Reimagining Game Design for Mental Health: A Call for Games that Heal, Not Hijack.

Entropy Interactive Position Paper
Author: Jessica Matotek

In an era where digital games are part of everyday life, their impact on mental health is undeniable. Games can bring joy, creativity and connection, but can also reinforce unhealthy patterns, exploit attention, and promote emotional avoidance. Many popular games are built on design loops that overstimulate the nervous system, creating a cycle of short-term pleasure and long-term dysregulation.

This position paper invites us to consider a new model of game design, one that centres nervous system health, emotional awareness, and co-regulation. Drawing from Psychotherapy, particularly Steven Porges’ Polyvagal Theory, and informed by my clinical experience, we at Entropy Interactive explore how interactive design can support rather than sabotage wellbeing. We introduce a new game concept currently in development that invites players into self-awareness, through sensory based, challenges, spaces for personal reflection and responsive gameplay rooted in player regulation, not performance. Our aim is to inspire dialogue across sectors; mental health, education, design and research, about what games could become when we design with curiosity, care and commitment to human flourishing. Video games have become one of the most powerful mediums of our time. They’re not just entertainment, they are being used as tools for connection, self-expression, stress relief, and sometimes survival. For some, gaming is a way to unwind after a long day. For others, it's an immersive world that feels more manageable than real life. As a Psychotherapist working in mental health for just shy of a decade, I have sat with countless people of all ages who turn to games to cope with anxiety, overwhelm or disconnection. Sometimes it helps. Sometimes it doesn't. I’ve seen games provide momentary confort, a space to explore oneself in creative ways, I’ve even seen games teach someone how to read when they were told they would never be able to. I've also seen games reinforce cycles of avoidance, isolation, or overstimulation. What has become clear to me is that many mainstream games are designed to keep players hooked and not regulated. This raised an essential question within me: What if games didn’t just distract us from distress but actually helped us understand and navigate it? What if a game could help players breathe, reflect, reconnect with their bodies, and return to a sense of safety or curiosity? That question led me to the team at Entropy Interactive, where we are collaborating to develop a new kind of game, one that isn't built around winning, or dopamine hits, but around inner regulation and getting back to the core purpose of play. This position paper outlines the rationale for such an approach. It offers reflection on the current landscape of game design, introduces our emerging project, and invites conversation about how games might become a force for healthing rather than hijacking the nervous system.

The Current Game Design Landscape

In the current gaming ecosystem, many popular games are designed not only to entertain, but to keep players coming back, often for longer and more frequent sessions; and the balance between these two priorities is shifting. These designs are often driven by what's referred to as dopaminergic loops: gameplay mechanisms that reward players with just enough unpredictability, novelty, or achievement to trigger a release of dopamine to the brain. While this makes for compelling gameplay, it can also lead to compulsive use. Recent research continues to support the central role of dopamine in gaming. A 2021 review examining the biochemical effects of video games found that playing certain games activates the brain's reward systems, leading to increased dopamine release. This is like the response seen with some addictive substances (Leménager et al., 2021). While dopamine is a vital part of how we learn and feel motivated, it is also what makes certain gaming structures so effective at reinforcing repetitive behaviours. This is not inherently harmful; after all, we need reward to feel joy and motivation, but problems arise when games are designed primarily to exploit this feedback loop without providing meaningful regulation or rest. A 2022 article in Psychiatric Times goes further by discussing the rise in problematic gaming and the concept of "dopamine detoxification" as a response to compulsive digital habits (Rosenberg, 2022). This discussion highlights concerns around overstimulation from fast-paced, highly reactive game mechanics that can keep players stuck in cycles of short-term reward-seeking without the longer-term satisfaction of connection, agency, or reflection. In a culture where overstimulation is easy and rest is hard, these systems can begin to override other forms of regulation. It is here that the mental health implications become clearer; not because games are inherently bad, but because some of the most commercially successful ones are optimised to extract attention, not to support well-being. This reinforces the need for alternative design approaches that work with, rather than against, our nervous systems. Further research has explored how this cycle of pleasure can blur into something less healthy. A 2020 paper, ‘Video Game Addiction and Emotional States’ (Gros L et al., 2020), found that individuals who play excessively often mistake the short-term dopamine-driven pleasure of gaming for longer-term emotional wellbeing. This can lead to emotional confusion and reliance on games as a primary means of mood regulation. Layered onto this neurological insight is a growing conversation around exploitative behavioural design. A 2021 report from the Trimbos Institute breaks down how many games use behavioural techniques such as variable rewards, time-limited offers, and infinite play structures to reinforce play habits, sometimes at the expense of player autonomy or wellbeing (Trimbos 2021). These aren't just clever mechanics, they’re calculated interventions that can nudge players toward more time spent and more money spent. What’s important to stress here is that these techniques are not inherently bad. In fact, many of them make games fun and engaging. But when they’re used without considering player wellbeing, they can contribute to patterns of overuse, disconnection from real-world activities, and decreased satisfaction in everyday life. This is where our work begins. We are interested in the question: How do we make games better for our brains? What if Games Could Regulate Instead of Dysregulate? If traditional game design often prioritises retention, reward loops and monetisation, what might games look like if they were designed to support regulation, reflection and wellbeing? This is the question at the heart of our work at Entropy Interactive. As game makers, mental health professionals, and people who care deeply about the impact of digital experiences, we are interested in how game design might shift from exploiting the brain's reward system to supporting the nervous system in meaningful ways. What happens when a game doesn't just entertain, but invites calm, curiosity, connection and emotional awareness? We’re not alone in asking these questions. A growing number of scholars and designers are exploring how games can be used as tools for self-regulation, mental health education, and psychosocial support. Research into therapeutic game design has shown promise in fields like anxiety management, mindfulness training and emotional regulation (Granic et al 2020). Some games use narrative and play to foster empathy or explore trauma. Others use rhythm, repetition, or breathing mechanics to help players down-regulate from states of stress or overwhelm. But there’s still space to go further. We believe there is potential for games that are not just therapeutic in content, but therapeutic in structure. Games that dont just simulate calm, but help create it. Games that respond to a player’s emotional state, offer tools for reflection, and reward not just action, but awareness. Our own practice draws from polyvagal theory, sensory modulation strategies and psychotherapeutic models that support regulation and connection. We’re experimenting with ways to: Integrate subjective units of state evaluation into game play, Build in self-regulation methods as part of the core loop, Respond to a players mood or state with adaptable game environments, And design narratives or mechanics that support movement up the polyvagal ladder, from shutdown or hyperarousal toward safety, play and connection. We know this is ambitious, and there is still a lot to test. But the paradigm we’re working toward is where games dont simply capture attention, they also help us come home to ourselves. As both a gamer and art psychotherapist, I have witnessed the role games can play in fostering connection, self-expression and regulation. In my own life, games like Super Mario World, The Sims, Animal Crossing, Stardew Valley and Baldur's Gate have provided joy, community, and meaningful escape, particularly during periods of stress, like the COVID-19 lockdowns. For many of my clients, especially those living with acute psychosocial disabilities, games are more than entertainment. They are a lifeline. They offer novelty, learning, play and access to social experiences that they might otherwise feel out of reach. This is why I feel uncomfortable when gaming is reduced to something harmful or frivolous in public discourse. Even when a player’s relationship with games becomes intense or consuming, I see it through the same compassionate lens I use in therapy: not as something to shame, but as something to understand. Often, gaming (like any activity adapted to coping) is protective. The question isn't whether gaming is good or bad, but what need is it meeting, and how can we support that need more safely and consciously? I’ve also seen how the wrong kind of gaming environment can overstimulate or deepen a player’s sense of isolation. That tension between gaming’s potential for good and its risks, is what inspired me to co-create this project. I want to contribute to a gaming landscape where play still feels fun and rewarding, but also soothing, empowering and self-aware. Our own game draws from the spirit of experiences like Dungeons and Dragons, which I love for its narrative depth, collaborative problem solving and identity exploration. As an art and narrative therapist, I believe the future of mental health support will increasingly involve digital and interactive spaces. I believe that games have an important role to play in that future. Introducing Myndzai Digital games are no longer niche. They are one of the most widely accessed forms of media in the world. Digital games are used by children, teens and adults across almost every demographic. In Australia, 81% of people play video games, and nearly half are women and girls (IGEA 2023). Games are social spaces, learning spaces, cultural texts and for many, they are emotional lifelines. As the digital health and wellbeing sector continues to grow, there is increasing appetite for interventions that are accessible, engaging and designed with integrity. Yet many existing digital mental health tools remain under utilised because they feel clinical, impersonal or disconnected from the types of digital experiences people already love. This is where Myndzai comes in. Myndzai is a role-playing game (RPG) designed to meet people where they are. Offering them quests, an immersive story and a reciprocal relationship with in-game characters that evolves over time. Unlike wellbeing apps or task-based gamification platforms, Myndzai creates a direct connection between the player and their avatar. You’re not caring for a digital pet… You are the character. Your real-world mental and physical state will shape the story you experience. As players navigate through the game’s environments, they will encounter opportunities to orient themselves in ways that feel authentic and comforting. Our core design principle is rooted in the idea that story follows state- a concept from both narrative therapy and polyvagal theory. What this means is that your character’s journey will adapt depending on your own internal state. This is a game that responds to you. Through levelling systems, players can unlock tools and features that support customisation, not just of visuals, but of the gameplay experience itself. These levelling pathways will include: Reflection level-ups: which encourage players to pause, notice patterns and build insight. Stat buffs/nerfs: which influence both in-game progress and real-world self-awareness. Expanded narrative quests: which evolve based on emotional check-ins and personal choices. We are literally giving players aesthetic distance - a therapeutic concept used in art, narrative and play therapy that allows for reflection through the safety of metaphor and imagination. Players can project, explore, and shift in ways that feel safe and empowering. In its current form, Myndzai offers: A breathing game that gently guides players through self-regulation. A colour and pattern matching game to soothe the visual system. A planting and growth game where motion and presence are rewarded. An audioscape feature allowing users to curate their own relaxing soundscape. A stone-skipping reflection game that allows players to consider key elements of their current experience. And a player profile that displays not only the progress of the player’s experiences with these features but their impact. We are proud to be developing a game that doesn't try to replace therapy, but instead supports mental health through play, creativity and emotional presence. It’s a game that's curious about you. A game that’s not trying to hijack your attention, but to hold it with reverence, not consider it a KPI. This moment is not just an opportunity for innovation, it's an opportunity for care. Myndzai is our offering in response.

Where to from here?

At this stage in development, Myndzai is ready to test one of Entropy Interactive’s core hypotheses: that offering players in-game activities aligned with their present emotional state can contribute to reduced distress and improved self-awareness. To validate this approach, the team will engage in a structured evaluation process using the vertical slice version of the game. This process includes: Test cases: Participants will be selected to reflect a range of mental health presentations. For example, a player with anxiety might be invited to complete the game’s in-game reflection prompts across domains like Mind, Body, Sleep and Self. Based on the results of this, they will engage in a mindfulness-based activity within the game relative to their reflection. Expected scores: Based on the activity’s design, Entropy Interactive anticipates a decrease of approximately 2 points in SUDS after 10 minutes of gameplay. Comparisons: Pre and post-activity data will be collected during gameplay to evaluate whether the selected in-game intervention effectively supports the player’s current needs. Analysis: If player scores align with expected outcomes, this will indicate that the game’s activity matching system is functioning as intended. If not, it will offer clear direction for adjusting the reflection questions, activity algorithms and feedback loops to better support players’ wellbeing. Our long-term goal is to build a game that encourages a virtuous cycle of self-regulation and insight rather than a vicious cycle of stimulation and avoidance. As we test our theories and collect evidence, we will also continue to build out the broader quest-based narrative and customisation systems. We want Myndzai to be more than a good idea. We want it to be a meaningful, measurable and memorable experience. One that players can return to again and again - as little or as often as they may feel they need.

An Invitation

We believe that Myndzai is more than a game, it’s an evolving experiment in what happens when game design is led by empathy, collaboration and curiosity about the human experience. We know we’re not alone in seeing the potential for play to become a supportive tool in mental health and wellbeing and we’re inviting others to walk alongside us in this discovery process. To therapists, educators, researchers and funders: We welcome your insights, your critique and your questions. We want to co-create, test and shape this game not just for communities but with them. To fellow game developers: Let's imagine together what it means to build not just engaging experiences, but games that support people where they are and help them to grow from that place. To gamers and the wider public: Your experiences matter to us. Whether gaming has been your lifeline, your joy, your stress release, your social world, your perspective is vital. We want to hear what helps you, what frustrates you and what you wish existed in this space. Myndzai is our way of saying: we see the good in gaming, and we want to build on it. This paper is not a conclusion - it’s a beginning. As we step into testing and further development, we are committed to evidence-based design and trauma-informed storytelling, but also to the creative human heart that lies at the centre of this work. We are open to partnerships, pilot testing opportunities, research collaborations and conversations to help us do better. We are also looking for playtesters to help us produce our own research. If this project resonates with you, we invite you to reach out, share your thoughts and join us in reshaping what games can be.

References

• Leménager, T., Dieter, J., & Kiefer, F. (2021). Biochemical correlates of video game use: From physiology to pathology. International Journal of Environmental Research and Public Health, 18(15), 8030.
• Rosenberg, R. (2022). Problem Gaming? Consider Dopamine Detoxification. Psychiatric Times.
• Gros L, Debue N, Lete J, van de Leemput C. Video Game Addiction and Emotional States: Possible Confusion Between Pleasure and Happiness? Front Psychol. 2020 Jan 27;10:2894. doi: 10.3389/fpsyg.2019.02894. PMID: 32047450; PMCID: PMC6996247.
• Van Rooij AJ, Birk MV, Hof S van der, Ouburg S, Hilten S. van, Behavioral design in video games: A roadmap for ethical and responsible games that contribute to long-term consumer health and well-being. Trimbos institute, Eindhoven University of Technology & Leiden University for the Dutch Ministry of the Interior and Kingdom Relations; 2021.
• Brand, J. E., Wilson, T. W., Jervis, J., & Huggins, P. M. (2023). Australia Plays 2023. IGEA.