INNOVATION| 02.11.2022

Therapeutic videogames: What if your doctor could prescribe you a videogame?

Redacción MAPFRE

The US has just authorized a medical prescription videogame for treating attention deficit hyperactivity disorder (ADHD) in children. Therapy that uses digital games to improve the lives of patients with chronic pain, depression, Alzheimer’s disease, autism, dyslexia, or mental health issues is growing at a remarkable pace, as it the demand for proof of the benefits it claims to deliver.

In July 2016, millions of people downloaded an augmented reality videogame, and they hit the streets and visited parks around the world to locate and capture the cute little creatures it featured. Using their smartphone cameras like butterfly nets, players interacted, met up in different locations, and shared information about the 151 original species that were released by the creators of Pokémon Go. The craze made headlines around the world.

Just a few days after it was released, a 6-year-old boy from New York’s story went viral. Ralph Koppelmon has autism spectrum disorder and he used to barely ever talk to anyone. When the Nintendo app started to become popular, he went outside to capture Pokémon and began to interact with others in a way “he’d never done before,” explained his mother in an exchange posted on Facebook.

That summer social networks were full of posts from parents and experts discussing the benefits that this videogame was having on children with these types of disorders. There was an even a rumor that Pokémon’s designer from Japan, Satoshi Tajiri, had Asperger’s and was consequently also neurodivergent, the implication being that this helped him develop the game. The rumor was denied.

Just a year later, in 2017, a small North American digital medicine company, Akili Interactive Labs, started getting serious about releasing a videogame that could serve as a therapeutic treatment for ADHD, which affects roughly 10% of children in the US aged between 4 and 17, though the figures can vary significantly from state to state. (Kentucky, for example, has an ADHD rate of 14.8% of children, while at the other extreme, Delaware and South Carolina have rates of 7%.) Currently, 6.1% of American children are being treated for ADHD with medication and the number of diagnoses is up over 40% in the last eight years.

Recently, in July 2022, EndeavorRX, designed by Akili Interactive, was cleared in the US by the Food and Drink Administration (FDA) for use in attention deficit hyperactivity disorder treatments (ADHD). In fact, this videogame has also received Conformité Européenne (CE) marking, allowing it to be marketed in the European Union. EndeavorRX is the first medical prescription videogame, and it will serve as a complement to drug and therapeutic treatments.

Throughout these years, Akili Interactive conducted studies of the videogame with over 600 children, and with the participation of neuroscientists and developers. The company’s main aim was to stimulate and improve certain areas of the brain linked to attention. The mobile device game is a typical racing game featuring an alien that travels in a spaceship collecting objects. The program starts with three months of therapy where the child dedicates 25 minutes a day to the game, which is enough time for them to ignore distractions and focus on their activity.

Pioneering study on stopping painful chemo for children

More and more studies are being published about the therapeutic potential of videogames, and more researchers are also showing interest in discovering the benefits they have, and not just for neurological disorders. Depression, dyslexia, Alzheimer’s, mental health, and physical pain are some of the other conditions experts are targeting.

Dr. Francisco Reinoso-Barbero, head of the Pediatric Pain Unit in Hospital Universitario La Paz (Madrid), is in charge of a groundbreaking study that has demonstrated that videogames can alleviate pain for children with cancer and help them to heal. The most common type of pain stems from chemotherapy treatments. “Mucositis is a type of pain that occurs when all the mucous membranes are blocked and hurt. It attacks the mucous cells and it’s as if the patient had swallowed bleach and their esophagus was burnt and inflamed,” the medical specialist explained, conveying the pain and anguish that chemotherapy provokes in young children.

“We saw that one of the things that indicated if a child was okay or not was if they were able to play, have fun, and be at ease. If they’re not in pain, they play. We did the opposite by looking at what would happen if we tried to get them to play. We chose a model with children that need a very high dose of morphine to deal with the pain. The result was that when we gave them videogames, they needed less morphine, and said that it hurt less,” commented Dr. Reinoso-Barbero.

To learn about how virtual reality affects mucositis pain relief, this specialist collaborated with Fundación Juegaterapia (Game Therapy Foundation), which gathered all the materials and distributed the devices in the hospital center. “Two hours of videogames a day,” claimed the doctor, “is the optimal amount of time to achieve this analgesic effect. That way we avoid bad posture and make sure they don’t get hooked on the game.”

The videogames they use are psychologically adapted, and they are not bloody or violent. “They’re about animals, trips, or historic events. The youngest participant in the study was 6 years old and the oldest was 16. The most important thing is that when you play, your illness recedes.”

Reinoso-Barbero is optimistic about the therapeutic potential of videogames being applied to other types of pain. “In this day and age, many illnesses cause children severe pain.” The head of the hospital’s Pain Unit recalled how one boy would get sick just thinking about an upcoming chemo session. “So one day we gave him the videogame and he started playing it immediately. When I went in to check his vitals, I asked him what time he’d had his chemo and he answered: ‘No, they didn’t give me chemo today.’ It was incredible, he hadn’t even noticed that he’d received chemo. He was oblivious to the medication because he was totally absorbed by the videogame. That complete disconnection gave us the sensation that this therapy was working,” recalled Reinoso-Barbero.

Mental health games pursuing medical certification

Another area putting its faith behind gamification’s potential to be a tool for improving mental health is cognitive training through digital games. The Guardians, a project started by the Massachusetts Institute of Technology (MIT), was designed to help people improve their lives through the power of digital games. Specialists at MIT are aiming to create a series of videogames that offer rewards, not for watching ads or through in-game purchase, but for completing healthful activities that improve your mental health.

Along similar lines, CogniFit is a digital health company created by the Israeli Shlomo Breznitz that is on the cutting edge of what’s known as brain fitness. According to their website, more than 4 million people use their brain games that are available in 18 languages. CogniFit, under the helm of Spanish CEO Carlos Rodríguez, is now looking to expand to the market for treating brain diseases and is trying to get several of its products approved for use in treatments for depression, insomnia, or epilepsy.

Avoid scams by using certified games

In America, which leads the world in these applications (brain games), the FDA requires companies to obtain individual certifications for potentially therapeutic products that they intend to sell. “Requiring certification for therapeutic games is a way of preventing snake oil remedies. What a videogame does and how it avoids any harmful side effects is analyzed in detail, because it’s clear that everyone learn through play,” commented Jordi Albó Canals, a social robotics specialist who heads up Lighthouse and is considered one of the most brilliant figures in the field of applying technological solutions to improve people’s well-being. “Companies might talk about the benefits of a game and how it can improve a person’s capacities, but they can’t be all talk, they need to demonstrate it and certify it. In the end they need to go through the same procedures as any drug would,” he stated.

Albó admits that concepts like serious games (products that are somewhere between educational software and commercial videogames), playful learning, and social and emotional learning in education are popular because they can help improve people’s well-being.

The problem that Albó has detected is that it’s very common for the objective of the game to become more important than the therapy itself. “The danger of gamification is when the objective of the therapy turns into the objective of the game instead of the therapeutic objective. That addiction that videogames can sometimes cause, which can be beneficial, carries the risk that using game therapy can have a numbing effect similar to opioids. If the therapy consists entirely of getting points and doing anything to get to the next level, the patient will only focus on that. It’d be like playing soccer, not to do exercise, but just to win the game. You’d spend the whole game kicking the ball because that’d be the only way to win. That’s one of the risks, I think.”

Advances in dyslexia and dementia

Another potential use for videogames is to help children with dyslexia to read more fluently. Dyslexia is a specific learning disorder that causes problems with reading comprehension and word recognition. Though it’s not easy to measure how much of the population is affected by dyslexia, Dyslexia and Literacy International, a non-governmental organization working in the field, estimates that it affects approximately 10% of the world’s population (more than 700 million people).

In 2017 the journal Nature published the results of a study carried out by scientists from the Basque Center on Cognition, Brain and Language (BCBL), an international research center located in San Sebastián in northern Spain, and the Psychology Laboratory at the Université Grenoble Alpes in France, that demonstrated that action videogames and books involve closely related visual processes, showing that certain digital games “can significantly improve dyslexic children’s visual attention and reading speed.” The experts chose to use action videogames in the study because they require players to react quickly and stay constantly alert.

The same is true for cognitive disorders like dementia or Alzheimer’s, which still have no cure and are treated with palliatives that are not sufficiently effective. Research on videogames, especially those known as serious games, would focus on finding non-pharmaceutical entertainment therapy tools that could prevent or delay the onset of these illnesses. Among the latest findings, the studies of the National Institute on Aging (a division of the U.S. National Institutes of Health) are especially noteworthy, as they discovered that videogames (Super Mario and Angry Birds, specifically) can improve the memory of people between 60 and 80 years old.

Using virtual games to combat depression and loneliness

What implications are there for virtual games being an escape mechanism for people who feel lonely or depressed? What if they could be used as an effective tool for improving mental health? Four researchers at the Victoria University of Wellington (New Zealand) concluded in their study, The Effects of Casual Videogames on Anxiety, Depression, Stress, and Low Mood, that this type of digital entertainment (videogames that are simple, easy to use, which can be played in short bursts of time) can have therapeutic effects on mental health.

Defense games like Plants vs. Zombies, puzzle games like Frozen Bubble, Bejeweled 2, Peggle, Bubble Shooter, or Bookworm Adventures, arcade games like Sushi Cat 2, and reflection games like Personal Zen have demonstrated very positive results linked to lower anxiety levels, stress relief, affective recovery, prenatal stress relief for pregnant people, and less nervousness in studies on the matter.

In reality, though a miracle cure doesn’t exist, it does seem that therapeutic tools can provide symptom relief for some mental disorders, with videogames being one example. Classic role-playing games like Dungeons & Dragons, based on the mythology created by the writer J. R. R. Tolkien, are also used in group psychotherapy to work on creativity, communication, and collaboration. The therapist is able to take on the role of Dungeon Master in this online videogame, and it also allows the patients to project real-life situations onto the imaginary worlds and lets their creativity flow, given that it is a role-playing game. Likewise, the game can help modify the patient’s behavior through reinforcement and character development, and it can help improve their social skills and self-esteem by learning strategies and how to communicate.