Gamifying mental health

(H/t to @TDAungst for bringing this to my attention by way of a brief write-up.)

In a substantial post on Simulacrumbs which kicks off promisingly with a graphic depicting the OODA loop, Alexander Boland writes:

Putting two and two together, it finally hit me that attention can be specifically defined as sensitivity to feedback.

So what does all this have to do with video games and their uncanny ability to fully engross even the most scatterbrained individuals? The answer lies in the specific type of feedback provided by video games. Most video games, in comparison to many other challenges, provide feedback that is extremely loud, extremely frequent, and extremely simple. […]

But the spectacle itself is not the central mechanism by which games hook themselves into the player, but rather a supplement. It’s the very structure of the feedback: most video games are designed so that the simplest tasks are rewarded by some tinge of satisfaction. A few more points for every monster slain, various badges for different accomplishments, and all done at a pacing that gives the player a cookie right before they get bored. The role of the game’s audio and visual elements is to create a sensory anchor for this feedback loop, providing visceral cues and rewards for the habit loop constructed by the game. The player literally sees and hears the satisfaction that will come from obeying the cue that has come up.

With this at the back of my mind, I came across the brain-training start-up Akili, which is concerned with developing “clinically-validated cognitive therapeutics, assessments, and diagnostics that look and feel like high-quality video games”. Their website doesn’t say much about their approach (and I haven’t dug into the papers and press articles which might hold more) but here are some relevant pieces:

[…] advances in neuroscience research and consumer-facing technology are enabling a new way to sensitively measure neural function, and intervene in any measured deficits […] Akili’s products address both quantitative measurement of and intensive intervention in cognitive functions in a variety of patient populations.

[…] new software-based method to measure and improve a key system of executive function known as “interference processing.” […] currently being tested in a variety of clinical studies in multiple patient populations around the globe, including ADHD, autism, depression, and traumatic brain injury.

We believe that traditional cognitive tests are barely tolerable by the patient […] Our goal is higher quality, more sensitive cognitive data.

Part of the snipped material traces the development back to research out of the lab of Adam Gazzaley. A Nature news piece interviewing him clarifies that the product “draws on a mix of cognitive skills just as real life does — such as attention focusing, task switching and working memory”. This seems reasonable particularly for the ADHD indication (but also potentially unavoidable given how tangled the cognitive capabilities connected with WM seem to be; search for “attention” or “switching” in the Dual N-back FAQ and feel overwhelmed…).

I’m left with the question of what differentiates Akili’s product from existing brain-training platforms like the (arguably homelier) Cogmed. It might be what Alexander Boland identified as the “spectacle”. Some threshold of razzle-dazzle might need to be crossed to push positive feedbacks from exponential decay to exponential growth. Or, more simply, the activity might need to occur under a sufficiently game-like facade to pattern-match to being one.

Alternatively, it may be that diagnosis is more likely to be successful than treatment (medically, technically, legally, etc.) and quantitative measuring/monitoring is correspondingly easier than diagnosis. For the challenge of fixing broken OODA loops, this might conceptually be the right place to be working. It’s hard to argue that Beeminder is treating me for anything even though it’s allowed me to bring to bear willpower that I couldn’t summon neurologically (e.g., already more miles of running logged year-to-date than through maybe July last year). And even though though I remain terrible at chess and just as bedeviled by time trouble in that domain as in real life, I still haven’t encountered a better way for quantifying how mentally sharp I am at the moment.