Doris C. Rusch, Assistant Professor, Game Development School of Design, DePaul University This presentation was given at the 2016 Serious Play Conference, hosted by the UNC Kenan-Flagler Business School. This talk addresses how we harnessed rules, mechanics, narrative and metaphor to meet these design challenges and create a transformational experience that teaches players productive strategies to respond to a broad range of anxiety disorders.

1. Lessons Learnt from Creating an Anti-Anxiety Game
Doris C. Rusch, PhD, DePaul University, Play 4 Change lab
@D_Carmen

2. The Problem:
40 Million US adults with
anxiety disorder

3. we owe it to our children, not to pass on
our anxieties.

4. research on the problem
• SME Prof. Reid Wilson
• anxieties.com

5. challenges to treatment
• anxious people’s rigid belief
system
• avoidance and resistance of
fear
• only seek help when current
strategies produce new set of
problems
Wilson, R. (2009): “The Art of Persuasion in Anxiety Treatment,” In Kerman, M. [ed.], Clinical P
Wisdom: Leading Therapists offer Essential Insights. New York, NY: W.W. Norton.

6. Soteria’s Goal
• Initiate perspective shift
• from avoidance & resistance of fear to
embracing & wanting it
• Leverage the “embodied experience” of
games
• Design structured after “recursive learning
model”

7. Embodied Experience =
learning through acting upon the world and
experiencing consequences of actions 1st hand
(Gee)

8. Recursive learning
Mitgutsch & Weise

9. Soteria is designed to disappoint old beliefs through
embodied experience in order to facilitate a perspective shift

10. Not a CURE!
Soteria is comparable to self help books. The
principles are sound and based on decades of
successful psychotherapy. But the game can only
get you this far. You have to apply its strategies to
real life yourself. It’s not a “What you do is what you
get” kinda game - it targets belief systems; it
doesn’t train behavior.

11. Soteria - development context
& approach
• DPU Play for Change lab
• 4 months concept phase
• 14 months development
• $12.000 funding
• students, alumni,
professionals, SMEs
• “poetry” meets “purpose”

12. Design Challenges
1. Game models “anxieties” in a general sense
2. Game overcomes players’ resistance to the
theme
1. not preachy!
3. “Overcoming fears” must be non-trivial
4. Promoting reflection and insight to facilitate
transfer to real life

14. https://vimeo.com/177131253
view Soteria video here

15. 1. Modeling “Anxiety” in a general sense: metaphorical
approach
To model the essence of anxiety
disorder, rather than depicting specific
surface manifestations of it, we decided
to take a metaphorical approach to the
design. According to our subject matter
expert, Reid Wilson, treating anxiety
disorders has little to do with the
content of a particular fear (e.g. germs,
flying, social judgment.) It is about
targeting the motivations behind anxiety
patients’ actions: namely to AVOID and
REJECT FEAR.
These motivations are the INVISIBLE
FORCE underlying all anxiety disorders.
They are also abstract. We can only see
their symptoms, e.g. carefully avoiding
the cracks between two cobblestones,
not flying.
Metaphors are excellent tools to make
the abstract concrete. They allow us to
get an “inside view”.
What is GOING ON UNDERNEATH THE
SURFACE?

16. 2. Overcoming Resistance:
Metaphors =“Magic Door”
• counter resistance to a difficult
theme & learning something
new
• tapping into fantasy
• stimulating curiosity
• (inspired by: Ruben Farrus,
Vander Caballero, Jesse
Schell)

17. Soteria’s core metaphors
gameworld = Ana’s inner world
= harbor town
harbor town = infested by
Shadows = fears
harbor town = worships Soteria
= goddess of safety
Goal: claim your dreams from
Oicys = disorder
Conflict: Oicys’ minions, the
Shadows

18. Soteria’s “servants” = aspects of Ana’s anxious self
the town is empty except for a few other
characters - Soteria’s servants - aspects of Ana’s
anxious self. They bestow protective items upon
Ana: the Soteria token to beam out of danger, a
flash bang to stun shadows, a compass and a
Phobos suit.

19. O’Malley the cat = “Therapist”
The only other character in Soteria is
the alley cat O’Malley, whose
sarcasm is only surpassed by his
mangy appearance. O’Malley is the
counter-voice to Soteria’s servants.
To reinforce the recursive learning
process, he is designed to raise
suspicion and resistance. He pushes
you out of your comfort zone, but you
are not ready. It makes sense to
doubt his trustworthiness at this
point.

20. Soteria’s metaphors, cont.
• 3 districts representing 3 salient (general)
aspects of anxiety
• music district: fear of self-expression
• theatre district: fear of judgement
• observatory: fear of uncertainty
• Each district features one anxiety “challenge”
location

21. Music store: Fear of self-expression

22. Puppet theatre: fear of judgement

23. Observatory: Fear of Uncertainty

24. metaphorical core
mechanics
• mechanics model Ana’s
relation to fear
• Part 1: stealth gameplay =
avoidance
• Part 2: safety at the cost of
agency through Phobos Suit
• Part 3: provoke and linger
through the fear

25. 3. From “fearful” to “fierce” -
the role of Game Structure to make “fighting fears” mean
something, and leverage recursive learning

26. modeling the journey, not
just the solution
• Part 1: models perceived reality of anxiety
patient
• Shadows = insurmountable
• Increased desire for safety / protection

27. modeling the journey, not
just the solution
• Part 2: impasse
• increase safety measures
through Phobos Suit
• safe & stuck
• disappointment as basis
for new learning

28. modeling the journey, not
just the solution
• Part 3: New Strategy!
• linger & provoke
• emotional challenge
• work through it, move towards
the fear
• gain key to recovery
• face Oicys
• claim dreams

29. 4. Speaking the Mind
the role of Voice Over to promote insight, reflection and real-
life transfer

30. • Ana’s VO: intended to convey her inner conflict
• Dialogue with Soteria’s “servants”: intended to
reinforce Ana’s doubts
• Dialogue with O’Malley: clarifying metaphors
and reflection prompt
• “What do you think happened?” 35 pages of dialogue
rewritten several times to make Ana
seem more hesitant in the beginning
Dialogues with O’Malley to talk
through the individual stages of the
game

31. Summary
• Soteria allows players to experience the ineffectiveness of common
anxiety strategies
• by way of disappointing these strategies, it prepares the ground for
new learning
• it uses metaphors to capture the essence of anxiety and to present
a “mystery” that incentivizes continued play
• the game “works”: you can’t win, without understanding the
message / new strategies
• it’s not a cure: players still need to do the work in real life
• AND: making = more effective than playing

32. Outlook: Soteria goes

33. thanks, questions?
drusch1@cdm.depaul.edu
@D_Carmen
http://playforchange.cdm.depaul.edu