Leveling up to Remission - A Clinical Study of Playing Toward Your Strength

[Music] Thanks so we heard before that there are new genres of games appearing and I'd like to talk to one of those and I'll make it short enough to have questions and I've got swag so you know swiss chocolates for people for the first person who asks a question afterwards if the question is good enough maybe but most like you know so maybe to set the stage a little bit for what players we have in the in the game we created I want to tell you a little story about myself when I was about 20 I went shopping with my sister which is a whole nightmare in itself and never done again

but I noticed a rash on my arm and I thought well you know I'll buy some antihistamines we'll be all good and indeed it went away but two weeks later it was full-blown it was back and I was delivered with a into the hospital and I stayed there for about five weeks nobody could find out what was wrong with me but I looked like a cross with a battered housewife that had the middle measles and that stayed for two years and it's now 20 years 20 odd years or later for those who want to calculate how old I am and it comes and it goes so you're catching me at a good moment a month ago I would have not have been able to probably perform this talk because more people would have walked out so those are the types of players that we designed our game for and I'm not alone the numbers are staggering if you look at you know depression there's still there's talk about it becoming a mental health epidemic almost 30 percent of

teens and young adults report self-report or have been noted and been diagnosed as depressed anxiety issues a lot of those come from chronicle issues according to the World Health Organization two in five young people under the age of 24 will have had at least one chronicle condition which means that it's something that lasts longer than three months and has a lasting impact on your on your emotional health those are big numbers and when we started this passion project we already had a book in the market we knew we wanted to provide help for those who really want to work on themselves and give them at an earlier stage interventions that they can use and so the first thing that we did was we looked at what do teens do online we wanted we knew we had the book the book was used in in to over 200 hospitals in the u.s. it was a more nonprofit

organization so all of our tools are free we're not also not doing in-app purchases or anything we just want to help basically which can also be tricky right what with what you provide then and so when we saw what's again what the teens we're talking about and that they do want to talk online we knew that it had to be digital we had to do something that really made sense and looking at these conversations that we mined so we mined about fourteen point two million conversations of teens in social groups on social media but also in online groups and forums through organizations like McMillan who have like an online community for mental health and and other communities like that we found that almost half the conversations are purely negative thoughts about you know suicide thoughts about not knowing how to go on with your life about 56% of those people said that they couldn't talk to anybody around them they really wanted to just you know go anonymous and

talk to people who'd been through what they had been through and we also started to see patterns emerge that depend not depending on what disease you have normally that's where you go into forums however if you have a chronic illness and you have cancer for example or if you have diabetes or if you have depression or if you're just anxious some common themes are the same and those are the kind of things that we looked at and that we explored so we came first from a psychological poins and looked at what kind of content do we need to offer to people and then what's our target audience and we knew we wanted to do something for teens because that's an audience in the healthcare that is really doesn't have many tools around that don't really have help oftentimes wait lists for psychologists are four to six three to six months and there's no help in between and so we knew we wanted to do something for that but then what to do right and so we figured well if you want to reach an audience that is on their mobile phone playing games then that's

where you got to go meet them with the content where they are at instead of making them come to us and then putting a white sheet of paper in them with totally serious questions that are very hard to answer on a white sheet of paper and we think that gaming has really an intrinsic value in being able to bring content across that otherwise would not really be palatable to them so being able to give them sort of exercises that would be used in therapy or give them information that can help them regulate their emotions or being able to help them understand themselves better and build more confidence those are all things that we think the the the natural things that gaming lends itself to is really enhanced by that so for example if you're in a game if you have to have a reward system you're more likely to really keep exercising you can't really can't really kick your brother under the table in real life but you can do it in a game so there's there's an obvious medium where you can really experiment and where you can in a judgment-free

environment exercise the things that you need to do to get better and let's not forget I mean it's so much more fun to figure out how to save the damn cat's than to actually read a 300 page manual on fire house response times and so we came up with a game and I just want to show you a little video not about the game itself you're welcome to download it it's no working we have Wi-Fi here it's free there's no purchases as I said but I wanted to show you one of our patients and what she said about the game [Music]

[Music] so this is one of our our players that we involved in our early better study and and she was one of the ones that really was from a concept phrase were out and so we learned a few things by working with teens on really creating a game for teens and for young adults that have health issues one of them is that they really like to be involved because of what they're going through they actually want to help others as well because they know what it's like and so for them to be involved in a game like this to help develop it and help reach out to others actually really was something that they liked we also learned that you can prove you can improve resilience through creating arts and creating stories because every time if you tell your story to somebody you tell it a little bit differently and that it that is because you start incorporating what happens into your story and that means that you're starting to accept what's happening to you and that means you can move forward and so we've noticed that a lot with the kids and so my talk in the topic of the

talk is for the studies that we created and the outcomes of those and therefore there we go and therefore I want to talk a little bit more about that than the game itself and I'll give some examples so we did an impact study of four weeks quite early on when we had a bet on when we didn't have like a backhand yet or anything but we had the major features and functions and the storyline and all of the all of the things in place that psychologically we thought would make it work so we worked with psychologists and team sessions we worked with the teens we had over 500 touch points and testing with the teens and that created the better and when we then had the better version we did four weeks of game play with 55 players that all had some form of serious serious condition so cancer or Lyme disease or chronic pain those types of things and we had them play three times per week for 20 minutes we did a baseline survey and an n survey we also

did player interviews with the psychologists we asked them to keep a player's diary to see how they were feeling while during and after they were playing the game and then we evaluated that we did this together with the Dutch government and with the University of Twente in the Netherlands it's not an official clinical study because you would have to have more participants for that quite quite frankly but we did really set the study up that way so that we could also publish some of the results and apart from the fact that a lot of the players came back and said you know I actually started talking to my parents about this and about what I'm going through because of playing the game and and that type of feedback we also saw that specifically measuring seven different types different components of building resilience in a person so making them emotionally stronger we it positively impacted very much three different topics and one is emotional regulation so being able to recognize your mood swings earlier and being able to intervene yourself and because you feel that this is coming up

and you know that it's happening then a positive self-identity looking at yourself differently and self-confidence and a positive outlook on life so optimism's all those three really help you better handle things that come your way in the future and because of that we got the interest from one of the largest hospitals in the u.s. nervous Children's Hospital and they are currently running a full clinical trial so the things that I'm talking to you about we've not published anywhere yet but I'm allowed to speak about the the preliminary results that we have it's we've recruited or they have recruited have to say because obviously we just gave the grants and they're doing this study this is a study with Laura's Children's Hospital Northwestern University and the Osher Institute in in the US and they've recruited 196 patients in their Hospital and their environments that are all at the end of cancer so they're going into remission and you think that that's fantastic right I mean that you've got a new life which is great but unfortunately it also

means that there is a lot of mood swings there's a lot of you don't know what's going on in your life moving for it and so therefore one of the things that they looked at again as well is just to see what is the variability I'm not going to name down the numbers here because you can read those but pretty much we see the same results as from the impact study that we did ourselves we see that optimism self confidence are improved we also see proactive coping is improved and we see that people write very short journal entries but they do want to reach out to others and they really like the in-game community here's some game statistics we've got almost 27,000 downloads so not quite my predecessor as a speaker not we're not quite there yet but the nice thing is we haven't done any marketing so this is all word-of-mouth this is all just people downloading it from hearing about it from other people and the mean playtime is is increasing which is also very very promising so with that just some learnings if you

want to build a serious game that has an actual purpose and that's what you build the game around so you have to involve your audience very early on which means it takes a lot of time it takes a lot of effort there's a lot of things that you have to think about in building evidence for what you do there's a lot of effort that goes into recruiting them you have to think about especially if it's something in health related that a lot of these people are going to jump up halfway we even had one of our better players die during this study because of his condition and all those types of things I think make game developments a smaller part of the project than the rest around it the other thing we learned is that it's very hard to bring such type of game to market as a small company we're a self-funded nonprofits we're team of 10 people some of them are part-time some of them are more voluntary workers we call them paid volunteers basically and so with that smaller team we don't we there's a lot

of tools we don't have access to publishers are not really interested in talking to us distributors not really interested in talking to us because it's all based on a revenue model and all based ads for example in game monetization all those things we decided at the beginning we didn't want the and that's a hard path to make those decisions and really say this is what we don't want in this stage that means that you have to really know at the beginning already that you're in it for a bit of the longer term and it's it's not a fast route to marking it as our predecessor said it takes time to build that and we also learned that one of the really good things that the kids like about our game is that it really feels like a good quality game and it's not just a game a fight app that asks you to walk around the block and then earn some badges but it does mean also that the psychological content has to be worked into the storyline into the characters in the game everything has to metaphorically work in the game to still be able to get that that psychological content across so

what does our future look like well we think that we hope that more games like these will pop up we see one or two already in the areas of like bullying we see things in the areas of healthcare education not that many and mental health yet but hopefully you know with with us and with other games actually starting that we hope that there's many more game developers that actually see that as their true passion and I invite you to ask questions about this thank you thank you very much super interesting and inspiring alright questions please first question gets chocolate alright who was the chocolate I want it no come on that question ya think you were a bit faster how did you like find the specific psychiatrist that you wanted to work with did you look for people in specific kind of fields of psychiatry or your question I never asked that question

never been asked that so we had one psychiatrist that already worked with us because my business partner the founder of the project she had a brain tumor when she was 19 and then that caused her to change her life and go into into psychiatry and she ran workshops at hospitals so she already knew a lot and through that we had a network of people that we could work with so yes we we have people from different areas of the field that work with us like end of life cycle psychiatrists mental health neurology psychologists pediatric psychologists so we've got a larger team of advisers that really help us on the content and all reviewed it with us and that keep on helping us with like YouTube and and other videos that help thank you question number two there was another hand all right thanks for the presentation so how do you see the game like in three years how do how do we keep momentum and how to keep the finances running because I expect it to

be like the your biggest issue I really really appreciate the effort and everything but like as a company owner myself I am a bit scared in Europe behalf on how you will keep this running and where's the game in three years and where's the company so that's not a largest problem which is great so we've got commitments for our our team as this for the next three years what we're looking for funding now and we are fundraising is you know additional things that we want to do we we have we want to really enhance the in-game community and make it a true platform for across illnesses and across conditions to be able kids to be able to talk to each other inspire each other by the graffiti they make in and things like that so we're fundraising for that we're approaching foundations but we also got some interest from VC companies for that which is really great and the other thing is cognitive behavioral therapy exercises we didn't learn to ride a bike by reading a book and so we want to build exercise into the games with

psychologists and we have quite a few companies that we're talking to now and hopefully one of them will bite that we're asking to sponsor it that are in like healthcare insurance companies those kinds of things to help us build it and then also do a study around it so it immediately also then becomes evidence-based but the the main funding for the like for the three years is done and to answer the the the associated question where do we see the game in three years well we have platform enhancements that we want to do in the area of cognitive behavioral therapy and obviously community so we see this becoming larger we think just from the prognosis looking back the last six months we think we can we can hit about a hundred thousand downloads end of this year with you know daily recurring players of a couple of thousand which in therapy is not bad and so one of the things that we really are now focused on is getting this game evidence-based that we can also go to psychologists to hospitals and have that be part of their therapy so that's that's our plan for

the next five years all right let's all try to get the word out about this game right so that the funding can come in don't you guys agree the more downloads easier it is for me to get the funding in so absolutely and if somebody wants some swag little things then you know where to find the game right thank you very much round of applause you [Music]