Wednesday, February 11, 2009

EXP Podcast #12: The Therapy Game

This week will see the release of thatgamecompany's unique new title, Flower. In an interview with MTV Multiplayer, Jenova Chen, the co-creator of thatgamecompany, explained that he hoped that Flower will feel "like therapy" to players. This got us thinking about the ability of games to act as stress relievers and how both the mechanical and narrative techniques in games affect our mindsets. We also talk about the traditional notions of why some games are considered relaxing, and we explore the soothing possibilities of games that normally would not be considered calming. We invite you to relax, take a deep breath, and then jump in with your thoughts!

Some discussion starters:

-What games, if any, do you use as "therapy?" Do they fall into one genre, or are there any you think are "surprisingly" calming?
-Is there a contradiction between a therapeutic game and one in which the player partakes in destructive in-game behaviors?
-What kinds of themes and imagery do you think of when you here about a "therapeutic game?"
-Does a genre of meditative or Zen gaming need to exist, or can it be encompassed within larger categories?

To listen to the podcast:
- Subscribe to the EXP Podcast via iTunes here. Additionally, here is the stand-alone feed.
- Listen to the podcast in your browser by left-clicking the title. Or, right-click and select "save as link" to download the show in MP3 format.
- Subscribe to this podcast and EXP's written content with the RSS link on the right.

Show Notes:

-Run time: 25 min 43 sec
-Patrick Klepek's article with excerpts from Jenova Chen: "‘Flower’ Should Make You Feel Better About Yourself, Argues Creator"
-Music provided by Brad Sucks


  1. A lot of the thing you describe as "therapeutic" are things that are also listed as a property of Flow by the Flow theory by Mihály Csíkszentmihály. It is no accident that the first game of That Game Company was called "Flow". The game Flow was part of a JenovaChen's thesis about the Flow Theory.

    I like that you pointed out that nature and growth is also an important cultural convention. I agree. Zombie slaying might be very calming and therapeutic but it is difficult to sell that notion to others. If a game designer wants to create a calming game, his thematic choices would gravitate towards nature.

    So, have you played it yet? Everybody else is yapping about it. Of course, I just envy them because I have no PS3. :-(

  2. Thanks for mentioning the Flow Theory; I meant to talk about the psychological aspect on the podcast, but I forgot.

    Both Jorge and I have played Flower, and we'll be reviewing it tomorrow!

  3. Interesting podcast. About therapeutic games with a destructive mechanic, maybe Katamari Damacy? I find it somewhat soothing, especially on the levels without timers, but you are ultimately causing massive amounts of destruction, including rolling up living things that are trying to run away from you.

  4. I realize I should probably listen to the podcast before I comment, but I'm just too eager to jot some of my thoughts down about this topic before I get back to work. I'll listen later.

    I have a bachelors and masters degree in clinical psychology and am currently working towards a PhD in that area. I'm also a rabid videogame nerd, so this is a topic near and dear to my heart. Unfortunately, my field usually only discusses the negative aspects of gaming, which I find hard to deny anymore- I must admit that videogames have taught me many tactics for killing people and getting away with it, given me knowledge and maybe even skills in the use of lethal arms, and one night after many hours of playing Midnight Club 2, I found my trip to the grocery store afterwards required an inordinate amount of self regulation to properly obey speed limits and traffic laws.

    However, any psychological technique with real power can do good or can do damage depending on how it is used. It wouldn't be powerful if it was any other way. So, videogames must also be able to have strong positive effects on our psyches as well as the negatives that everyone warns you about. The main argument against videogame violence is that it models to children (and adults) all sorts of antisocial behavior, plus it has an interactive element that requires the player to virtually enact that violence. I haven't seen any scientific research yet that definitively shows that the interactive component really makes videogames any worse than books, movies, or other media, but everyone assumes it does. Modeling, however, clearly happens. Rather than focus on the negative though, I think video games also have the power to model pro-social behaviors.

    Lately, I've been playing a lot of Persona 3 and Persona 4. As a suicide specialist, I am more than a little disturbed that I gain the power of my inner demons in this game by shooting myself squarely in the head. Nevertheless, there is also a positive therapeutic aspect to these games with a very pro-social message: you must lead a balanced life that combines your work, school, and friendships in order to succeed in your game life. If you don't create strong relationships with your friends, they won't be as helpful to you in battle and your ability to live up to your persona's potential won't be nearly as strong. Likewise, you can't develop relationships with your friends if you lack characteristics like courage, understanding, knowledge, expression, and dilligence that you gain from doing work and defeating evil. Plus, everything happens under a time limit, so you have to choose how you are going to spend your time wisely. Maintaining this kind of balance with a focus on managing time effectively is EXACTLY the key to a healthy psychology. This is the kind of thing I try to get across to my clients all the time, and it is beautifully mapped out into the game design of the latest persona games. I often find that while playing the game, I'm reminded that I need to do my own real-world homework or that maybe I should hang out with a nice real-world friend. It also reminds me of the importance of confronting one's inner demons, accepting both the good and bad in oneself, and with the self-understanding gained from that, create your best ideal persona that ultimately becomes who you are- I am thou, and thou art I. The Persona series is one of the very few videogames that have actually inspired me to become a better person (which is very surprising given the amount of times you shoot yourself in the head in P3).

    There is another kind of therapeutic aspect to games, which is largely what you are discussing with flower, which is that ability to soothe and provide a sense of flow. I actually don't think being soothed is the goal of psychology by any means, so I'm much more interested in games like Persona that provide you with an example of living a well balanced life. Nevertheless, the soothing aspect of videogames can be used to great advantage when we are talking about temporary relief from pain. There is a researcher at my university named Hunter Hoffman that uses virtual reality as a form of treatment for burn victims. Anyone who has suffered a severe burn has to go through these routine cleanings of the wounds which are basically scraping off your burned skin with a cheese-grater-like instrument. It's horrendously painful. What Hunter has done is to hook these people up to a virtual world where they are gliding through icy canyons and throwing snowballs at smiling snowmen as they go by. The results are astounding. People using the VR snowman game report pain reductions as every bit as dramatically as people on the strongest analgesic pain meds available. Incredible! The critical element is the ability of VR to immediately immerse you in a fantasy world by taking up your field of vision and overcoming your hearing with noise cancelling audio headphones. The icy images are the opposite of the burning sensations these patients have and by wearing VR goggles, they aren't able to see their wounds while they are being scraped away (or hear the process because of the noise-cancelling headphones pumping relaxing Paul Simon music into their ears). Normally, everyone wants to see what is happening while they go through the dermabrasion procedure, but not when they can have a cool VR helmet on. This ability to immerse oneself into the virtual world powerfully distracts the mind away from the physical pain they would otherwise be experiencing. It works just as well as pain meds without any of those annoying side effects.

    Hunter Hoffman has also done work using virtual reality to help people with severe phobias or even Post Traumatic Stress Disorder. The standard treatment for these disorders is exposure therapy. Exposure works on the principle that people have overgeneralized their fear beyond the feared stimulus, and this is leading to increased anxiety and problems in their life. For example, the dog phobic is not just scared of the dog that bit them, but of little puppies, pictures of dogs, streets where dogs might be behind fences, etc. In exposure, you repeatedly expose yourself to the nonharmful feared stimuli until your anxiety eventually subsides and you are eseentially bored with it. A toy spider can scare the hell out of a spider phobic, but if they force themselves to stay with it until the fear subsides and they do this repeatedly, they will eventually lose their fear of spiders (except for the ones that are actually dangerous). In exposure you also usually start with feared stimuli that are somewhat feared, then work your way up the hierarchy to the most feared. Hunter is using Virtual Reality to enhance his exposure treatments. By placing his clients in a virtual world, he can control exactly what they are exposed to and can increase or decrease the intensity at his command. He can also provide cross-modal experiences that stimulate multiple senses. For example, with one spider phobic, he had her looking through the VR goggles at a huge virtual spider. She also had a sensor on her finger that would allow her to move her virtual finger around in the VR world. A similar sensor was attached to a furry toy spider that Hunter was holding up. He could move the toy spider around in the real world, and that motion would correspond in the virtual world and when his client was ready, she was able to reach out and touch the virtual spider and when she did she felt the fuzzy sensations of the toy. This provided a dramatic multi-sensory effect and was the critical turning point in the therapy. Traditional exposure treatment had not worked for this woman's spider phobia, but the VR enhanced exposure therapy did, particularly after this cross modal experience of touching the virtual spider.

    Another thing video games can do is teach us a new skill. I fell in love with Guitar Hero instantly. I'm also a musician, so I know it can take years of patient practice to develop the skill required to play a new instrument. I was AMAZED at how quickly I was doing insane fingering maneuvers on my stupid little plastic guitar, but it felt similar to the mastery I have over the piano, which was really cool. What makes the game so incredibly good at teaching is that it uses perfect behavioral principles of operant conditioning and shaping. First off, the game uses positive reinforcement to excellent effect. Every note you hit correctly, comes out sounding perfect and the crowd responds accordingly. You have a meter on the side that tells you how well you are doing and the music production improves so that it sounds more rocking the better you are doing and the crowd gets more into it. The animations on stage get better and you can even build up your power meter to really rock out. Punishment is also in effect-you have clear feedback when you make mistakes. You hear that annoying "clunk" sound whenever you miss a note and the audience gets less interested if you can't keep up. The game also shapes you throughout the stages to get better and better, but you will sound just as good in the easy stages as the later hard ones, you just feel more godlike in the hard stages. In the real world of music making, there is no experience like this that is so much fun, so well designed to give you instanteous feedback, and so quick to pick up and learn, but that's not to say that there couldn't be.

    Unfortunately, no matter how skilled you become at Guitar Hero, it doesn't translate directly into being able to play an actual musical instrument. This does suggest though, that videogames can teach you to become quite skillful at something. If only they made a Piano Hero game with a MIDI based keyboard system, you could actually train people to be excellent pianists with this kind of game format. And even thinking beyond the ability to teach music, any sort of skill could be taught through the medium of videogames that cleverly use operant conditioning. With the right amount of ingenuity, I could imagine a Cooking Hero or a Public Speaking Hero or even a Relationship Hero.

    In summary, I think video games can utilize principles of modeling, operant conditioning, exposure, and immersive distraction to be profoundly therapeutic. We simply need to make games that actually target these effects because as of right now, the therapy of videogames is merely a side-effect in their attempt to be entertaining. If they can be designed to actually treat disorders, this could become an interesting new direction for the videogame industry.

  5. @csecrist

    Epic post on which I agree on all accounts. I'm particularly intrigued by the Persona example. It is a game I would love to play if I had the kind of time the game demands.

    The VR psychology study is interesting too, not just because it can help others, but it is interesting in regards to conditioning gamers and non-gamers through their play time, for the benefit of the over all experience. Say horror game design for example.

    Lastly, I would recommend this recent escapist article by Jamie Dunston (

  6. @David:

    I too found it deeply satisfying to roll up entire buildings. Could it be the game's presentation that allows for wanton destruction to feel relaxing? Perhaps the stylized, simplistic graphics allow the requisite amount of abstraction?


    Wow, thanks for such an in-depth comment.

    I think your point about Persona is extremely important, as it brings up both games' potential for positive behavioral influences, and addresses how this potential can be implemented in games. No one wants a preachy game, so it seems that the trick is to incorporate "pro-social" messages into games on a level where they effect people without hitting them over the head or nagging them.

    Hunter Hoffman seems like a really interesting guy; we're all lucky to have folks like him who take novel approaches to old problems.

    Do you ever see yourself incorporating video games into your research or practice?