Video game for young people’s mental health

The challenge

Young people aged 10 – 14 in the UK have some of the lowest levels of wellbeing in Europe. Low levels of wellbeing place young people at risk of developing mental health problems, and many young people do not have the skills to deal with stress, or moderate their emotional responses.

Childhood and adolescence are critical times for developing these skills. However, despite the existence of proven methods for managing emotional responses using simple behaviours such as rhythmic breathing, there are almost no effective, mass scale, non-stigmatised interventions to help young people learn these methods.

The intervention

A video game that teaches young people rhythmic breathing, facilitates regular practice of these breathing skills, and thereby helps improve emotional regulation, and supports wellbeing.

Who is it aimed at?

Young people aged 10 -14.

How does it work?

The game uses wearable sensors to measure and analyse players’ heart rates. The more in control of their breathing and therefore heart rate the player is, the better they do in the game. Embedding this mechanism into a video game encourages young people to practice breathing patterns that have been shown to have a positive effect on people’s anxiety levels and are recommended as a relaxation technique by the NHS and Bupa.

Advantages of this approach to improving well-being

• Relevant and stigma-free – not marketed as a ‘wellbeing product’, so overcomes barriers preventing some young people from seeking help with stress, anxiety and emotional issues.
• Habit-forming – enjoyable game encourages young people to practice breathing techniques frequently.
• Scalable – potential to reach a huge number of young people as 9 in 10 children aged 5 -15 use some form of device to play video games at home and young people spend an average of 8.7 hours a week gaming.
• Evidence-based – underpinned by a substantial clinical evidence base demonstrating the effect that regulated breathing can have on stress and anxiety, and the impact of biofeedback interventions.

Who has created the game?

• Shift – Formerly known as We Are What We Do, a social enterprise with ten years experience designing consumer products that address social problems by helping people make better choices.
• Complete Coherence – A consultancy with a long track record and expertise in applying heart rate variability and neuroscience research to improve performance in schools, business and sport.
• Playlab London – A development studio which specialises in games that produce measurable positive changes.
• 2CV – An international research agency with specialisms in gaming and digital research.

The development to date has been supported by The Nominet Trust

How the game was developed

Teachers, youth workers, mental health paediatricians and young people were interviewed to understand the challenges they face in developing wellbeing, and managing stress and anxiety. This was followed by a review of the literature on the relationships between heart rate, breathing, emotional regulation and wellbeing, and consultation with a video games expert to assess how the engaging and addictive qualities of video games could be harnessed. A working, playable prototype game was then developed, which uses live data from a wearable heart rate monitor to affect game play.

How its impact was evaluated

In September and October 2014, a pilot was run in The Billericay School in Essex to evaluate the playability of the game, and its effect on young people’s self-reported wellbeing.

Sample included:

• The treatment group: 30 boys from Year 9 who had volunteered to play the video game for five minutes every lunch break for four weeks.
• A larger control group: All the boys from Year 9 in the school who didn’t play the video game.
• A smaller control group: a sub-set of 30 boys from the larger control group who didn’t play the video game.

Data collected from students:

• The Short Warwick-Edinburgh Mental Well-being survey was taken by all the boys in the sample before and after the pilot.
• Heart Rate Variability (HRV) measures (SDNN & RSA) were taken from the treatment and smaller control group before and after the pilot.
• Game play data was collected from the treatment group during the pilot, including time spent playing the game and HRV levels whilst playing.
• Focus groups were held at the end of the pilot with the treatment group to explore the boys’ views on the game, breathing in the game, any impacts of playing the game and awareness around the role of breathing in stressful situations.

In addition to the student data a survey was sent out to the parents of the treatment group and teacher feedback was collected.

The research design and analysis plan were reviewed by MindTech, recognised experts in the evaluation of technologies for mental health, to ensure our evaluation was rigorous, yet proportionate.

Results from the evaluation

The evaluation showed that regular play of the game taught players emotional self-control techniques that they could use in their everyday lives to deal with stress and anxiety. More specifically:

• The game created an enjoyable and engaging experience that encouraged repeated practice.
• The game encouraged compliance with the breathing technique
• The game taught players emotional regulation techniques that they transferred out of the game context
• The game was supported by parents and school staff

There was a small, but not significant, increase in the average SWEMWBS score for both test and control group, with the improvement in test group being slightly larger than the improvement for the control group. In the second pilot, currently being designed, we will be administering a follow up survey 6 months after the completion of the pilot, in line with recent evidence which shows that wellbeing interventions often have increasing impact over time.

Click here to read the full evaluation report.

Next steps

The game was a finalist in the 2014 Google Impact Challenge, securing resources for a second stage of research and development which includes:

• Hardware and software testing
• Development of a new version of the game
• Usability testing
• Impact testing with school students in a second pilot to be run in October 2015