Silja Litvin psychologist and founder of PsycApps and developer of the multi-award winning eQuoo – the emotional fitness game – talks us through her desire to use gamification to improve mental health
As a psychologist I have always been interested in behavioural health, the maintenance of it and how to treat mental illness. Working with clients at NELFT (North East London NHS Foundation Trust) and in a private practice was a life-changing experience that highlighted the fact that only 35 per cent of all the people in the UK are getting the mental healthcare they need. The stories and fates I have heard are harrowing and take a toll on the practitioners as well as the clients.
With mental illness being on the rise and insufficient care worldwide, mental health products that are scalable, affordable and evidence-based are a dire necessity.
As of now, 41 per cent of insurance company claim payments are mental-health related, and WHO says depression alone will overtake cancer by 2030 as the no 1 global disease burden.
After gaining a masters in psychology I wanted to continue research and started my PhD, but I also wished to create something new. Something that had an impact, that could reach thousands, maybe millions of clients rather than the few patients I would be able to help in praxis. That’s when I pitched the idea of an app to my supervisor, Professor Markus Maier at the Ludwig Maximilian University in Munich, Germany.
Psychology is a slow-moving science, mainly due to the responsibilities that come with innovation. After learning about digital therapies and their rather high success rate, I thought that smartphones would be the perfect platform for digital therapies due to privacy, easy accessibility 24/7 and the familiarity people have with this specific technology. Thankfully Prof Maier was intrigued and allowed me to develop PsycApps, an evidence-based app that treats depression, with which I conducted a trial study with over 1,000 participants, a pre- and post-evaluation, a test and a control group. While the app proved to significantly lower depression levels, it was impossible to commercialise because retention was sub-par.
Going back to the books, I discovered that all digital mental health therapies have issues with attrition – most digital health therapies, that is, not only in the mental health space. The best app in the world won’t be able to help if people won’t stick to it. Med Bukey – my co-founder – and I sat down with a number of app developers and came to the conclusion that gamifying the therapeutic process could be the solution. Games intensely stimulate the brain’s reward system, leading to increased interest and ‘stickiness’ to the game. The billion-dollar gaming market, serious games, gamified therapy for children and learning games such as Duolingo proved that there was a high demand for games. So why not for mental health games? Med introduced me to Philippe Erwin, CEO of Collision studios, a game development company that worked on games such as Game of Thrones, The Walking Dead and many more. A few weeks later, we signed a contract to develop a sub-clinical mental health game now called eQuoo.
The game teaches psychological skills that help build resilience – acting preventatively to heighten life satisfaction and happiness. Our beta in Australia and New Zealand generated over 4,000 downloads with a 4.8 rating in the app store, proving that users enjoyed the game, spending on average 10 minutes a session playing it.
While some companies like SuperBetter, Pacifica and Happify use gamification to make their mental health apps more attractive, no one has made an actual mental health game until now. I believe this is because most psychologists are unlikely to think outside the box of face-to-face therapies, game developers not having the academic expertise to develop mental health games, plus the conservative view that learning games are for children – even though the gaming industry makes billions every year. Games that are interactive and very successful, like Choices or My Story have no positive mental health benefits – and might have quite the opposite effect. My idea was to combine the know-how of the gaming industry with the benefits of psychology to make a fun game that would help people.
After the initial introduction to eQuoo with ‘Dr Joy’, our games avatar who has been designed designed to be a chatbot at a later stage, our game teaches two psychological skills for each level that the player must master before being able to unlock a choose-your-own-adventure game. In the story, the player has to use the skills they have recently learned to win the level. While playing the game, the player is asked questions that evaluate their personality on the Big Five personality traits. Then, after each level, the player is given feedback about their personality, positively framed. Throughout the game the player collects coins that unlock parts of the game and further information in a library with in-depth content on the skills, the personality traits and how they impact on people’s lives.
While writing the content for the game, a team of accredited UK psychologists and I used psycho-education, story-telling, positive psychology, low-level cognitive behavioural therapy (CBT) and gaming to make sure the skills are permanently implemented into the players psychological skill set, making them accessible for when stressful or emotionally complex situations arise.
My vision for PsycApps is to develop a mental health platform that is integrated into our clients’ everyday lives, being a part of their sought-after and enjoyed routine – just as checking one’s Facebook profile or watching Netflix is now. How about playing eQuoo on the tube or while waiting in line instead of Angry Birds?
PsycApps’ first product, eQuoo, is the beginning of an holistic and overarching mental care service, using gamification to bridge stigma, unawareness and treatment resistance as well as motivational thresholds. After beginning with prevention and resilience building, we will move on to evidence-based interventions for disorders such as depression and anxiety, for which we are now raising a seed round. The next step is to build multi-dimensional treatment opportunities such as IoT, VR, Wearable Tech, AR, AI and Voice Technology. These can all be used for ecological research, real-time diagnosis and mood detection as well as treatment support, combining IoT, Voice Tone Analysis, Facial Expression Detection and AI.
eQuoo is now available in the iTunes App and Google Play Stores in the USA, UK, Canada and Australia. We are looking for distribution partners while raising the funds to add the therapeutic game features that will be able to treat depression and anxiety.
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