Long viewed as a contributing factor in teenage isolation, computer games are now being used to treat adolescent depression in an innovative New Zealand programme.
Rather than simply encouraging players to engage in mindless destruction, the SPARX video game attempts to teach teenagers how to deal with depression using a psychological approach known as cognitive behavioural therapy (CBT).
Just as importantly, its creators set out to make the game exciting for those teenagers who are often reluctant to seek counselling and bored by well-meaning advice on how to cope with depression.
The result is a role-playing fantasy game, where teenagers adopt a warrior avatar and get to blast negative thoughts with fireballs while trying to save the world from sinking into a mire of pessimism and despair.
Project leader Sally Merry, a child and adolescent psychiatrist at Auckland University, said the unconventional approach had proved popular with teenagers, allowing them to address their issues in privacy and at their own pace.
"You can deal with mental health problems in a way that doesn't have to be deadly serious," she said. "The therapy doesn't have to be depressing in and of itself. We're aiming to make it fun."
International studies consistently show New Zealand has one of the highest youth suicide rates in the developed world and Merry said she was keen to make treatment for depression more accessible.
"The problem of depression in young people is an international one, it's common and mostly untreated," she said.
Merry said 75-80 percent of adolescents who suffered depression received no help at all, leading to potential problems such as poor school grades, social isolation and a negative outlook.
"Often young people can be feeling low and not really realise what it is," she said.
"They just know that they're feeling 'blah' and accept that as something they have to put up with. SPARX and cognitive behavioural therapy show them we don't have to accept that."
The game has seven levels, each lasting 35-40 minutes -- the same as a counselling session -- and is aimed at 13- to 17-year-olds, the age range when adolescent depression generally kicks in.
It introduces players to a guide, or mentor, who helps them through the levels, each of which has a lesson embedded in it teaching skills such as anger management, conflict resolution and breathing relaxation exercises.
As the game progresses, the online world depicted in it becomes brighter and less forbidding.
Metia Interactive managing director Maru Nihoniho said the challenge was making the game compelling for teenagers, so they could play it without actually realising they were learning anything.
"We had to look at the learning objectives and still design it to be a game," she said.
"That meant keeping the entertainment value, such as interactive 3D environments, puzzles and quests that you'd find in commercial games."
To do that, they relied on feedback from test groups of teenagers over a 14-month development period, including elements that adolescents wanted while tempering their requests for blood-and-gore and shoot-em-ups.
"We knew we couldn't have shooting because of the nature of the game," she said.
"So instead of having your character going around shooting or killing with machine guns or bombs, we gave the avatar a staff so they could shoot lighting bolts to turn negative thoughts into positive ones. It was about compromise."
A clinical trial, the results of which were published in the British Medical Journal earlier this year, found the game was as effective as traditional face-to-face counselling in helping adolescents cope with mild to moderate depression.
Merry said the game, which won an innovation prize at the UN's World Summit Awards, had generated interest in the United States, Britain, Canada and Australia, as well as non-English speaking countries looking to translate it.
Its release details are still being finalised but Merry said she would like to make it available through schools, doctors and youth centres as an easily accessible resource for teenagers struggling with depression.
Other options include releasing it on the Internet so it can be played on iPad and Android tablets, as well as developing specialised versions, such as "Rainbow SPARX" for gay youths.
The clinical trial found SPARX helped reduce mild to moderate depression as effectively as traditional counselling, meaning it could potentially be used as an alternative to face-to-face therapy, particularly in rural areas or settings where mental health services are not available.
Merry said that even for those youths whom SPARX may not be suitable for, such as those with severe depression or mental illness, the game could make them feel that going to seek help was less daunting.
"It's not going to fix everyone," she said. "But for those it doesn't help, some may be more receptive and interested in getting counselling."
"I'm very aware that, as a psychiatrist, when young people come to see me they sometimes enjoy chatting and so on, but it's not necessarily what they want to do most with their time.
"I'm trying to find a way of doing things that is much more engaging."