Elderly Californians are battling aliens and exploring foreign worlds to help researchers understand whether an iPad game could help combat depression in seniors.
Depression in the elderly is a common occurrence. As they age, seniors become particularly vulnerable due to prolonged social isolation, the loss of a partner, or management of a chronic illness.
Although common symptoms can include low mood, crying, and irritability, depression in seniors can manifest as exhaustion or trouble concentrating on tasks, which can make diagnosis more complex.
It's also challenging to treat—research has shown that 40 percent of depressed older adults also struggle with cognitive disorders, which can reduce the effectiveness of antidepressants and some types of psychotherapy. Finding cheap and accessible ways to treat depression among the elderly is becoming increasingly important. By 2030, 21 percent of the population is projected to be over 65, according to a 2015 report by the US Census Bureau.
In a recently published eight-week study led by Patricia Areán, a psychologist at the University of Washington, researchers compared the effectiveness of traditional problem-solving therapy (involving journaling in planners, weekly appointments, and a seven-step problem-solving model) against daily video game play in the treatment of depression in those over 65.
Participants in the study played Project: EVO, an iPad game designed by Akili Interactive Labs, a biotech company in Boston. In the game, players navigate eight different alien worlds via rocket ship while collecting color-coded alien figures. As players advance, the driving becomes faster, oncoming targets accelerate, and the identifying characteristics that help a player to select targets become harder to distinguish.
Remarkably, the study had a 100 percent participation rate—an almost unheard-of statistic within this field. Despite their advanced age and the daily 20-minute playing commitment required, none of the 22 elderly participants from the San Francisco area dropped out due to illness or disinterest.
In comparison with cognitive behavioural therapy—which involves short-term counselling designed to change patterns of thinking, and can cost thousands of dollars for an eight-week session—a patient's only investment in video game therapy is the purchase of a game app and the upfront cost of a mobile device.
Apps can be downloaded anywhere, regardless of geographic isolation or distance from mental health professionals.
"I've always been interested in finding ways to make mental health care easier for people to use," Areán said in a phone interview.
"Games aren't for everybody," she continued, "but I think there's a big swath of people who would rather play a video game than talk to me about their problems."
Stigma can be another barrier to seeking treatment in older adults.
"A lot of people don't see a professional until they're really sick and they need it," she said.
The idea of using video games to boost mental health isn't new. A third of people over 65 are using digital games to improve their cognition, according to a study in Computers in Human Behavior. However, not everyone agrees on their efficacy—critics have challenged the belief that consumer-grade video games can significantly improve mental acuity.
Project: EVO is the first to be stacked against traditional behavioural therapy and come out the winner, although the number of study participants here was relatively small. Players of the game experienced marked improvements to their working memory and attention span. Surprisingly, they were also less likely to identify with negative self-descriptive language.
Project: EVO is currently under assessment for the treatment of other cognitive disorders, including ADHD, traumatic brain injury, and autism
"That blew us all away. It just was wild," she told me. "There's nothing in the game that has anything to do with that."
As opposed to commercially available, "over-the-counter" video games, Project: EVO has been specifically designed to target cognitive functions, its designers claim.
Although it was originally designed to treat children with ADHD, elderly participants enjoyed the game so much that they requested copies after the study ended, but were turned down, according to Areán. For now, the game is considered an experimental device and it isn't available for purchase.
Assuming that Akili gets FDA approval, consumers will be able to download Project: EVO directly onto their mobile devices. And in the future, the researchers behind the project hope it might be used to treat other conditions, too: it's currently under assessment for the treatment of other cognitive disorders, including ADHD, traumatic brain injury, and autism.
The diverse applications for video game therapy are numerous. Researchers at the University of Southern California are using virtual reality to help treat veterans with PTSD by guiding them through environments that mimic stationed combat zones, for example.
Areán envisions a future where doctors are able to prescribe video games as they would any other form of traditional behavioral therapy.
"You're gonna get a dose," she said, "as long as you follow the instructions and play it the way we ask you to."
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