Depression is common among young people, but this target group often does not get the help they need. Books, exercise, and other depression prevention programmes do not achieve the envisioned results for everyone. Video games might help reach another part of this target group. Anouk Tuijnman co-developed two applied video games to target depression in adolescents and will defend her PhD at Radboud University on 28 November.

Previous research revealed limitations in the effectiveness of existing depression prevention programmes: improvements to those programmes did not lead to sufficient results, and the programmes were unable  to effectively reach all young people. Tuijnman's research focused on the social context of depression: “A lot is happening in young people's lives when it comes to social interactions. Friends become increasingly important, but as a result, the impact of rejection on mental health also increases,” Tuijnman explains.

“I wanted to explore whether we could develop materials that help and support young people in finding help. In the process, my attention soon turned to video games. We were inspired by games like Stardew Valley, Animal Crossing, and Dark Souls, which we know have a positive impact for many people. Video games can provide an environment in which you can meet like-minded people, but also learn to deal with difficult moments.”

“Games have unique characteristics: they are a great learning environment to practice behaviour without consequences. We also know that interventions are more effective if they are entertaining and motivating. This is relevant because many existing anti-depression programmes can be quite boring. The message is more likely to stick if you use video games.”

Two video games

To test this hypothesis, Tuijnman joined forces with game developers to develop two applied video games: Moving Stories and ScrollQuest. In ScrollQuest, an action game, four players work together to defeat monsters and collect gold while responding to various social situations in the game's story. Tuijnman had fathers and sons play the game together to see how they reacted to these situations. “In the game, players get rejected. We explored whether fathers could guide their sons in dealing with these feelings of rejection. A first study found that the video game could successfully evoke feelings of rejection, and that the presence of fathers could mitigate negative feelings. But we did not observe any real learning moments yet. A second study showed that if young adults would play the game alone with online players, they could also experience feelings of rejection, but at the same time feel motivated to continue playing. We also found differences between young people who were more sensitive to rejection and those who were not.”

In Moving Stories, the players are concerned about Lisa, their fictional cousin, being depressed. They spend time with her in a house, trying to help her. They are presented with various options to help Lisa, which the virtual avatar then provides feedback on. Tuijnman: “We had an entire class play Moving Stories, after which we organised a Q&A session for the students with someone who had suffered from depression. We saw that participation reduced some of the stigma around mental health in secondary school. We also saw that conversations arose between students on the subject.”

Not a treatment tool (yet)

Tuijnman says that there are no plans to deploy the two video games in their current form. “If we want to do it well, we need more budget and time. However, ScrollQuest and Moving Stories do offer valuable insights for research and practice. They prove that video games have a lot of potential for improving mental health. In her current research, Tuijnman, who is now affiliated with the Trimbos Institute, is, among other things, looking at ways to help children and young people achieve a healthy digital balance in their lives.

Previous research revealed limitations in the effectiveness of existing depression prevention programmes: improvements to those programmes did not lead to sufficient results, and the programmes were unable  to effectively reach all young people. Tuijnman's research focused on the social context of depression: “A lot is happening in young people's lives when it comes to social interactions. Friends become increasingly important, but as a result, the impact of rejection on mental health also increases,” Tuijnman explains.

“I wanted to explore whether we could develop materials that help and support young people in finding help. In the process, my attention soon turned to video games. We were inspired by games like Stardew Valley, Animal Crossing, and Dark Souls, which we know have a positive impact for many people. Video games can provide an environment in which you can meet like-minded people, but also learn to deal with difficult moments.”

“Games have unique characteristics: they are a great learning environment to practice behaviour without consequences. We also know that interventions are more effective if they are entertaining and motivating. This is relevant because many existing anti-depression programmes can be quite boring. The message is more likely to stick if you use video games.”

Two video games

To test this hypothesis, Tuijnman joined forces with game developers to develop two applied video games: Moving Stories and ScrollQuest. In ScrollQuest, an action game, four players work together to defeat monsters and collect gold while responding to various social situations in the game's story. Tuijnman had fathers and sons play the game together to see how they reacted to these situations. “In the game, players get rejected. We explored whether fathers could guide their sons in dealing with these feelings of rejection. A first study found that the video game could successfully evoke feelings of rejection, and that the presence of fathers could mitigate negative feelings. But we did not observe any real learning moments yet. A second study showed that if young adults would play the game alone with online players, they could also experience feelings of rejection, but at the same time feel motivated to continue playing. We also found differences between young people who were more sensitive to rejection and those who were not.”

In Moving Stories, the players are concerned about Lisa, their fictional cousin, being depressed. They spend time with her in a house, trying to help her. They are presented with various options to help Lisa, which the virtual avatar then provides feedback on. Tuijnman: “We had an entire class play Moving Stories, after which we organised a Q&A session for the students with someone who had suffered from depression. We saw that participation reduced some of the stigma around mental health in secondary school. We also saw that conversations arose between students on the subject.”

Not a treatment tool (yet)

Tuijnman says that there are no plans to deploy the two video games in their current form. “If we want to do it well, we need more budget and time. However, ScrollQuest and Moving Stories do offer valuable insights for research and practice. They prove that video games have a lot of potential for improving mental health. In her current research, Tuijnman, who is now affiliated with the Trimbos Institute, is, among other things, looking at ways to help children and young people achieve a healthy digital balance in their lives.

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