DEVELOPING VISUAL NARRATIVE EXPERIENCES TO RELIEVE DEPRESSIVE SYMPTOMS THROUGH GAME DESIGN FOR BANGKOK’S MILLENNIALS

Abstract

Background:

In recent years, there has been growing concern over the yearly rise in depressive symptoms among millennials in Bangkok, Thailand. Their daily activities revolve around the use of their smartphones for both work and recreational purposes. While access to mental health care is improving, it cannot keep up with the increasing demand for psychiatric treatment. Outside of Thailand, there are several projects and studies that have attempted to combine gamification mechanisms and cognitive behavioral therapy (CBT) to develop apps and serious games for mobile health interventions that have led to positive outcomes. This provides an opportunity to explore a similar approach in Thailand.

Objective:

This study develops the process of visual narrative experience in an ongoing commercial serious game, BlueLine. The primary target audience of this research is Bangkok’s millennials. The aim is to first develop a framework that supports the gamification of CBT. Secondly, to create visual, narrative experiences in the game where players play the role of Blue, a millennial from Bangkok who struggles with the societal norms that affect his digital life and relationships. Through in-game scenarios, players will have the opportunity to understand and familiarize themselves with the effects of depressive symptoms through gamified interactions.

Methods:

Firstly, this research traverses each developmental stage of solidifying the BlueLine game structure by integrating the ABCDE model (Activating Events, Beliefs, Consequences, Disputation of Beliefs and Effective New Approaches) and narrative in games. Secondly, the approach of selecting CBT and related therapeutic elements for gamification to use in serious games. Throughout the development, CBT experts in Thailand are involved in the scenarios in the game. This process forms the basis for the player’s interactions in BlueLine's scenarios. There are four types of gamification mechanisms in total: narratives, verbal interactions, physical interactions and social media interactions.

Results:

The result of this research is a serious game that provides a visual narrative experience to relieve depressive symptoms of millennials in Bangkok in collaboration with CBT experts in Thailand. In addition, this research describes the process of integrating CBT techniques, narrative construction, and game mechanics to create two types of interactions (verbal and physical interactions) using the Player Interaction Framework (PIF). The PIF consists of three key sections: setup, aim, and execution. The setup section utilizes the ABCDE model (Activating Events, Beliefs, Consequences, Disputation of Beliefs, and Effective New Approaches) to integrate narrative and CBT techniques such as gratitude and self-monitoring. The goal of the Aim section is to dissect the intended experience of both the player and the main character to clarify the CBT goal of the interaction. Finally, the Execution section covers the representation of player interaction in the game through input and feedback.

Building on the ABCDE model, BlueLine's game structure incorporates gamified mechanisms along with various cognitive behavioral therapies (CBT) and related therapeutic elements. These include behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. In each scenario, players navigate Blue through challenges to overcome his triggered dysfunctional beliefs. Through this process, players can learn and understand how to mitigate the effects of depressive symptoms through gamified interactions.

The visual style of BlueLine is based on user research of the main target group, the millennials in Bangkok. While the esthetics may not be suitable for players beyond this group, additional visual examples have been developed to serve as a guide. The key factor for the esthetics in a serious game is emotion.

Conclusions:

This paper describes and presents the process of gamifying Cognitive Behavioral Therapy (CBT) and related therapeutic techniques using the Player Interaction Framework (PIF) in scenarios to provide a visual narrative experience via the serious game BlueLine. The scenarios in a sequential chapter may include various techniques such as behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem solving. Importantly, BlueLine's game structure is flexible, meaning that the same combination of CBT elements can be integrated into different game mechanisms. This structure can also be transferred to other serious game projects that integrate CBT and related therapeutic techniques. The result of this process is a serious game that can be used as an additional tool by CBT experts in Thailand.

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