Can a Game be a Digital Therapeutic?

Similar to therapy, Shadow’s Edge creates a safe place—a blank slate to “hold” and process feelings.



When we decided to create Shadow’s Edge, the first step was figuring out if a game really could help teens work through their feelings surrounding health challenges in a fun way. The goal of Shadow’s Edge became to empower teens to take charge of their emotional health and wellbeing…so I got to thinking: Can Shadow’s Edge be considered a digital therapeutic?

Digital therapeutics harness the power of technology to deliver interventions to achieve positive health outcomes. Most digital therapeutics are apps that help patients monitor symptoms, track medication, implement treatments regimens, or deliver medical information. Psychological interventions include delivering cognitive behavioral interventions for depression, anxiety, phobias, and stress reduction, teaching mindfulness, learning coping behaviors, or delivering information to support psychosocial health in an interactive way. Some of these digital therapeutic apps even include elements of “gamification”, for example, the app Super Better helps users set goals for healthy behaviors through “quests” during which a user’s avatar earns points.

But we had something quite different in mind—a truly immersive game with worlds, a storyline, and characters, in which the game is played by processing feelings and creative expression. Embedding psychosocial interventions based on narrative therapy and positive psychology within the context of a true game would be a novel concept in the healthcare app space—and potentially a new kind of digital therapeutic.

Teens may not be very likely to pick up a self-help book from their local bookstore. Instead, they live and learn through their technology. Our goal became to help teens learn the wisdom of self-help books within a digital game.

Similar to therapy, Shadow’s Edge creates a safe place—a blank slate to “hold” and process feelings.  But in the world of Shadow’s Edge, this “blank slate” is not a sterile white sheet of paper nor a therapist’s office, but a cityscape that comes to life through players’ expression—a cityscape that players can paint with feelings and experiences in the form of graffiti!

Just like therapy, the goal of Shadow’s Edge is to help players process their emotions and give meaning to their experiences in order heal and move on. Shadow’s Edge let’s players do this in a fun way, by creating graffiti with powerful words and creating a journal to hold their personal narrative. Our hope was that through gameplay, young people struggling with serious illnesses would find their voice and reconnect to themselves and others.

We did more than hope. We studied it. Before we launched Shadow’s Edge, recruited 40 teens (13+ with chronic or serious illness), to play the game for 20 minutes/day for one month. Before, at the midpoint, and after, we measured teen’s resilience, using a test battery focused on seven factors of resilience frequently correlated with resilience, namely Emotional Awareness, Mindfulness, Proactive Coping, Optimism, Derived Meaning, Positive Self-Identity, and Social Connection. Our preliminary findings show that especially the factors of Proactive Coping and Optimism grew during the month of game-play.

In addition, we learned that over 80 percent of the teens enjoyed themselves, felt more creative, and felt they came to understand themselves and others better. Over 70 percent said the game helped them realize that other teens think and feel the way they do, and teens felt they were “more real” after playing. And over 50 percent felt they had a better handle on their situations in life, felt they could better express their feelings, and felt more comfortable communicating with their health care providers and family.

Shadow’s Edge is not meant to replace therapy. But with its therapeutic goals of helping young patients come to terms with their experience, improve their wellbeing, and increase their connectedness with teens in similar circumstances, we hope that it can support young people as they uncover their narrative, integrate their illness experience into who they are, and grow through their trauma.