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Welcome.

The Get Happy Club is a game playing club for people here in Minnesotawho are overcoming depression. Join us here and we will help each other -and help science - as we learn to get better.

Your health-worker recommended you to this site, and you have a fullmembership. The Get Happy Club is an exclusive club - it’s open only topeople while they suffer from clinical depression. We are glad you’re here- but we can’t wait until we have to kick you out.

On our site, you will find favorite single-player games : Solitaire, Sudoku,Match Three, Find It. Lots more, including two you’ve never seen.Think of us as a gym. These games are exercise equipment for your brain.Don’t miss a single workout. Your personal trainer will help you remember.

In a gym, you run into other people who are care about self-improvement -The more you play, the more chance you have to meet these interestingpeople. You can chat - or leave messages. You can even play games withyour new friends.

Shy? Don’t worry. In the Get Happy Club you can be whoever you want.Come as you are. Or come as you wish you were. Nobody will bother you.You can show off your scores, or not. You can compete against otherplayers to win prizes. You compete against players at your own level.

Can playing games help defeat depression? Science does not really know.Not yet. You can help find the answer.

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Behind the Scenes at the Get Happy ClubThe Get Happy Club is not exactly what it seems, although it is exactly what it says it is.

Players are invited to join the Get Happy Club when they enroll as patients. They are informedthat the club is an experiment to discover correlations between playing games and improvingdepression. Although there is no outright deception, there is a little benign misdirection.

Patients are likely to consider game score the principal metric of the study. They are informedthat this is only one of many measures. But the researchers can still allow patients to focus ongame scores and leader boards even though these are of only minor interest.

The other measures will be more accurate when players are unaware that these data will beclosely studied. There is an array of nice prizes, which go to high scorers, frequent players, anda good number of randomly selected active club members.

There are enough leader boards that everyone is meaningfully ranked somewhere and cancompete against peers. This affords a degree of stickiness.But, more importantly, there is a social element that combines the virtues of anonymity andexclusivity ­ ie: the shared experience of depression and the common goal of remission.

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RewardsPlayers will be encouraged to play the games with social rewards. For example, dedicated gameplay ­evidenced by high score or unbroken streak­ may earn a player extra posting privileges. Inparticular these posting privileges are transferable, so they become more valuable, socially .This is a familiar mechanism to players of Zynga games, Puzzle Pirates, etc.

Players give informed consent for research use of all their playing data (after it is anonymizedand aggregated). Although these data are enumerated briefly for the players, most players willstill assume that the scientists’ principal interest is traditional game measurements like score,frequency of play and duration of game sessions.

However these typical measurements are a minor part of the data stream. The actual data ofinterest are much more precise and direct measures that reveal psychological and neuro­motorcondition.

For example: We don’t care how many games of Solitaire you win or lose. We care how quicklyyou respond when you turn over an Ace. We care about the speed with which you slide thecards. We care whether you watch the “win” animation or not.

We measure several dozen independent behavioral indicators, and track changes in yourbehavior over time. These data are available online in realtime to researchers.

Researchers will correlate the changes in behavior with outcomes. In particular, they will lookfor markers that are predictive of success in remission of depression after six months oftreatment.

Future neuroscientists may use these results to create game­based diagnostic tools. Thesetools may provide an early warning signal for patients that risk failing to achieve remission andmay sound the alarm for hospitals that underserve their depressed patients.

The Get Happy Club will incorporate explicit gamification mechanisms to reward frequent andextended play, and player publish their high scores on a broad leaderboardsit as well asimproved scores.

No claims are made that the Get Happy Club can help its members get happy.

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Why Depression?

PrevalenceIn Minnesota, depression is nearly as big a healthcare issue as vascular disease, judging by theAF4Q study data.

Optimal Vascular Care population: 66910Depression Remission population: 51329

SuccessUnlike the vascular care patients ­ among whom 40% receive optimal care ­ only 5% of thedepression patients achieve the desired outcome.

Optimal Vascular Care percentage: 40%Depression Remission percentage: 5%

It might be argued that the criterion of success for depression care (remission after six months)is harder to achieve than merely delivering to vascular patients the mandated elements thatdefine “optimal care”. After all, remission rates measure outcomes, which are more difficult tocontrol than procedures.

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DiscrepanciesThe differences between the criteria for different care categories (depression remission vsvascular optimal care) are factored out when the best hospitals in a given category aremeasured against the worst.

Consider the 1000 luckiest Minnesota vascular patients in 2011. They went to the mostsuccessful hospitals and 648 of them received optimal care. Meanwhile, among the least lucky1000, only 120 got such treatment.

1000 Luckiest Vascular patients: 6481000 Least Lucky Vascular patients: 120

The worst hospitals can certainly improve, if they learn from the best hospitals.

The depressives have a different story to tell. Among the lucky 1000 who went to the Mayo ClinicNortheast or Mayo Clinic Northwest or three other top clinics, 233 were freed of depression. Butthe least lucky 1000 went to sixteen other clinics (of which five belong to the Mayo Healthsystem). How many of this unhappy thousand were cured? Not a single one.In fact, among the 2000 unluckiest depressives, there is only one lone remission.

1000 Luckiest Depression patients: 2331000 Least Lucky Depression patients: 0

Perhaps the worst psychology clinics can learn from the best. Or maybe not.Right now they seem to be on another planet.

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Pillars:These are the design goals of the Get Happy Club

Lots of Data:This is a Big Data project in which large web­based data sets will be created. Identifiable datawill be absent, and the resulting information will be open to queries using a well defined API.Access will be open to all researchers

Lots of MetricsA wide variety of different measurements will be performed ­ mostly measuring unconsciouspreferences and behaviors. A broad selection of games offer very differing measures ­ fromreflex action to more profound cognitive effort.

Lots of PlaysWe want to deliver a longitudinal stream of data from each player. It is not absolute measures ofplayer performance that we seek, but rather changes in performance level over time. We expectthat some of these trends are predictive of final outcomes.

The design target is to host six plays a week from each participant for a six month period.Gamification incentives (including extrinsic rewards) will be enough to get players started. Butnot enough to achieve the high level of compliance sought. For this we need to develop highlyaddictive games.

Lots of PlayersSimilarly we want to achieve a high degree of participation. Patients suffering from depressionare difficult to motivate, but we need to persuade a large percentage of them to participate in theGet Happy Club for a serious amount of time.

Again ­ incentives can be employed to get a patient to sample the site ­ but large scaleparticipation will depend upon the games. These games must have highly refined game design.They must appeal to these patients ­ even those who do not consider themselves gamers.

Solution:We can guarantee additive, appealing games: We render the classic casual games that thispopulation prefers. Most already play Sudoku, Solitaire or similar games every single day.In the Get Happy Club, these games have been instrumented to collect performance data.

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Data MineAn almost unlimited variety of data can be gleaned from cleverly instrumnented games:

Cognitive TasksDepression has been correlated with cognitive impairment. In particular with defects in memory,attention and psychomotor speed and dysphasia.1

Color PreferenceColor has long been associated with affect. After all, outside the clinical setting, depression isknown as the “blues”. Early attempts to measure this association were disappointing, but morerecent, more sensitive studies have successfully quantified color preference biases that predictdepression and anxiety. Interestingly, differences in stated color preference were less dramatic2

than demonstrated preference.

The Get Happy Club offers researchers a stream of unconscious demonstrations of colorpreference, rather than deliberate color decisions. Many games can be engineered to create thiscolor preference data. For example a Match 3 game in which win opportunities (and shapeassignments) are randomly distributed among the colors can measure the color bias with whicha player pursues matches.

Psychomotor & ReflexGet Happy Club games will measure the interval between stimulus and response for a verybroad group of stimuli. They will also measure cursor trajectory and dynamics for simple touch(or mouse) actions in order to detect telltale elements such as lethargy, tremor, hesitation andsloppiness. These are revealed in the manipulation of game pieces and the handling of userinterface elements. Our studio did very interesting work in this area under an NSF grant in 2004.

Facial AffinitiesWe want to see which faces the patient chooses. Researchers have shown that depressedpatients seek smiles less often than healthy people. Stranger avatars, in­game GUI elements,components of Memory, Find It and Whack­a­Mole can all provide opportunities for subtle facechoices. Another, more profound choice is the Player’s single choice of his own avatar.

1 Kauhanen ML; Korpelainen MJ; Myllylä, VV Poststroke Depression Correlates With CognitiveImpairment and Neurological Deficits Stroke.1999; 30: 1875­18802 Helen R Carruthers, HR; Morris, J; Tarrier, N; Whorwell, PJ: jThe Manchester Color Wheel: developmentof a novel way of identifying color choice and its validation in healthy, anxious and depressed individualsBMC Medical Research Methodology 2010, 10:12 doi:10.1186/1471­2288­10­12

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Dysphasia and VocabularyWord­frequency maps of the patients postings and chats will reveal a pattern of word choice thatoffer a clue to the progress and perhaps the prognosis of their depression. At a much higherlevel, changes in the total measure of social activity in the Get Happy Club have an obviousinsight into the patient’s emotional state.

Confounds

There are many confounds that can distort the results. For example QIPS: Minnesota Dept ofHealth’s Quality Improvement Program, which incentivizes hospitals for improving their six­monthremission score, has had an unintended consequence. Evidence shows that hospitals preferentiallyenroll patients with lower severity and comorbidity in order to artificially elevate their success rate3This gaming of the system, will distort all AV4Q research as much as it does the Get Happy Clubdata. Hopefully a solution to this problem will be found outside the Get Happy Club and can beshared.

Where is the Creativity?Look.

We are really a creative studio. Honest. We have designed, developed anddelivered scores of innovative games. We are rather embarrassed to suggestthat your best bet is to use folk games like Sudoku and Solitaire. But it is.

Let’s be real. You are not going to convince large and representationalsamples of patients to play a brand-new game. Not for a long period. And,Good Lord! not depressed patients!

We could claim that our new game would be as addictive and as well tunedand as appealing as these games that the patients already love. But that is anaive and ridiculous claim.

If the goal were to experiment with creative design, we would. But the goalis to develop a large database for neuroscientists to experiment creatively.

Our job is to support that creative effort.

3 Minnesota Department of Heath: Minnesota Statewide Quality Reporting and Measurement System:Quality Incentive Payment System Updated May 2012http://www.health.state.mn.us/healthreform/measurement/QIPSReport051012final.pdf