Can An Online Game Help You Learn To Help Struggling Friends?

Enlarge this image toggle caption Kognito/Screenshot by NPR Kognito/Screenshot by NPR

It can be difficult to know what to say when a friend is struggling. The conversation is hard to even start. Maya Cohen, a first-year student at Tulane University, says she knows better how to intervene after playing a video game created to help people learn how to recognize signs of psychological distress like depression, anxiety and substance abuse, and get them professional help.

Like all incoming students at Tulane, Cohen had to participate in an online conversation simulation game titled "At-Risk For College Students." The purpose is to teach empathetic conversation skills. In the game, you play Jesse, a friend of Travis, a depressed young man who's been failing his classes. Jesse notices that Travis hasn't been the same lately, and goes to his apartment to see how he's doing.

Checking in is the kind of supportive effort that friends ideally do for one another, and the game is supposed to encourage more of that. We hear out each other's burdens. Friends are the first bulwark of support when times are a little rough or when something's deeply wrong. We might pride ourselves on the advice we give, the shoulders we offer, the general "being there" for our friends.

But our skill at doing that varies, says Glenn Albright, a psychologist at Baruch College at the City University of New York and cofounder of Kognito, the company that developed the game. "It's the sad reality that a lot of people don't know how to help people," he says. "How to identify those who are struggling, to approach them, talk to them and give them a level of comfort."

Enlarge this image toggle caption Kognito/Screenshot by NPR Kognito/Screenshot by NPR

Albright thought that the right conversational training program could help people help those around them. "You're talking about 40 percent of college students reporting systems of depression where they say it's interfering with their functioning," Albright says. Kognito's first simulation, released in 2009, focused on faculty-student conversations. The company has since developed over a dozen simulations.

Many focus on peer conversations, like the game that Cohen played; others address patient-doctor or family interactions. At the end of the conversation, participants get examples of how to sensitively suggest mental health services. In simulations for medical professionals, that might mean managing care collaboratively with other health professionals.

Kognito grounds all of these simulations in psychological counseling methods such as motivational interviewing, which stresses conversation techniques like using open-ended questions and listening and reflecting on what someone says during a conversation.

"[This] is really trying to engage the other person in dialogue, understand what's happening and what's influencing their behavior," says Marlyn Allicock, a health behaviorist at the University of Texas in Dallas who is not involved with Kognito. "Those skills are really grounded in empathy."

In the game that Cohen played, when Jesse relates to the things his friend is saying, Travis responds much more warmly. If Jesse is brusque during the conversation, Travis clams up. "They've done a really nice job modeling a person's behavior," Allicock says.

The games also shows things that might push people apart, Allicock notes. Giving unwarranted advice, for example, might give the impression that you think you know better than your friend. "Those are things that push people away," Allicock says. "I'm not going to open up to you if you're saying, 'You're not doing this right.' "

Cohen says she didn't realize any of this until she started playing through the Kognito simulation. "A speech bubble came up with tips," she says. One says using "I" statements is good, but not when a judgment is attached. That reminded Cohen that when a friend of hers would complain about something, Cohen would make a judgment. "I would approach her and be like, 'I think you're overreacting,' " she says.

Cohen, 19, says she kept thinking back to one time last year when she feels she really should have talked to her friend. She got a screenshot of text messages that her friend Angie had sent to her boyfriend. We aren't using her last name to protect her privacy. The reason will become clear later in this story. "[Angie] was texting her boyfriend saying, 'I feel none of my friends care about me. Would anybody even notice if I was gone?' " Cohen says. She was worried, and wanted to ask Angie about it. "I just didn't know how to start that conversation. And once I did I wouldn't know how to continue it."

Instead, Cohen brought the text to her school counselor, who pulled Angie out of class. "At the time I was really mad because I was like, so depressed, and now you're making my life harder," Angie says now. "They added this entire like new situation."

Angie, 18, says that at the time she was considering killing herself. The counselor's intervention got her the help she needed, but the fact that none of her friends tried talking to her first made her upset. Cohen feels like it put a strain on their relationship, even after they made amends. "We could never go back to how we were before," Cohen says.

After the Kognito training, Cohen says she'd been thinking a lot about how she could have handled the situation better. At the very least, she says, she could have gone to Angie first to check in on her, talk to her and find a way to get her help, but with her consent. "That would have been more inclusive of Angie," Cohen says.

Angus Chen is a freelance writer based in New York. Find him on Twitter @angrchen.