How Gamification Can Be Used in Counseling

Technologic breakthroughs in the 21st century have touched nearly every process and augmented basic human behaviors and interactions. Technology and internet use is now ingrained in basic daily functions. This shift creates both problems and opportunities when counseling individuals especially beholden to their smartphone or the latest app, particularly children and adolescents. But there’s no age restriction on technology use, and mental health professionals are increasingly seeing all types of clients discuss online use and how it may affect their well-being.

Technology has been thought of as a detractor to healthy living in some respects, but there is potential for it to be leveraged by mental health counselors in emerging ways to engage with clients. Gamification is one emerging trend that counselors can experiment with to reach tech-savvy clients. Now often deployed by companies in the form of training programs on subjects like workplace regulations, gamification is the application of game structures (points, motor skills, competition) to an otherwise routine process in working or personal life, usually realized in the form of a computer game or a relatable medium.

Gamification, as an enhancement to counseling, is only really starting to gain a hold in mental health counseling, so counselors must be exceptionally careful when using such methods.

The history and role of gamification

Game theory has been present in counseling methodology for some time. A guide to using games in counseling was published by Personnel and Guidance Journal in 1975. Play therapy, as it can be applied in child counseling, offers a real glimpse into a child’s state of mind. When disarmed during play, children are unencumbered by normal pressures and allowed to freely express themselves. When this enthusiasm is directed toward a game (either a board game, one without props or the virtual kind seen today), mental health professionals can observe interactions and behaviors in different contexts, which might be able to help improve their overall understanding of a client.

The conditions of the game — its rules and motivations — may be able to produce reactions that can be analyzed in context of treatment. Playing games might also have a therapeutic calming effect or skills teaching element (depending on the setting):

• Consider students placed on a team, and each is given a model to reconstruct with a prize promised for the fastest and most accurately built. Children must then learn to cooperate, as well as focus on the details.

However, children are now as likely to be playing online as they are outside. According to an American Psychological Association (APA) article published in American Psychologist titled “The Benefits of Playing Video Games,” 97 percent of American youth played one hour of video games a day in 2014. The wide breadth of video game use could be considered by counselors as a potential opening to engage with clients.

The potential of video games for mental health

Video games have gotten something of a bad rap in media, and though research on violent games does exist, researchers are beginning to focus on the opportunity for developing and using video games specifically to address mental health needs. The authors of the American Psychologist article who analyzed video game benefits asserted that they had “become particularly inspired by the potential that

games hold for interventions that promote well-being, including the prevention and treatment of mental health problems in youth.” Yet, it is important to note they found few current examples of games designed in this way. Though gamification appears to have great potential, there is still much research needed.

What would a video game look like in a mental health setting? Researchers from Australia and New Zealand recently considered this question in “Serious Games and Gamification for Mental Health: Current Status and Promising Directions” published in Frontiers in Psychiatry. Researchers outlined virtual reality and augmented reality games as immersive structures that offer sensory stimuli, which increase engagement and potentially therapeutic effects. Cognitive behavior therapy (CBT)-based games, on the other hand, were defined multilevel games designed to challenge users to progress past milestones and/or collect points and badges. A third category was entertainment computer games: Instead of being used for evidenced-based therapy, these games were leveraged as a way to improve mood through stress release or emotional regulation (researchers noted Tetris could be used to reduce cravings, as the player can use the game to combat such feelings and focus instead on making strategic moves).

The overarching challenge is developing games to enhance counseling. High-quality platforms are needed, and they must be designed with the user in mind, as well as the context of the use in treatment. Though there is a way to go, progress is being made on designing such video games that counselors may want to investigate further.

Real-world examples of gamification

A video game called SPARX is an example of a video game that functions as a counseling tool. The game — which is based in a fantasy world and consists of seven levels taking about half an hour each — was developed as a way to decrease depression. Adventures, quests and puzzles are used to teach skills to manage mental health. Users are able to customize their character and embark on a journey to bring light back to the distressed fictionalized realm. A traveler teaches the user the secret to a breathing exercise as a reward for completing a task. Collecting these skills throughout the course of the game helps the user construct what the game calls a shield against depression, which has proven beneficial in real-life applications. A study published in British Medical Journal scored participants’ levels of depression on a rating scale and found a greater reduction of the number in SPARX users than in individuals receiving traditional face-to-face treatment, a separation of almost three points. Researchers concluded that rather than replacing normal counseling, SPARX could complement counseling .

While role-playing games can offer immersive, textured and rich virtual experiences for users, a less intensive option can also have the same effect in servicing clients’ mental health needs. A mobile game developed by Hunter College and City University of New York took 25 minutes to reduce anxiety and stress in adults. In a study published in Clinical Psychological Science, researchers monitored the effect of their attention-bias modification training (ABMT) mobile application called PersonalZen, as reported by NPR In the app, users trace a burrowing avatar’s path while a soothing soundtrack is played over a placid field of green grass. Though researchers were unconvinced the app could be used exclusively to treat more advanced clinical cases of anxiety, the quickly rendered service the app provides is a key advantage for other clients who need help when a personal meeting is not possible.

“Gamifying psychological interventions successfully could revolutionize how we treat mental illness and how we view our own mental health,” said Tracy Dennis of Hunter College, lead researcher.

Cautionary use is still needed
Though gamification in mental health counseling could carry potential benefits, there are risks. Some pitfalls to keep in mind, outlined by the researchers published in Frontiers in Psychiatry, include:

• Offending clients with what they may consider a “trivializing or inappropriate” attempt to reconcile serious mental health issues. Counselors should gauge whether it’s worth having a conversation about using gamification after a rapport has been established.
• Using an untested or low-quality game. Not every option will be a good one, and counselors need to be sure they are using a game developed with counseling objectives in mind. The game should be fun, but leisure cannot be the overarching purpose of the interaction.

Though gamification has much yet to prove in terms of its value to counseling, a body of evidence indicates it may have some advantage. Gamification seems to have the most promise with young children and adolescents. School counselors may be interested in learning more about gamification. As technology continues to reshape life, professional mental health counselors will need to find ways to embrace and address it in their work.

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