“Ludic loops” may be just the push many need to improve our health behaviors

September 23, 2019

By Beverly Beaudoin

If digital games can be habit-forming, could the powerful techniques used to glue people to their screens, known as “ludic loops”, be put to use to break bad health habits or create good ones? They’re a potential force for good, and health marketers are now looking at them closely as health gamification 2.0 becomes more widespread and sophisticated.

For those who haven’t been following this series of posts, gamification is the application of games and game principles — score-keeping, competition, leaderboards, badges, rewards — to non-game contexts, and health care has been quick to adopt it. Many smartphone and online games of varying quality now exist for helping to manage medication, control weight, reduce substance abuse, and educate about disease self-management. And as gaming grows, so does the science underpinning its ability to engage users.

Health promoters are excited about gamification in part because changing health behaviors has historically proven difficult. Short-lived bursts of enthusiasm for a change for the better (remember those New Years’ resolutions?) tend to peter out quickly, and bad health habits often rapidly return as novelty turns to drudgery. People often have the best intentions but lack a reliable means for turning those intentions into lasting improvements. So making behavior change fun—by making it a game— holds promise as a way around this challenge. Imagine if people got as deeply into diet improvements, exercise regimens, or medication adherence as they have with Minecraft or Pokemon Go. As I noted in a previous blog, I’ve seen subway riders miss their stops, so engrossed in smartphone games that they lose awareness of where they are.  There’s no denying how “sticky” (in the digital argot) Internet and smartphone games can be. Studies show that of the 150 million Americans who use the games, 60% now use them at least daily.

What makes people return again and again to games? It’s no accident. Today’s games are programmed with the intent to hook us. They deliberately apply psychological and neuroscience insights from the world of compulsive gambling, among others. Game designers systematically apply what MIT anthropologist and author Natasha Dow Schüll has dubbed “ludic loops”, a moniker derived from the Latin word ludos meaning “games”.

Ludic loops are patterns of sensory feedback that activate neural pathways of reward in our brains, stimulating repetitive game-playing. Schull discovered ludic loops when she studied slot machine users, seeking clues to why people return again and again to these aptly named one-armed bandits. She discovered that semi-predictable and multisensory feedback rewards —flashing lights, jangling sounds, and bright colors that unexpectedly congratulate desired user actions (and mildly punish undesired ones)—create in users a relaxed, focused feeling that they start to crave—an otherworldly calm not unlike that gained via meditation.

Schull and others have found that it isn’t a big jackpot win that gamers typically are after; rather, they find playing and getting these rewards puts them in a trance-like state they experience as soothing and pleasurable. A neurochemical phenomenon,  this zone isn’t the result of deep thought. It’s more the outcome of continual attention and activity. It’s rewarding essence is escape from the stressors of the real world. Further research suggests that the cognitive component of constant cycling from uncertainty to certainty and back again that gamers experience additionally triggers dopamine, a brain neurotransmitter associated with reward and motivation.

It’s been known since the days of behaviorist pioneer B.F. Skinner that random rewards reinforce behavior more powerfully than predictable ones. Schull’s findings and similar research, however, go way beyond Skinner’s work. Today’s game science has become what a New Scientist article called “a recipe for obsession”—a way to engineer games to make playing them more compulsive. Ludic loops have become a central tenet of game design.

As an example, a friend of mine trying to learn French has developed a quasi-addiction to the app Duolingo and the ludic loops built into it. He finds it hard to stop “playing” after reaching his daily goal, often spending an hour or more interacting with the game. He gets into a pleasant and energizing reverie (is that French?) while playing. He worries that if he misses a day, he’ll lose a wager (of imaginary points) that the game offers him, or drop down a notch on the leaderboard of other learners. He claims he was never so diligent when taking classes or studying on his own. And he says he’s having a lot of fun.

For someone looking for help in overcoming bad health habits, this is precisely what the doctor ordered. We know that people often try again and again to change their health behaviors, only to slip back under stress or when caught off guard. There’s a statistic from a 2016 study, for example, that people who quit smoking on average do so only after trying – and failing – 30 times.[1] People, it seems, want to have better, more effective choices they can rely on to give their efforts staying power. When willpower flags, ludic loops provide staying power in abundance.

The stakes in health care are often a lot higher than in other areas where gamification works. A patient who succeeds in taking blood pressure medications could prevent a deadly stroke, for example; changes in diet and lifestyle can reduce risk of some cancers. That’s a strong argument in favor of offering patients the power of ludic loops.

Some critics of the game industry say that the “addictiveness” of games raises ethical questions, but  simple common sense suggests that the potential health benefits of, say, reducing tobacco use, decreasing obesity, or preventing a stroke as in my husband’s case, far outweigh any harm associated with obsessively playing a smartphone game.

Can there be too much of a good thing when it comes to healthy behavior? I don’t think so. That’s why I’m eager to see more health challenges addressed by games and their ludic loops… and to see good health become habit-forming.

As a marketer, I’d like to see us continue to explore methodical, scientifically sound approaches to designing and testing games that use a combination of digital best practices, behavior change theory and gamification 2.0 to help patients realize healthy behaviors.  It’s not only fun, it’s the right thing to do.

In upcoming posts I’ll venture into how games can address specific stages along the route to better health behavior—from denial to determination to relapse prevention. Stay tuned!

[1]  Chaiton M, Diemert L, Cohen JE, et al. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers.  BMJ Open 2016;6:e011045. doi: 10.1136/bmjopen-2016-011045