While game-based learning is now accepted as legitimate pedagogy in education, game-based therapy is on the fringe of acknowledgement in the medical community. Despite major organizations like Games for Health, the knowledge that positive affect speeds recovery for several major illnesses, and the fact that mental health can be improved by shaping behaviors, you’d be hard pressed to find a doctor who would prescribe a course of games for depression or anxiety. Can you imagine an insurance company paying for an Xbox 360?

There is a general lack of awareness among students about therapy, social support, social services, institutional support, and how unmitigated stressors can lead to anxiety and depression.

The truth, however, is that many freshmen who enter college could benefit from play, which is known to relieve stress and provide practice for future adult behaviors. Freshmen enter college with more questions than answers. They come from highly structured high school environments, where they are told which classes to take and when to take them. Stress occurs when freshmen are suddenly asked to make several important life decisions while also being bombarded by new concepts and practices from professors and administrators. In addition to these stressors, many students are working full time, supporting their own families, or contributing to the income of their parents’ family. At York College, these non-traditional students are typically the first in their families to go to college, which implies that they have little guidance in the process.

Freshmen entering college are also unaware of the mental health challenges they face. Apart from students in the health sciences, few students receive formal training on anxiety and depression. There is a general lack of awareness among students about therapy, social support, social services, institutional support, and how unmitigated stressors can lead to anxiety and depression. According to several models of depression and anxiety, self-esteem is critical to sustaining mental health. A student who is overly pessimistic, blames themselves for external frustrations, or lacks the ability to self-sooth will be at risk for depression.

Consequently, we developed a game to help improve the self-esteem of students on a difficult artistic task. Most people feel they lack artistic talent, and that it would be difficult or impossible to develop artistic talent. Yet, many artists report that artistic talent is the result of training and practice. The goal of “iSketch” is to use art therapy to improve self-esteem in students that are “at-risk” for depression. We predict that students with low self-esteem or low confidence in their ability to draw will have higher reports of self-esteem after learning to draw with the game. It is our hope that this improved confidence will generalize to other domains.

There are some difficult challenges in conducting this experiment. First, without the supervision of a licensed therapist, it would be unethical to use this game to expose students to specific stressors that provoke anxiety. The game is not meant to be a post-traumatic therapy for anxiety or depression. Rather, the game is designed to foster confidence before serious stressors are presented. Second, we can’t objectively measure the quality of the art produced by the subjects, and thus we can only provide feedback on self-reports of quality. The game can directly affect self-esteem but not absolute drawing ability, which is satisfactory considering our goal is to improve esteem. The remaining details are provided in the project abstract:

 “Art Therapy is a variation of psychotherapy used to promote self-expression and self-confidence through drawing, sculpture, or painting. When used in conjunction with traditional therapies, it may alleviate pain associated with various pathologies or painful treatments like chemotherapy. While there is a paucity of research on the subject, art therapy appears to be more effective for subjects when used as a method for distraction. College freshmen are known to be at-risk for depression. Learned helplessness and pessimism are thought to contribute to this depression, and thus therapies that bolster self-esteem are known to help. Consequently, we developed a game where college freshmen learn to draw as preemptive therapy. We seek to improve self-esteem by demonstrating that difficult drawings can be accomplished with practice. It is predicted that reports of self-esteem will be enhanced because our drawing game can adapt to user performance in real time. Volunteers from the York College Research Subjects Pool will play a game where they have to complete several drawings in response to photographs or creative challenges. Upon completion, subjects will rate the success of their attempt. The self-reports of quality will be used to adjust task difficulty in succeeding trials using psychophysical staircase procedure. If this program is successful, we will consider developing a method to include exposure therapy in a game. Under proper supervision, a therapist might use our game as a safe way of introducing potentially stressful content to a patient. The therapist can use the game to regulate exposure therapy in a quantitative manner.”