The casual gaming roots behind Happify Health

Happify Health uses the same incentives learned from gaming to encourage behavioral change

Recently, there have been several acquisitions of startups focused on self-care, self-administered digital therapeutics, in other words evidence-based interventions in cognitive behavioral therapy, mindfulness and positive psychology run by software vs therapists. AbleTo bought Joyable, it was announced earlier this week. This follows the shut down of Lantern, which ultimately saw its parts sold to a number of providers, such as Spring Health and Ginger. Earlier this year, Livongo picked up myStrength.

The activity makes you wonder whether the market is too early for self-administered software to heal and soothe one's mental state.

Happify Health is one of those startups focused on self-care software-automated solutions. The New York-based startup, which raised $25 million since it started in 2012, offers solutions to help people cope with stress, anxiety, and depression, and built resilience.

Happify Health co-founder and President Ofer Leidner joins us at #InventHealth - Future of Mental and Behavioral Health on April 4, at UCSF. Join us! 

Its platform draws on the best, evidenced-based practices of all of the behavior change sciences including cognitive behavior therapy, positive psychology and mindfulness.  For example, one of the psychological mechanisms of cognitive behavioral therapy is helping people identify how they feel, and connect those thoughts with behavior. This helps them change their perception and reality of their state of mind.  

While its programs are offered via self-insured employers and health insurers, like Cigna, consumers can also purchase off the Happify.com website. In my free trial, I selected games to cope with stress. In one game, I had to click on positive words. Each positive word I clicked on I received points. 

In my free trial, I selected games to cope with stress. In one game, I had to click on positive words. Each positive word I clicked on I received points.

For words like "Happy", I received 10-20 points. For words, such as "Prickly" [below], I lost similar points. The idea was to gain enough points to level up to the next activity.

It's an interesting exercise, and clearly reinforces positive thinking. I can imagine not being in a happy place, and wanting to click on "angry" or "ticked" as many times as I saw it fly up just to cathartically release my frustration.  For individuals who tend to look for the negative, I can see how this would start to re-train your brain to start looking for the positive.

It's a bit like counting to 10. In another activity around "gratitude" I was asked to write down what I was grateful for. This is relatively easy since my family (and my kids) have made giving thanks a routine, whether it's in our night-time prayers or right before meals.

Happify Health has more than 60 programs that address specific topics, from family and kids, work and money, relationships to personal growth. For me, based on the brief questionnaire I answered, I was recommended the track "Feel less overwhelmed as working parent" under the family and kids topic.

“Our solution is really effective in addressing episodic mental health challenges, which account for 80% of the behavioral health challenges,” said  Ofer Leidner, co-founder and President, in an interview with me. “We are not the solution for chronic mental illness. Once we help users with episodes (mild moderate and severe symptoms) we often support them in maintenance mode, due to our platform high sustained retention rate. Our month 12 cohort retention rate is 40%, meaning 40% of the users on our platform become habitual users.”

Habitual means two-to-three times a week if it's desktop and 14 minutes per session and three-to-four times a week for six-to-eight minute sessions for mobile.

As for how it's working, Leidner says that Happify Health can "reliably predict a reduction of one category of PHQ9 from severe to moderate for anyone who does 16 activities on the platform." To this end, if someone is doing two-to-three activities a week, they can see a change in a month. Here’s a link to a study and published on the International Journal of Wellness.

But with no therapist to be accountable to, how does Happify Health ensure people stay with their activities?

This is where Ofer's gaming background comes in handy. He's spent his past career trying to get people engaged, and he was successful.

Prior to Happify, Ofer co-founded and built several digital media businesses, most recently iPlay/Oberon Media, a leading casual gaming company and he also served as co-founder and president of Gate42 Technologies, a software startup in the customer relations management space.

In 2006, he recalled thinking about the 49 billions of hours he engaged users through the use of games. It's been studied that games release dopamine, a neurotransmitter in the brain that makes a person feel blissful and motivated. While that doesn't sound so bad, excess dopamine can lead to paranoia and psychosis, seen in schizophrenics.

"I thought, 'Holy Crap' - imagine if we took those hours of dopemine-enhancing loops and used those hours to help people live better lives?"

Unlike games where interpersonal competition is a key component of engagement, that type of competition has no role in the Happify Health activities. "Most games are based on leaderboards but we decided to take on the challenge to gamify the platform while taking out the one of the most powerful gaming principle - competition."

Interpersonal competition isn't a good incentive for people who are struggling with their own mental state as it could be stifling or intimidating. Rather Happify uses intrapersonal incentives like achieving medals after a certain number of activities have been completed to help encourage and motivate the person to continue their journey to stronger emotional health.  And of course, the real reward comes from a person feeling better. "When people do activities on our platform, they start to feel better. This is a mechanism that drives them to do better."

As for what gets people to start these activities before they're in crisis mode?

"Our approach is to de-stigmatize the entrypoint," said Ofer. "We don't ask: Are you depressed or If you have a substance abuse problem, call us. There’s different messages that people are more concerned about. We’ve spent years and millions of dollars to test and figure out what brings people in. It’s not about happiness; it’s not about depression, it’s counterintuitive.”

Happify Health originally started reaching out to consumers, but has since been selling to health plans, payers and pharmaceutical companies. As a consumer who wants to try this out, you can see subscription costs here.