A Digital Approach to Mental Health | General Wellness | Hudson Valley | Hudson Valley; Chronogram
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A Digital Approach to Mental Health 

Fighting Depression with Avatars and Apps

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In the Bay Area, men and women in their golden years are logging onto iPads to fight invading aliens and explore new worlds via rocket ship. These senior citizens are not your usual gamers; they're booting up and taking on avatars in the name of science. As participants in the clinical study "Games to Overcome Late-Life Depression (GOLD)," they're prescribed a 20-minute daily dose of a video game called Project: EVO to measure how the game might boost their mood and mental health. A small pilot study completed last year had positive results, with nearly 100-percent adherence among participants. That's better than drugs: Adherence rates for antidepressant medications hover around 50 percent. Whether it's the nagging blues or a life-altering condition, depression affects about 2 million of the 34 million Americans aged 65 and older, according to the National Institute of Mental Health.

Project: EVO is part of a growing cadre of brain games designed to improve cognitive function in older adults. "By improving their cognitive abilities, might we also improve their depressive symptoms?" asks researcher Joaquin Anguera, assistant professor of Neurology and Psychiatry at UC San Francisco, who is coleading the GOLD studies along with Patricia Areán, a psychologist at the University of Washington. "We thought that by improving one area, we might be able to help the other. We found [in the pilot study] that their mood got better." The researchers are motivated to seek out alternative treatments to depression besides pharmaceuticals. "We're looking at video game treatment through a behavioral mechanism that doesn't involve medications," says Anguera. It's also not a far-off assumption to say that some people would rather play a video game than parse through their feelings in talk therapy.

Video game "treatment" sounds odd to most ears, and it certainly raises some eyebrows. Gaming gets a bad rap, labeled a waste of time, or worse, as a means of propagating violence. Project: EVO, developed by biotech company Akili Interactive Labs and based on neuroscience research by Anguera, doesn't intend to fall into the either category. The game teaches you to respond to certain stimuli and to ignore distracting information; the hope is that this can translate into helping people ignore or turn off negative emotional cues in real life. (In psychology speak, this is called "far transfer": the idea that a game can help the brain improve at an unrelated task for a therapeutic benefit.) If it's a leap of faith to believe this, the science will speak for itself; if the current, larger study into Project: EVO demonstrates positive results and no objectionable side effects, Akili will receive FDA approval to market the brain game as a treatment for depression, and it will become available for doctors to prescribe, just like a drug.

"No matter how well it works, we don't think this is the solution," says Anguera. "It's another solution—for example, for people who live in remote areas or who may not have access to cutting-edge care. Until it's fully evaluated, no one should assume it's the right solution for them." Meanwhile, he and Areán have been surprised by some feedback from gamers, many of whom reported that they engaged in less negative self-talk during the pilot study. The senior citizens also just plain liked the game, as if it were a pill encased in a more palatable candy coating. Says Anguera, "They didn't want to give back the iPads because they were enjoying it so much."

The Superhero Approach to Tackling Mood Disorders

Novel methodologies like video game therapy and smartphone apps are bringing mental health interventions and treatments into the Digital Age, propelled by the hope that they can reach more people across the age spectrum. Of course, not everyone is convinced that such unusual modalities can work, and some psychologists have questioned the evidence behind brain games. Other voices say that some form of play is essential for the wellbeing of humans of all ages—including Stuart Brown, founder of the National Institute for Play and author of Play: How It Shapes the Brain, Opens the Imagination, and Invigorates the Soul (Avery, 2006).

Game developers like Jane McGonigal share Brown's conviction. McGonigal created the app SuperBetter to help herself recover from a deep depression and suicidal thoughts after sustaining a serious concussion. Limited in what she could do as she waited for her brain to heal, she conceived a game out of the daily self-care and baby-step progress required to surmount her medical and emotional challenges. SuperBetter unfolded into a series of Quests (daily missions) and Power Ups (small, feel-good activities) to help people overcome obstacles, all with the aim of scoring Epic Wins (larger, end-in-sight goals and achievements). Players are asked to create a secret identity (your Avatar) to help you feel strong, and there is an emphasis on social bonds (your Allies) to cheer you along on your mission and keep you accountable. The app is free, and the idea is to become the superhero of your own life as you quest toward super-betterness.

Not just designed for mental-health challenges, SuperBetter is super malleable: People have used it for everything from dealing with a chronic illness to losing weight or facing a difficult diagnosis. Its basis in happiness research can make it a good fit for someone confronting a mood disorder like depression, just as McGonigal used it to pull herself out of an emotional abyss. The game's detractors say that SuperBetter is colored by too much positivity in a way that sugarcoats life's challenges. Yet there is some science around what McGonigal calls "post-traumatic growth," or the belief that our difficulties can make us stronger, a core idea behind SuperBetter.

Britt Bravo, a creative coach and consultant based in Oakland, California, used SuperBetter two years ago to help combat PTSD after a medical trauma. The game offered her small, manageable goals that she could tackle each day. "It gave me focus and control in a situation that felt out of control," she says. "If you feel anxious and depressed, it's not like you have a wound that you can see heal. You can't watch your nervous system heal. But it made me feel like I was making progress towards recovery."

Per the game's instructions, Bravo created a secret identity that combined some people she admired (fictional adventurer Lara Croft, crime solver Maisie Dobbs, and singer Michael Franti) for inspiration. A daily Power Up could be as simple as taking a walk around the block or playing Angry Birds. A Quest could be getting acupuncture or taking a Zumba class. In the end, she achieved her Epic Win: successfully overcoming obstacles and anxiety so that she could take a trip with her husband to Maine. As the months went by, she felt more like herself. "I liked that [SuperBetter] gave me a series of small wins. I looked forward to it," Bravo says. The game's bright-eyed positivity held appeal and egged her on. "It was silly and fun, and that probably helped more than anything."

Saving Lives? There's an App for That

The game-ification of life doesn't work for everyone. Depression is a serious and complex mental health issue that people experience differently and in varying levels of severity. Even in the midst of a deep, dark depression, ideas of harming oneself might never come to the surface. But if they do, one app developed in the Hudson Valley could be a lifesaver.

The Suicide Prevention Education and Awareness Kit (SPEAK) app is a tool designed mainly for friends, family, and community members at large, in addition to at-risk individuals themselves. Available for free smartphone download in both iOS and Android versions, it's something that people can have with them at all times. "We wanted to engage a new technology to help people," explains Vincent Martello, director of Community Health Relations for the Ulster County Department of Health and Mental Health, who worked with a team of mental-health professionals under the aegis of Ulster County Executive Mike Hein to create the app. "It's not meant for long-term therapy," he explains, "but it's something to help people recognize the signs of suicide risk in people around them. Features include instant call and text buttons to seek more expert help. The analogy would be a first-aid kit. We chose an app over a website because we knew we'd be able to reach more young people with it."

The three highest risk groups for suicide are veterans, teens and young adults, and older adults. Alarmingly, some experts have witnessed an increase in teen and young adult suicide risk in recent years. "A school counselor told me, 'If we had a handful of students in previous years with suicidal ideation, that would have been a lot. Now we get them every week,'" says Martello. He sees mitigating factors like the breakdown of family and community, pervasive violence in our culture, and the omnipresence of social media, which amps everything up. Pressure to perform in school also begins at an early age. "All these things combined can become a toxic mix."

Launched in 2013, the SPEAK app has been made available to communities worldwide for free; it's been downloaded in various cities and countries, from Huntsville, Alabama, to Spain and the Caribbean. Recent updates to the app include an added element for the LGBTQ community, which faces special issues with stigma and discrimination. The app gives people anonymity, and as such, the county does not use it to gather data. Buttons throughout the app link to 24-hour crisis hotlines, which connect people to highly trained professionals. Because of the nature of the technology and the anonymity, there is no feedback loop to let administrators know if the SPEAK app is actually saving lives. But one school counselor in Kingston told Martello a story about a student who had a friend with suicidal thoughts. "This student went to her friend and helped her. The counselor said, 'How did you know what to say?' She said, 'Well, I have the app.'"

Amid the digital advances in mental health treatment and prevention, we can't forget about tried-and-true practices and evidence-based social services. People can always pick up the phone and call a hotline without the help of an app, and most regions have some form of mobile mental health assitance that's available on call. The Dutchess County Stabilization Center in Poughkeepsie offers an alternative to a hospital emergency room for mental health and substance use crises and is open 24/7 year-round. Mobile mental health services—available in Orange and Ulster counties through ACCESS: Supports for Living—bring responders to the home (or school or workplace) of a person in crisis. Sometimes it's a lifesaving service, and sometimes it's less critical but can launch the start of a treatment journey.

While social media, video games, and apps can help us feel more connected, they can also have the opposite effect. "Humans are social animals, and we need that connection," says Martello. "If we can't get it in real life, we'll get it virtually." Nothing can replace real, in-the-flesh human relationships. For people facing a mental health behemoth like depression, human connection might just be their Epic Win.

RESOURCES

SuperBetter

National Suicide Prevention Lifeline; (800) 273-TALK


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