble Company’s “RESET” game, in which they perform a trail-making task, connecting 25 dots as quickly and accurately as possible. The game is based on a standard psychological measure of visual attention. CogCubed makes use of the TOVA, or Test of Variables of Attention, a standard diagnostic and monitoring test for attention-deficit hyperactivity disorder.
While some researchers are carefully testing mental health games, hundreds of unproven apps available in the iTunes store have little grounding in sound therapeutic practices. Consumers should be wary of those, researchers say.
Some mental health professionals are skeptical that games will ever replace in-person therapy. A human touch, especially in mental health therapy, is irreplaceable, said Northwestern’s Mohr, who studies mobile mental health interventions.
“We’ve had bathroom scales forever and people are still fat,” he said. “Novelty will wear off, and even the most elegant of apps will get old fairly quickly.”
The novelty hasn’t worn off for Quinn, who is no longer seeing a therapist or taking any medication. Games are games, not therapy homework or an extra task on a to-do list, she said, and that’s why they can help people.
“When I’m depressed, I don’t want to do anything,” she said, “much less any kind of work.”Sanjena Sathian can be reached at firstname.lastname@example.org.