itch.io

Thanks. That does help somewhat, but does still leave me with some questions. 

Based on the "Move, Breathe, Feel, and Think" paradigm, I am assuming analog games, especially in the LARP format, are encouraged? While most of the examples for the Move component feature video games that use motion controls of some kind, I don't think most people participating in itch jams have access to APIs or developer kits to actually be able to make full motion control experiences, let alone test them properly, in the short time span of a jam. There is probably some open source webcam based stuff that exists out there, but I doubt such a thing would be especially newcomer friendly. 

The same goes for breathing. I am sure there are ways that I, as an indie developer, could figure out ways to incorporate breathing into the gameplay, but it would likely take me the better part of a month just to come to grips with the basic input / output implementation, let alone figure out how to work it into a design comprehensive enough to put forth as a competitive jam submission. I can think of a few basic implementations that use standard I/O (keyboard, mouse, controller) off the top of my head, but those cannot be truly interactive - the game cannot provide adequate feedback to the player without actually measuring their breathing, so it would have to rely on essentially telling them how to breathe and hoping they follow directions, or else ask them to breathe in time with their button presses, which might work with a lot of testing, but again relies on the player's ability and desire to follow directions with no way for the game to actually measure whether they are doing it "correctly" and providing them with rewards and encouragement. 

Which leads me to the next question, which would be an issue that applies to both analog and digital games. We're game designers, and are hardly experts on exercise regimens, breathing rhythms, and their effects on the body and mind. Therapists generally have to go to training and seminars for that sort of thing, and when it comes to other "interactive" therapy regimens with biofeedback components, such as EMDR (Eye Movement Desensitization Reprocessing) there is a risk of actually doing more harm than good with the wrong application of a technique.  Some of this can, of course, be remedied through research, but we hardly have the resources to do this properly within a jam context. 

A corporation would hire an expert consultant on such things, and we obviously can't do that, which means we have to spend time we could be coding or making art poring through youtube videos on yoga, medical journals, wikipedia articles, and we probably could do this for hours every day and still not scratch the surface of understanding it after a full month. I doubt it's a huge issue with the breath component (though even then, I'd be worried about users with irregular breathing patterns or conditions such as asthma, and am personally not super comfortable with my ability to tell other people how to do something as crucial as breathing), but the movement component could be potentially fraught - even light aerobic exercise has procedures and orders of operation for safety and the like. When we're talking about recreational products, like Wii sports and Just Dance, it's probably not a huge issue, since players come with no expectations and the premise is simple and scalable to individual preferences - nobody goes into one of those games expecting anything beyond a bit of waggling about. As soon as we start specifically designing games for what is essentially a very specific medical purpose, we become subject to medical levels of liability, at least in the abstract. Sure, major issues or harm are unlikely, but if the game promises that it will make you feel better, in a clinical sense and with the intent of addressing specific clinical issues, and it not only fails to deliver but makes someone sick or injured (hopefully nothing more than a sprained muscle, but still) due to improper exercise instructions given by a keyboard jockey like me who, let's face it, knows diddly squat about proper exercise, then it's no longer just a "bad game" or even a "failed game," it's now "bad therapy" or potentially even a form of "quackery."

And that ultimately brings me to the original question. If the goal is simply to make games first and foremost, and make sure those games, in some abstract way, happen to encourage players to do a bit of light movement and very, very basic breathing exercises, without explicitly promising therapeutic benefits, then that's one thing. If we are supposed to be making therapeutic tools / "treatments" first and foremost, then we're in a whole different ballgame. And I am still not sure which one of the two modalities this jam is oriented towards. I am assuming and hoping it's the former, but the wording is more than a bit unclear on that front, both on the itch page and the deepwell website, which contains a LOT of additional information that I really wish was included on the jam page, as it seems rather important. Now, obviously the video indicates that we don't have to do all of the above, or even more than one, but I kind of feel like this is another one of those tidbits that could have been placed much more front-and-center, and also doesn't really solve the underlying conundrum I am experiencing here. 

I could, for example, try to make a narrative game that incorporates CBT or DBT techniques for the "think" component, but those are modalities that cannot easily be generalized and really work best when applied to individuals and their specific situations over an extended period of time. They are also extremely deep rabbit holes and generally require training for professional therapists to be able to apply well. Just as with physical issues, and perhaps even more so, there is a danger that if someone presents these concepts as scientific fact, but does so incorrectly or incompletely, and if an impressionable player accepts them without some requisite skepticism (a younger player, for example) then it could actually cement harmful thinking patterns instead of helpful ones. 

Both DBT and CBT have their proponents and detractors, and when it comes to the latter there are some good points to consider. Without nuance and care, they can veer away from regulating negative thinking and emotions into dictating cognitive rigidity, forcing patients to minimize their traumas and immediate pain, excessive self blame ("beating yourself up") for "not doing it right," and so on, and so forth. Now, none of those things are the intent of those therapies, and while some people find the methods more or less helpful, if they are presented with nuance by a trained and competent therapist in a one to one setting most of the above pitfalls can be avoided - at worst, the patient may feel that something like CBT is simply not helping them as much as they'd like. But if you read any of the foundational texts, such as Feeling Good, on their own, and fail to parse some of the potential issues, and then start presenting half baked misreadings of CBT techniques in a generalized format, you can actually do some real damage. Since not all therapists are, sadly, created equal, I've known several people whose therapists actively made them feel worse because they themselves didn't really understand the methodologies in question. Without a lot of careful consideration, CBT can turn into "law of attraction" style  "I can think myself out of my pain, and if I can't I'm even more of a failure because it's basic science" nonsense, and DBT can turn into a complete denial of the very traumas that it's supposed to help address. And so on and so forth. In short, while talk therapy carries less stigma than medication when it comes to potential risks, the wrong cure can still be worse than the disease. At least when a patient fails to respond to specific meds, there is usually a managed procedure of stepping down and stepping up and very clear physical indicators. When you're locked into a warped process with a bad therapist, on the other hand, you may not know that there is a problem until years later.  

So I guess in the end my question is no longer whether or not we're supposed to be making games that are about illness versus games designed to address illness. It does seem clear that it's the latter. At this point I am just more concerned with the extent that these games should be labeled as "therapeutic tools" and how this can be done safely by people who, like me, have no actual expertise in something as complex and delicate as mental health.

I don't contest the assertion that games can have real mental health benefits on an individual level. But it's one thing for me to say that Dragon Age Inquisition really helped me through a rough couple of months (mostly because it happened to be new at the time and distracted me for a few hours every day - not like it taught me any actual coping skills or genuinely treated my depression), and a whole other thing for a representative of Bioware to get up on a stage and say, "here's Dragon Age Inquisition, out brand new interactive therapy for depression and PTSD."  

TLDR: I have actual OCD and autism, and once I start typing, I do not stop until every possible angle of an issue that I can possibly think of at the time has been addressed at least once, and thus there is no way for me to do an effective TLDR section without retyping everything. Sorry.