Chocolate, broccoli, and a test of strength: where do games and therapy interact?

As someone whose cultural diet exists primarily of questionable television shows, comics and computer games, I’m inevitably a fan of Steven Johnson ‘s concept of the Sleeper Curve. In his book, Everything Bad Is Good For You, he argues that ‘pop culture’ today, including reality shows and computer games, is actually encouraging complex and sophisticated thinking, rather than being the path to cultural brain-sludge that modern entertainment is typically portrayed as. He’s particularly complementary about computer games.  The potential role of games in supporting people with mental health problems is something I’m interested in, but when I was rereading the book the other day, one problematic angle in  particular stuck out: that a crucial aspect of the appeal of games, at least if you are talking about most games and certainly most modern computer games, is that they’re hard.

How does this square up with the idea of games-as-treatment? When colleagues of mine in health research talk about the potential of ‘serious gaming’ to influence treatment, they seem to be thinking about the fun aspects, or the reward systems. They don’t tend to say “and the important thing is we’ll make it difficult as hell.” But if, as Johnson argues, that difficulty is actually the key to the ‘fun’ – or at least enjoyment – and the reward, where does that leave us?

One option is that we need to revisit our idea of what ‘difficult’ means. This doesn’t necessarily mean grinding away at dull repetitive tasks to accomplish a goal (hello Farmland) or endlessly, frustratingly trying to overcome a particular problem (I have about a million of these from point-and-click games which have NO INTERNAL LOGIC WHATSOEVER. Ohhh, I had to combine the orange with the washing machine in the library to open the door? Well, now it’s obvious…) What if the challenge could be there to improve the immersion or emotional engagement experienced, rather than to bully people into picking up a skill or overcoming an obstacle? This article talks about a game called Gone Home. The thing about this game, is that there aren’t actually any puzzles, or problems to solve. Rather, there is a story to experience.  It’s still difficult though – in this case, the ‘player’ has to learn to navigate through the virtual space. As the article says, “The twist is that Gone Home demands significant skill of its audience. It’s as if watching Star Wars required you to actually be an X-wing pilot.”  You, the player, have to explore the space, and work out the story, and ‘accomplishing’ the task is driven by your need to find out what happens next. The difficulty of the game and the emotional immersion in the game are interlinked.

Shot from Gone Home -

Shot from Gone Home –

It struck me that this might be exactly what’s missing from a lot of psychological treatments. Modern psychological therapies are perhaps more akin to grind or to laborious skill acquisition. We actually refer (in CBT therapies) to ‘homework’. We make this dry, and dull, and it’s difficult- but without helping the patient immerse themselves and find their emotional connection with the experience. Adding superficial gaming elements to this – badges to say you completed your weekly session for example – doesn’t change much about the experience of the treatment itself. In educational gaming, this is known as chocolate covered broccoli. Kids don’t like broccoli, and dipping it in something they do like doesn’t mean they’re going to want to eat it (and may in fact just ruin some perfectly good chocolate). Gamification doesn’t mean dressing up something boring in something fun. I suspect at the moment though that in health research we are still just trying to conceal the broccoli. Perhaps this is why we focus on the ‘chocolate’ (the fun and the reward) of gaming, rather than considering how games and therapy could really integrate and interact. I wonder if starting from the point of view that they both share the quality of being really hard could help overcome this.

This plan is FLAWLESS!

This plan is FLAWLESS!

As a counter to this, some people might think that emphasising the challenging aspects of therapy could be dangerous – it could worry people, and put them off. But I would argue that this could just help us acknowledge right from the start how difficult therapy can be.. A participant in one of our studies of computerised CBT referred to the treatment as “a test of strength”. Maybe putting the fact that’s it difficult front and centre would be more honest and perhaps even more reassuring – this is really, really tough, so don’t worry if you get upset, or frustrated, because that’s only natural, and it’s ok.

I’ve written before about how ‘gamification’ means a lot more than adding a player ranking table or giving people badges for ‘winning’ at their goals for that month. I do think it’s the case though that at the moment in health we’re still assuming that the fundamental way we ‘do’ therapy is fine, and we’re trying to trick people into doing it our way by adding bits of games we think they like. Considering the broader aspects of gaming that appeal to people, beyond the badges and the leader boards, could help us reconsider what aspects of therapies don’t appeal, and what we might be able to do to change that.

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