There is increasing evidence of the positive impact ‘serious games’ can have on health outcomes. A recent report by the PM’s Chief Science Advisor Sir Peter said there is increasing evidence that e-therapies are as effective as face-to-face therapies in mild and moderate mental disorders, and a new mental health strategy will feature social media and e-health therapies.
A pioneer in this field is the SPARX videogame, created by NZ reseachers to tackle teenage depression using cognitive behavioral therapy, packaged in a fun and appealing way. Metia Interactive, an Auckland based game development studio partnered with the Ministry of Health and Auckland University to create SPARX.
The British Medical Journal has recently released the results, which show that SPARX delivers on its promise.
44% of those who played SPARX recovered completely from depression, compared with 26% of those in regular treatment, a significant difference. The study follows up two smaller trials of the game by the same group, which found that it was superior to placebo and to being on a waiting list for treatment. The authors conclude: It is at least as good as face-to-face treatment as usual, would be cheaper and easier to disseminate and could be used to increase access to therapy. It could also provide access to treatment for young people who may be reluctant to have more conventional therapy.
We caught up with Metia CEO Maru Nihoniho to find out more about SPARX, and gaming and health.
Gamedojo: Hey Maru, we appreciate you making time for us! What are some of the best applications of gamification & health that you have seen (outside of Sparx!) & what makes them so good?
Maru Nihoniho: I remember one of the first serious games I became aware of was a big game called Global Conflicts: Palestine. I thought it was a good initiative and it included presentations outside of the game as well as group discussions (within a class or school setting).
Another was the Re-Mission game by HopeLab to engage young cancer patients. It was shown to help teens undertaking chemotheraphy to adhere to and respond better to their treatment”.
These two games show how serious real world objectives can be used within the gaming platform to engage, entertain and educate.
GD: Maru, what in hindsight are the things which have made the biggest contribution to you finding yourself where you are now in your career?
MN: My first big break was getting our first commercial title funded and published. I designed puzzle game Cube for the PSP and spent over a year pitching it before it was picked up by US publisher D3P. It was a massive breakthrough for me. Cube was published across three major territories and in five languages.
I’ve always been creative. I like making things and putting stuff together. At school I was good at technical drawing and art. I thought back then I might be an architect or interior designer but went through years of working in a completely different industry. However, working in hospitality gave me the management skills I use today. And now I’m in a place where I use my creativity and my management skills, not quite architecture as I thought back in my school days but a different type of architecture: game design.
GD: Tell us about SPARX! Firstly, to quote from the www.sparx.org.nz website:
SPARX is a self-help computer programme for young people with symptoms of depression. In order to actively engage young people, SPARX uses a 3D fantasy game environment and a custom-made soundtrack. The programme teaches skills to manage symptoms of depression, in a self-directed learning format. Young people learn cognitive behavioural therapy techniques for dealing with symptoms of depression (e.g. dealing with negative thoughts, problem-solving, activity scheduling, and relaxation). It can be used with minimal oversight. Users are able to customise their avatar and journey to the seven Provinces, each with a unique set of challenges and puzzles.
Firstly Maru, what excited you about working on this project?
MN: Well, before Sparx I hadn’t worked on serious games before so I knew I was in for a challenge. When I heard that the game was targeted at NZ youth with depression and it had serious outcomes, I thought “what a great initiative… this game can actually help people“. It was a really neat feeling to be working on a game like SPARX.
GD: Would you like to work on another similar project? What have you enjoyed about applying gaming principals into healthcare?
MN: Definitely, I have worked on another serious game project since SPARX and we are to develop SPARX 2 later this year. I will continue to work on serious game developments or gamification projects.
It’s a challenge to find the balance between entertainment and education as the objectives must be clear but not interrupt gameplay but become part of it so there are certain things to be aware of.
MN: Well, we wanted to get the messages across through the gameplay as much as possible and we did this through puzzles, quest challenges and engaging in conversations with other characters. We were aware that things that are normal in most commercial titles wouldn’t be acceptable in Sparx.
An example with SPARX: the game is targeted at teens with depression. Test groups wanted shooting in the game and this came from both boys and girls although there were differences in their choice of weaponry. We had to come up with a compromise and allowed the players to have a staff that shot fireballs or lightning at ‘negative thoughts’ either getting rid of them or changing them to positive thoughts.
GD: From a game designers perspective, what are the top priorities you attend to in terms of gaming and health? What are the aspects that need to be “right” in order for the game to meet its healthcare objectives?
MN: I think the most important thing is to understand the content and what the intended outcomes are and to work with a team of experts in that particular field.
With Sparx we worked with a team of clinicians, psychiatrists, consultants all experts in their field. The two teams working together worked really well and the mental health team knew what needed to be in the game to meet the healthcare objectives. Then, it was our job to make it work within a gaming environment.
GD: Gaming can get a bit of a bad rap out there sometimes. What would you say to those who may believe that gaming and health are somewhat of an oxymoron?
MN: The gaming platform is a powerful engaging, interactive and educational tool. Its uses are many from teaching people how to run a business, to giving them tools to help deal with depression. I believe serious gaming, e-training and gamification will be used and developed much more in the near future.
GD: And just to finish off, we’re interested to hear your opinion on the future of the games industry here in NZ. What is your crystal ball showing about this exciting creative technology sector?
MN: I believe that games with learning objectives such as serious games, e-therapy, e-health, training and the gamification of learning programmes will continue to grow quickly worldwide and there’s a real opportunity for NZ to be world leaders in this field.
Our thanks to Maru Nihoniho of Metia Interactive. If you have any questions you’d like answered after reading this interview, why not join the discussion on the Gamedojo forum.