Advanced software-based health treatments are offering new hope for people struggling with many chronic diseases and conditions such as ADHD, depression, diabetes, and anxiety.

先进适用的 一个 基于软件的健康理疗，为人们与许多慢性疾病和病症，如多动症，抑郁症，糖尿病和焦虑挣扎着新的希望。

Akili Interactive recently released their innovative Endeavor game-based treatment for ADHD (4/22/20)[1], while several other digital therapeutic (DTx) companies have health game projects under development. Your doctor may soon prescribe a therapeutic game to help you or your child confront a medical challenge.

Akili Interactive最近发布了他们针对ADHD(4/22/20)的创新性Endeavor游戏疗法[1] ，而其他几家数字治疗 (DTx)公司也正在开发健康游戏项目。 您的医生可能很快会开出治疗游戏来帮助您或您的孩子应对医疗挑战。

The key element of these interactive programs is their ability to guide people into a tightly focused “flow” state where our sense of time fades way and tasks seem effortless. We’ve all probably experienced the flow state at one time or another in our lives. It could have been while running, skateboarding, surfing, or any one many athletic pursuits.

这些交互式程序的关键要素是它们能够引导人们进入紧密关注的“流动”状态，在这种状态下，我们的时间感逐渐消失，任务似乎变得轻松。 我们每个人可能在一生中都经历过一次或多次的流动状态。 它可能是在跑步，玩滑板，冲浪或进行任何一项运动追求时。

Or you may have entered this pleasant mental condition while singing, dancing, playing music, or other creative activities (even writing and design can produce flow).

或者您可能在唱歌，跳舞，演奏音乐或其他创造性活动时进入了这种令人愉悦的心理状态(即使写作和设计也会产生影响)。

Psychological researcher Mihaly Csikszentmihalyi coined the term “flow” to describe a satisfying, self-directed, hyper-focused state.

心理研究员Mihaly Csikszentmihalyi创造了“流动”一词来描述一种令人满意的，自我指导的，高度专注的状态。

Our perceptions of our lives are the outcomes of many events that shape experience, each having an impact on whether we feel good or bad. Most of these forces are outside of our control. Yet we have all experienced time when, instead of being buffeted by anonymous forces, we do feel in control of our actions, masters of our own fate. We feel a sense of exhilaration, a deep sense of enjoyment that is long cherished and that becomes a landmark in memory for life should be like.

我们对生活的感知是许多塑造经验的事件的结果，每件事都会影响我们的好坏。 这些力量多数不在我们的控制范围内。 然而，我们都经历了一段时光，那时我们确实感到可以控制自己的行动，掌握自己的命运，而不是受到匿名力量的打击。 我们会感到一种令人振奋的感觉，一种长期珍惜并成为记忆生命的里程碑的深刻享受感，应该像。

His insight grew out of his wide-ranging studies of what makes people happy. Csikszentmihalyi was surprised when people said what gave them the most joy and happiness was not leisure or passive entertainment but self-directed, challenging experiences that required total focus.

他的见解源于他对使人们感到高兴的广泛研究。 当人们说给他们最大的快乐和幸福不是休闲或消遣娱乐，而是自我导向的，富有挑战性的，需要全神贯注的经历时，奇克森特米哈利感到惊讶。

With these conditions, people would enter a timeless state of action without an inner critic. And when they returned to their normal “non-flow” existence, they felt refreshed and energized by their time “in flow,” despite being often physically or mentally depleted from the effort.

在这些条件下，人们将没有内在的批评而进入永恒的行动状态。 当他们回到正常的“非流动”状态时，尽管他们经常在精力上或精神上耗费精力，但他们仍为自己的“流动”感到精神焕发和充满活力。

Csikszentmihalyi identified several key factors, or conditions, for producing flow:

Csikszentmihalyi确定了产生流量的几个关键因素或条件：

• Complete concentration on the task完全专注于任务
• Clarity of goals and reward in mind明确目标和奖励
• Immediate feedback立即反馈
• A balance between challenge and skills挑战与技巧之间的平衡
• A feeling of control over the task对任务有控制感
• The experience is intrinsically rewarding经验本质上是有益的

Csikszentmihalyi’s studies were relegated the backwaters of psychological research as mainstream researchers focused on the causes of and possible treatments for negative mental conditions, such as depression and anxiety.

Csikszentmihalyi的研究陷入了心理学研究的死水，因为主流研究者专注于消极心理状况(例如抑郁症和焦虑症)的病因和可能的治疗方法。

Publication of his national bestseller, “Flow, the psychology of optimal experience[2]” in 1990; however, provided psychologists and more than a few game designers, including this one, a theoretical basis and practical guide for creating flow experiences.

他的国家畅销书《 流动，最佳体验的心理学 [2] 》于1990年出版； 但是，它为心理学家和许多游戏设计师(包括该设计师)提供了创造流动体验的理论基础和实用指南。

在健康游戏中创建流程 (Creating Flow in Health Games)

Designers of digital interactive games specify all aspects of the player’s experience: what they can see, hear, and do. So it’s certainly within our skill set to create engaging situations that fulfill the necessary conditions for flow–if we know how. The following sections reveal the secrets for meeting Csikszentmihalyi’s objectives and creating flow in health games.

数字互动游戏的设计师指定了玩家体验的方方面面：他们可以看到，听到和做的事情。 因此，创造满足条件的必要条件的参与环境当然是我们的技能范围(如果我们知道如何)。 以下各节揭示了满足Csikszentmihalyi的目标并在健康游戏中创造潮流的秘密。

流程条件1：完全专注于任务 (Flow Condition #1: Complete concentration on the task)

Health games should allow the player to concentrate on performing only one or two key actions at each step of the game. Providing too many options can sidetrack the player into evaluating the different alternatives instead of focusing on one or two key actions to achieve game success.

健康游戏应允许玩家专注于在游戏的每一步仅执行一个或两个关键动作。 提供过多的选择可能会使玩家侧重于评估不同的选择，而不是专注于实现游戏成功的一个或两个关键动作。

Psychologist Timothy Galway explored the differences between the “thinking about”and “doing” brain in his book, “The Inner Game of Tennis [3]” The “thinking about” brain has its merits; it’s how we learn by comparing and contrasting evidence and connecting new information to our existing knowledge. But to achieve “peak performance,” Galway stressed, you need to put the evaluating and judgmental part of your brain in the back seat and focus straight ahead on the task.

心理学家蒂莫西·戈尔韦(Timothy Galway)在他的著作《 网球的内在游戏 [3] 》中探讨了“思考”和“做”大脑之间的区别。 这是我们通过比较和对比证据并将新信息与我们现有知识联系起来而学习的方式。 但高威强调，要实现“最佳表现”，您需要将大脑的评估和判断部分放在后座上，并直接专注于任务。

In the “Designing Health Games” course I created and taught at the American University Game Lab, I often compared the directed attention of flow to a searchlight that focuses all its light in a concentrated beam. Anything we can do to help players achieve this focused state will improve their gaming experience and through that, their health.

在我在美国大学游戏实验室创建和教授的“ 设计健康游戏 ”课程中，我经常将流的定向注意力与探照灯进行比较，探照灯将所有光聚焦在聚光灯中。 我们能帮助玩家达到这种专注状态的任何措施都会改善他们的游戏体验，从而改善他们的健康状况。

流程条件2：明确目标和奖励 (Flow Condition #2: Clarity of goals and reward in mind)

The goal of a health game should be fairly simple. Here some examples of the goals in games I’ve designed:

健康游戏的目标应该相当简单。 以下是我设计的游戏目标的一些示例：

· Find the hidden numbers (cognitive game to help kids with severe anxiety)

· 查找隐藏的数字 (帮助严重焦虑的孩子的认知游戏)

· Stand up and sit down to move a virtual rail car along a track (balance game for people with Parkinson’s disease)

· 站起来坐下来沿轨道移动虚拟轨道车 (针对患有帕金森氏病的人进行平衡游戏)

· Grab balloons that have words you need to remember (memory game for people with MS)

· 抓取带有您需要记住的单词的气球 (针对MS患者的记忆游戏)

· Shift your weight to smash planets with your spaceship (balance game for children with cerebral palsy)

· 转移体重，用飞船砸碎行星 (脑瘫儿童的平衡游戏)

With some health conditions, it may be necessary to address multiple aspects of the person’s physical or mental capabilities. In my experience, it’s often been better to create several mini-games instead of attempting one comprehensive game. This allows the designer to tailor each mini-game to a specific clinical need.

在某些健康状况下，可能有必要解决人的身体或精神能力的多个方面。 以我的经验，创建多个迷你游戏通常比尝试一个全面的游戏更好。 这允许设计人员根据特定的临床需求量身定制每个迷你游戏。

Rail Runner was one of nine mini-games we designed with Glenna Dowling and Marcia Melnick at the UCSF School of Nursing, each one targeting a different aspect of the patient’s gait and balance. The subjects in our study nearly tripled their amount of exercise over 12 weeks, which led to measurable improvements their balance and gait.

Rail Runner是我们与UCSF护理学院的Glenna Dowling和Marcia Melnick合作设计的九个迷你游戏之一，每个游戏针对患者步态和平衡的不同方面。 在我们的研究中，受试者在12周内的运动量几乎增加了三倍，从而使他们的平衡和步态得到了明显的改善。

流程条件3：即时反馈 (Flow Condition #3: Immediate Feedback)

Players need to know when they’re doing a game task correctly (or not) so they can quickly correct mistakes. Lack of clear feedback can lead to confusion, which will break their concentration, and drop them out of flow.

玩家需要知道何时正确(或不正确)执行游戏任务，以便他们可以快速纠正错误。 缺乏清晰的反馈会导致混乱，这会破坏他们的注意力，并使他们脱离潮流。

In addition, you need to display the feedback where the player will see it. Players won’t notice a small update in their score if it’s displayed in a box at the top of the screen while they’re focusing on avoiding an obstacle in a driving game or trying to catch tokens as they fall. Eye-tracking studies will show you where to place the feedback; although common sense will also often work. Players will focus where you direct them to look (with animation and dynamic graphics).

另外，您需要在播放器看到的地方显示反馈。 如果玩家将注意力集中在避免驾驶游戏中的障碍或试图在掉落时捕捉代币的同时，将分数显示在屏幕顶部的框中，则玩家不会注意到分数的微小变化。 眼动追踪研究将向您显示反馈的位置； 尽管常识也通常会起作用。 玩家将专注于您将其引导到的外观(带有动画和动态图形)。

We employed this tactic in a game to help children with cerebral palsy improve their balance. A key goal was helping them learn to shift their weight without bending over. The game asks players aim their spaceship to crash into targets or planets by shifting their weight on a Wii-fit board.

我们在游戏中采用了这种策略，以帮助患有脑瘫的儿童改善他们的平衡。 一个关键目标是帮助他们学会转移体重而不会弯腰。 游戏要求玩家通过在Wii-fit板上改变其重量来瞄准飞船，使其坠入目标或行星。

We tried several different ways to provide feedback when a child was leaning over so that he/she would see it and shift their weight correctly. The game was very dynamic and getting their attention was difficult.

我们尝试了几种不同的方法来在孩子俯身时提供反馈，以便他/她能够看到并正确地转移他们的体重。 游戏非常活跃，很难引起他们的注意。

Our solution: we displayed the feedback exactly where the player was looking. We changed the color of the spaceship they were controlling from green (good posture) to red (leaning over).

我们的解决方案：我们准确地显示了玩家正在寻找的反馈。 我们将他们控制的宇宙飞船的颜色从绿色(姿势良好)更改为红色(俯身)。

In a small test, we turned the feedback on and off between game levels and measured how many times the player leaned over during each level. Clearly this feedback strategy worked.

在一个小测试中，我们打开和关闭游戏关卡之间的反馈，并测量玩家在每个关卡中俯身的次数。 显然，这种反馈策略有效。

As you are designing your game, you need to provide clear and immediate feedback. You also need to deliver it in a way that players can easily see it and react to it while playing a challenging game.

在设计游戏时，您需要提供清晰，即时的反馈。 您还需要提供一种方式，使玩家在玩具有挑战性的游戏时可以轻松看到并做出React。

流程条件4：挑战与技能之间的平衡 (Flow Condition #4: A balance between challenge and skills)

The design task of creating game challenges of “appropriate difficulty” directly addresses this requirement. We can not only adjust the difficulty of a game level but also assess the player’s skill at the same time.

创建“适当难度”的游戏挑战的设计任务直接解决了这一要求。 我们不仅可以调整游戏级别的难度，而且可以同时评估玩家的技能。

The green diagonal line in this graph shows how flow occurs when game difficulty and ability are matched. It also shows what happens when they’re not in balance. People will quickly get frustrated with a game that’s much too hard for them and will soon tire of a game that is way too easy. The green line fades away from the diagonal because players will “drop out of flow” as the imbalance between ability and difficulty increases.

该图中的绿色对角线显示了当游戏难度和能力匹配时流如何发生。 它还显示了当他们不平衡时会发生什么。 人们会很快对一款对他们来说太难的游戏感到沮丧，并且很快就会厌倦这种过于简单的游戏。 绿线从对角线逐渐消失，因为随着能力和难度之间的不平衡增加，玩家将“退出流程”。

There are several ways to create game challenges that match a broad range of player abilities but the two most prominent are closed-loop design and difficulty staircase progression. A future article will explore the strengths and weaknesses of these complimentary approaches and a provocative hybrid that leverages their specific advantages.

有多种方法可以创建与各种玩家能力相匹配的游戏挑战，但最突出的两个是闭环设计和难度阶梯式增长。 未来的文章将探讨这些互补方法的优势和劣势，以及利用其特殊优势的挑衅性混合动力。

流程条件5：对任务有控制感 (Flow Condition #5: There is a feeling of control over the task)

Within a game or game level, players tend to be more engaged when they feel they’re in control. This is part of the “designer-player contract” of game design. The designer creates a set of rules for how to play the game and if the player follows those rules, then they should win. Violate that “contract” and you’ll have an angry bunch of players on your hands. Or more likely, they’ll just quit and won’t play anything you design, ever again.

在游戏或游戏关卡中，玩家在感到自己处于控制之下时往往会更加投入。 这是游戏设计“设计者与玩家的合同”的一部分。 设计师为游戏的玩法创建了一套规则，如果玩家遵循这些规则，那么他们应该会获胜。 违反该“合同”，您将有很多生气的玩家在手。 或更可能的是，他们只会退出，不会再播放您设计的任何内容。

Additional support for the importance of control comes from the Self-Determination Theory (SDT) developed by Richard Ryan and Edward Deci[4]. Their research into the factors that affect people’s motivations to learn something new or change their behavior identified “autonomy”–being able to direct your actions–as one of the key components of success in effecting change. Your design should empower the player’s sense of control within the game and you need to confirm this with careful user testing.

理查德·赖安(Richard Ryan)和爱德华·德西( Edward Deci) [4]提出的自决理论 (SDT)进一步证明了控制的重要性。 他们对影响人们学习新事物或改变其行为动机的因素的研究将“自主性”(能够指导您的行动)确定为成功实现改变的关键要素之一。 您的设计应增强玩家在游戏中的控制感，您需要通过仔细的用户测试来确认这一点。

流程条件6：体验本质上是有回报的 (Flow Condition #6: The experience is intrinsically rewarding)

Health games typically rank high on this condition because players have chosen to play the game to improve their physical or cognitive condition and few things are as important to us as our health. This differentiates health games from the larger class of interactive games whose primary goal is entertainment. Our games have to be engaging and produce measurable benefits.

在这种情况下，健康游戏的排名通常很高，因为玩家选择玩游戏来改善其身体或认知状况，并且对我们来说，没有什么事情比我们的健康重要。 这将健康游戏与主要目的是娱乐的较大类的交互式游戏区分开。 我们的游戏必须引人入胜并产生可观的收益。

But this poses a burden on the health designer to fulfill that promise. One of the ways I’ve done this is by partnering with leading clinical researchers, often on NIH-funded projects. We would adapt and extend their proven non-gaming approaches to produce engaging games that provide measurable health benefits.

但是，这给健康设计者实现这一承诺带来了负担。 我这样做的方法之一是与领先的临床研究人员合作，通常是在NIH资助的项目中。 我们将调整并扩展其久经考验的非游戏方法，以制作引人入胜的游戏，从而提供可衡量的健康益处。

大图 (The Bigger Picture)

Creating engaging flow experiences in health games is just the first crucial part of a powerful “multi-timescale” health game design strategy that includes specific tactics for the Seconds, Minutes, and Weeks timescales. Health games only work if people play them often and long enough for the small incremental benefits of each session to accumulate. The next article in the series will explore some aspects of the “designer’s toolbox” for each of these timescales: Timescale Strategies for Better Health.

在健康游戏中创造引人入胜的流程体验只是强大的“多时标”健康游戏设计策略的第一关键部分，该策略包括针对秒，分钟和周时标的特定策略。 健康游戏只有在人们经常玩并且足够长的时间才能累积每次会话的小增量收益时才起作用。 该系列的下一篇文章将探讨以下每种时标的 “设计者工具箱”的某些方面： 改善健康状况的时标策略。

This series is based on my experience designing and managing the production of four, in-depth clinically-inspired games that helped a diverse group of people: seniors with Parkinson’s disease, children with cerebral palsy, adults with multiple sclerosis, and kids with severe anxiety. I really enjoy applying my game design and team-building skills in the creation of games that can help people get better.

该系列游戏基于我的经验，设计和管理了四款具有深远临床启发意义的游戏，这些游戏为不同的人群提供了帮助：患有帕金森氏病的老人，患有脑瘫的儿童，患有多发性硬化症的成年人以及患有严重焦虑症的孩子。 我非常喜欢将我的游戏设计和团队建设技能运用到可以帮助人们变得更好的游戏创作中。

My efforts in creating and teaching the Designing Health Games course at the American University Game Lab (2016–2019), helped gel some ideas that I’ve shared here. I had to update the syllabus every year to keep up with this rapidly emerging field!

我在美国大学游戏实验室(2016-2019)上创建和教授“ 设计健康游戏”课程的努力，帮助总结了一些我在这里分享的想法。 我必须每年更新教学大纲，以跟上这个Swift发展的领域！

[1] https://www.akiliinteractive.com/news-collection/akili-announces-endeavortm-attention-treatment-is-now-available-for-children-with-attention-deficit-hyperactivity-disorder-adhd

[1] https://www.akiliinteractive.com/news-collection/akili-announces-endeavortm-attention-treatment-is-now-available-for-children-with-attention-deficit-hyperactivity-disorder-adhd

[2] Csikszentmihalyi, Mihaly. Flow: The Psychology of Optimal Experience. New York: Harper & Row, 1990.

[2] Csikszentmihalyi，米哈利。 流：最佳体验的心理学 。 纽约：Harper＆Row，1990年。

[3] Galway, Timothy. The Inner Game of Tennis. New York. Random House, 1974

[3]戈尔韦，蒂莫西。 网球的内在游戏 。 纽约。 兰登书屋，1974年

[4] Deci E.L., Ryan R. M., Self-Determination Theory. Canadian Psychology, Canadian Psychological Association 2008, Vol. 49, №3, 182–185

[4] Deci EL，Ryan RM， 自决理论 。 《加拿大心理学》，《加拿大心理学会》，2008年，第1期。 49，№3、182–185

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