A young girl glasses is sitting in her bed, with rays eminating from the screen reaching her brain.
Can mental health apps with a gaming twist keep children focused on their well-being? Photo courtesy: Pexels. Illustration by (c) Reset Fest Inc, Canada


Can Spending More Time in Front of the Screen Benefit a Child’s Mental Health?

Gamification can revolutionize mental health applications.

Delhi-based Instagrammer Preeti Pahuja’s two sons have taken to the COVID-19 induced lockdown as a vacation. Kirit, 15, and Kiaan, 10, spend their days talking to their friends, watching child influencers on YouTube, playing Fortnite, and now watching Instagram reels.

“It’s an addiction,” Pahuja told Re:Set. “They’re thinking this is the best part of their lives, as their learning has reduced and they’re home during the day with so much time on their hands. It’s like they’ve always wanted to do this. Not many kids like going to school.”

Like countless other parents hoping to curb screen time, Pahuja has tried to regulate their access to cellphones. Apart from virtual classes at school, they can use their phones for a maximum of two hours a day. She’s even enrolled them in Zumba and guitar classes online.

“But they keep asking for more time on their phones,” Pahuja lamented. “They even go crying to their grandparents, thinking they will be more lenient. And if we do take their phones away, they set up YouTube on TV.”

Image of an Indian family celebrating a birthday.

Pahuja struggles to keep her children’s screen time at a minimum. Photo courtesy: Preeti Pahuja

Even their mother’s Instagram fame, with her nearly 80,000 followers, hasn’t gotten past the younger son. “I’ve made it a point to not give them much importance on social media,” Pahuja stressed. “But Kiaan keeps asking me for a shoutout on Instagram.”

How screen time effects mental health

A large number of studies focus on the effects of increased screen time for children and young adults, and most of them paint a grim picture.

One study published in the Preventive Medicine Journal found that the psychological well-being of children getting seven or more hours of screen time a day was much worse than those using it for an hour or less. This was across a variety of well-being data points, including measures of self-control, relationships with caregivers, emotional stability, diagnosis of anxiety and depression, and mental health treatment.

There’s a reward mechanism in our brains, and more screen time activates it more often,” Prashant Punia, Associate Professor of Neurosurgery at Dr. D. Y. Patil Medical College, Pune told Re:Set. “For example if someone likes their picture on Instagram, they think about why this person has liked it and how is this going to affect our friendship going forward.”

Is all technology that bad?

Each like on a social media app activates the brain’s reward system and inflates a child’s small and still developing ego, Punia explained. The brain needs its rewards from time to time, but increased usage of social media apps from an early age links rewards to these likes intrinsically.

“When these apps aren’t available, children get anxious because in real life you don’t get rewarded at this pace,” Punia said.

Researchers have found that the detrimental effects of screen time in children are only increasing as usage rises with time. A 2018 study in Ireland found that screen usage was much higher in kids born in 2008 in comparison to those in 1998, resulting in the decline of their mental health.

But, is all technology that bad?

Gamification of mental health

The usage of mental health apps for kids have also recently spiked, especially during COVID-19, indicating that parents are also looking to use the screen as an effective tool for their child’s well-being. The problem here is the same faced by a majority of mental health apps: after a while, people just stop using them.

A clinical psychologist turned gaming company CEO, Silja Litvin was all too familiar with this conundrum. “I failed to retain users with my first evidence-based app, PsycApps,” she told Re:Set. “I did some research and saw that retention was a huge problem for mental health tools, and that the best app in the world was not going to help anyone if people didn’t stick to it.”

Litvin’s answer to get users to continue using these apps: gamification. It’s using game-like elements, such as levels and points to encourage participation.

Image of a young girl studying, with her tablet in front of her.

Turning mental health apps into mini-games got people to use the apps for longer. Photo courtesy: Pexels

“Those [living with] illnesses like depression and anxiety struggle with motivation, curiosity and being able to start and stick to tasks,” Litvin explained. “In order to get someone to digitally work on their mental well-being, you have to tap into the brain’s reward system. Gamification uses a lot of tools to do that. Like rewards, levelling up and earning feedback.”

The brain’s reward system can cause harm to one’s mental health, as Punia explained, but can also be trained to get people to spend more time on mental health applications.

Along with three other researchers, she published a paper based on the results of a mental health app she had designed that incorporated gamified elements. While building the app, the team turned to research on the uses of gamification and existing data including one study that found that only 10% of people with mood and anxiety disorders stuck to using apps despite downloading them.

After audience testing, Litvin and her team found that the overall attrition rate for their app was around 31%, much lower than when compared to mental health applications without gamified elements. Essentially, turning mental health apps into mini-games got people to use the apps for longer, and by extension, to work on their well-being for longer.

Dire physical and mental health consequences of gaming have been well-documented.

The general consensus of empirical studies done on gamification and mental health found its effect on well-being to be 60% positive, but more research is needed into how gamification is applied. There’s evidence that mental health apps are effective in treatment of anxiety and depression, though research into addiction to mental health apps is sparse.

According to the World Health Organization (WHO), half of all mental illnesses start by the age of 14 while 21% of all gamers in the U.S. were found to be under the age of 18, with the worldwide gamer population pegged at 2.5 billion. According to PEW research, 97% of teens play video games, and half of them play everyday. The pandemic increased this even further, as more and more people have gotten into gaming during the lockdown. The dire physical and mental health consequences of gaming have been well-documented.

These phones are a big problem.

Through her own gaming company, Litvin then launched the very game used for the study, called, ‘eQuoo: Emotional Fitness Game.’ She said the app has five times the retention rate of an average mental health app, so using gamified elements can get more young people to use and stick to mental health apps. This week, eQuoo was picked to be featured in a Unilever campaign for young people.

The key to walking this tightrope between training the brain for good versus bad, Litvin said, is the role of the developers. In her app, for example, they lock in content and only open it on a weekly basis, making sure that a user can’t binge even if they wanted to.

However, getting parents on board with the idea of using devices to aid mental health might prove to be tough. When asked  if she would let her sons spend time on screen if it aided in their emotional well-being, Pahuja shot back with a flat, “No.”

“My son got headaches from using his phone too much. I had to keep him away from school and confiscated his phone,” she said.

“These phones are a big problem.”

Also read: How Occupational Therapists Are Helping Children with Special Needs During COVID-19


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Can Spending More Time in Front of the Screen Benefit a Child’s Mental Health?