The Guardians: Designing a Game for Long-term Engagement with Mental Health Therapy

Abstract

This work introduces The Guardians: Unite the Realms, a novel free-to-play and publicly released mobile game that encourages the adoption of healthy real-world behaviours in exchange for rewards that enrich the gaming experience. We describe the game, its grounding in a mental health therapy known as behavioural activation, and how we designed it to keep players engaged over time. Instead of using traditional digital health gamification techniques such as badges or leaderboards, The Guardians creates a motivational pull by embedding the therapy into a complete mobile game. In-game items earned via the therapy have an immediate purpose in the game and, thus, they are considered intrinsically valuable by players. Analysis of game interaction data from 7,782 real-world users suggests 15day and 30-day retention rates of 10.0% and 6.6%, respectively, which is more than double the average retention levels of most digital mental health interventions. Furthermore, players reported completion of a healthy real-world task on 69.0% of days played (37,574 completed tasks in 54,461 total days). We also report interaction metrics with game features and the effectiveness of the players' chosen real-world activities.Index Terms-digital mental health interventions, mobile game design, serious games, real-world user data, well-being, behavioural activation.

Interventions to Modify Psychological Well-Being: Progress, Promises, and an Agenda for Future Research

“…For example, one study of a game implementing mental health therapy in real-world conditions (7,782 users) reported 10% retention at 15 days which was a doubling of the previously reported retention rates. Despite this improvement, it is still the case that 90% of those who started therapy were not retained (Ferguson et al, 2021). Moreover, participants who drop out are often those who are most in need of the intervention or who are the least motivated, so failure to retain them can produce a biased understanding of efficacy.…”

Can a Recommender System Support Treatment Personalisation in Digital Mental Health Therapy? A Quantitative Feasibility Assessment Using Data from a Behavioural Activation Therapy App

“…The experiments in this paper use data from a free mobile game with an embedded behavioural activation therapy module that gives players in-game rewards for regularly choosing and completing real-world therapy tasks [12]. The game was released publicly in 2020 and has since registered over 10,000 users.…”

“…However, the game has a strict privacy policy 2 and so no identifying information was collected from the players, including no demographics or identifable locations 3 . The detailed design of the game is presented in past work [12]. For the purpose of the RS analysis presented here, Table 1 summarises the properties of the dataset.…”

Computational Empathy Counteracts the Negative Effects of Anger on Creative Problem Solving

“…Video games are an area of growing interest in affective computing and other computational sciences, where much of the work benefits from two key properties of video games. First, video games can deeply engage players and evoke poignant emotional experiences, thus enabling the study of various psychological constructs on large study or realworld user populations [20,21,22]. Second, video games can be customised to create highly controlled environments that probe specific cognitive and affective processes, thus giving researchers fine-grained control of their experiments and the ability to objectively measure constructs of interest by analyzing the game telemetry data of player actions and decisions [23,24].…”