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The “Game Layer” and Emotional Health

SCVNGR's Game Mechanics Playdeck

SCVNGR's Game Mechanics Cards, driving their CEO's vision of the "Game Layer on Top of the World"

The Game Layer

The idea of the “Game Layer” has been on my mind a lot lately after reading Thomas Goetz’s wonderful Wired article on the power of feedback loops and viewing the above video of Seth Priebatsch’s TED talk on his vision of this decade becoming the decade of games. Priebatsch is a fascinating young entrepreneur who dropped out of Princeton at age 19 to start SCVNGR, a company that combines mobile technology and location-based services to create “game experiences” for different businesses. Priebatsch is a passionate speaker who believes in the power of “game mechanics” to promote engagement. In addition to the ones outlined in his TED talk, SCVNGR has an entire “playdeck” of game mechanics that includes includes a number of dynamics inherent in games. Some of these include ideas related to reinforcement paradigms and schedules (Variable Ratio, Fixed Interval) and others related to the sense of accomplishment and drive that games give us, such as progression dynamics and blissful productivity.

In a world of Foursquare mayorships and GrouponNow, it’s not hard to see how the “Game Layer” can apply to retail businesses: your favorite coffee shop can offer “Levels” of customer loyalty, with increasing benefits and rewards as you spend more time (and money) within their establishment. You feel the rewards of getting great deals and being treated like a regular while they have created a loyal customer who gives them repeat business. However, trying to envision how it would apply outside of social media and retail business can be challenging.

As a clinical psychologist, I can’t help but recognize the roots of Seth Priebatsch and SCVNGR’s game mechanics, from Social Psychology and social learning theory to Behaviorism (and its modern counterpart, Behavior Analysis). I also wonder about bringing this information “full circle” in a manner that concepts such as the “Game Layer” and gamification influencing healthcare broadly and emotional health in particular. Some of the features of gamification that have been interesting to me have come from the Goetz Feedback Loop article and Chirag Patel’s presentation at Chicago’s Techweek. These have included Vitality’s Glowcaps, an effort to aid in medication compliance, and Greengoose, a company that is looking to incentivize healthy activity. However, there does not appear to be much currently going on in the mental health/behavioral health sphere to create the “Game Layer” in a way that produces greater emotional well-being. There seems to be tremendous opportunity in several domains within behavioral health treatment, but I’d like to talk about two in particular:

Treatment of Chronic Mental Health Issues

As a psychologist working both within a fairly large non-profit social services agency as well as in private practice, I have had the opportunity to get exposed to several facets of the mental health system. One area that the overall system struggles in is in treatment of individuals with chronic mental health conditions such as Bipolar Disorder and Schizophrenia and other psychotic disorders. Intensive, 24-hour treatment and monitoring is expensive and often unsuccessful, limiting an individual’s ability to develop the independent living skills they need to manage their treatment successfully. However, treatment in community settings also has challenges. Some specific issues for this population that may benefit from game dynamics include the areas around maintaining connection to supports and ongoing medication compliance. Incentives and progression dynamics related to connection to caseworkers, care coordinators, and providers may add some strength in initiating and developing the important relationships required for ongoing treatment. Additionally, the game layer could provide a boost to medication monitoring and compliance through technology such as “smart’ medication dispensing devices, awards and progression for taking medication, and time-sensitive bonuses for taking medication within recommended or required time-frames.

Psychotherapy in Private Practice Settings

One of the issues for providers in private practice is that you meet with an individual for an hour a week and need to make the most of that time as only one hour of a total of 168 hours that week within that individuals experience. Within that time-frame, you need time to help understand their experience, gain insight into their challenges, and work with them to develop skills to meet those challenges. Within that one hour, you need to create understanding, acceptance, and change that will influence the other 167 hours of that individual’s life.

As a cognitive-behavioral therapist, the notion of concrete mental skills and practice of those skills outside of sessions is key to how I work. It is also something that fits the needs of my clients, who are primarily adolescents and young adults who are looking for material changes in themselves and their situations. Our current technology holds some promise in providing avenues to practice skills such as deep breathing, guided imagery, and progressive muscle relaxation. A game layer could make this technology even more effective by providing opportunity for reinforcement and rewards related to the practice of these mental skills. Game mechanics such as level systems and awards can bring about a sense of progression that can encourage further engagement in mental skills development and a greater perspective on the change that has taken place over time through measurable progression.

Caveat: The Moral Hazard of Game Play

One interesting dynamic that Priebatsch has discussed in talks and has in the SCVNGR “playdeck” is the “Moral Hazard of Game Play”. In the SCVNGR playdeck, this is defined as “the risk that by rewarding people manipulatively in a game you remove the actual moral value of the action and replace it with an ersatz game-based reward.” In other words, if you provide artificial incentives for an action, the intrinsic value of that action may be lost and replaced by action for the sake of just reaping the rewards. An example of this is grading in education. Through our current educational system, we have, in many ways, replaced the intrinsic value of learning with an emphasis on getting top grades. The notion of the moral value of self-actualization through learning becomes lost as top grades (and not knowledge) becomes the new goal. And the emphasis on grading creates behavioral side-effects such as cheating. This is an interesting concept for both physical and emotional health, since we would never want a strong emphasis on game mechanics and incentives to replace our true reason for providing psychotherapy: improving emotional well-being.