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Swatee Surve has been working on games that can improve mental health for more than 10 years. She is still at it, and she has added a new minigame called Gratitude to the mobile game Sinasprite that she launched a decade ago to help patients manage problems such as stress, anxiety, or depression.

Starting in 2012, Litesprite created a game called Sinasprite, which used a fox character named Socks to go on journeys through an animated world. I wrote about the company years ago and caught up with Surve at the recent DICE Summit event in Las Vegas.

In contrast to many action games, the journeys that Socks takes players on are soothing or relaxing. Surve said her company has become adept at measuring the impact of the game on the behavior and health of its players, and it has clinical findings that support the notion that it helps people cope.

Ohio State University’s peer-reviewed analysis determined Sinasprite delivered a “clinically relevant improvement,” which meant a player was productive two more days each week than before the intervention (i.e., playing Sinasprite).

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Recent internal findings showed that within six weeks that 34% of users reported a clinically relevant improvement; 19% of users reported a minimally clinically important difference (MCID) in anxiety; 34% of users reported a clinically relevant improvement; and 12% of users reported an improvement in depression. Findings will be out later this year.

In December 2020, Litesprite launched the commercial version of Sinasprite on iOS and Android, and in January of this year, the company re-launched Sinasprite’s Gratitude mini-game, adding it to the commercial version.

Gratitude is a minigame with multiplayer options.
Gratitude is a minigame with multiplayer options.

Gratitude adds another journaling technique, this time with a multimedia experience, to address depression and anxiety. Players can play on their own, or they have the option of a multiplayer experience. Studies found a correlation between gratitude practice and improvements in mental health, including one that saw a 35% decrease in depressive symptoms with this kind of technique. The analysis by Courtney E. Ackerman is at PositivePsychology.com.

Surve said part of the mission is to destigmatize mental health issues and remove barriers to help. This is why the company offers a forever-free version of our game.

Since 2019, the company has raised more money from strategic investors NexCube and AARP Innovation Labs, joining other strategic investors Bayer Pharmaceuticals, Tabula Rasa, and Jumpstart Foundry. And the company became an approved vendor with large, national benefits consultants like Mercer and Aon, and channel partners like Shortlister and BenefitsPitch. Litesprite has also expanded its team with Sarah Danzo, chief clinical officer; Vivin Purushothaman, chief technology officer; and Taraneh Fultz, chief revenue officer.

And Litesprite is formalizing a partnership with Rise Above, a nonprofit that serves Native American Youth across the country. Rise Above is looking for digital forward solutions, such as Litesprite, that meet the needs of its communities. 

Here’s an edited transcript of our interview.

Swatee Surve is CEO of Litesprite.

Swatee Surve: At Litesprite we’ve relaunched our Gratitude mini-game. It’s a multiplayer experience as part of the app. We’re very excited about that. It confirms what Laura, the keynote speaker, had talked about, where we want group experiences, but small, intimate groups, close friends, and family. Gratitude lets you play with four or five of your friends and family. The idea is to teach the practice of gratitude but also engage your social network in that small, intimate fashion. Recent reviews from players have said they’ve used it multiple times throughout the years. Some people have said it saved their lives. That’s pretty exciting.

From a business perspective, we’re working with several employers now. They’re very happy about the results. We’re expanding with some of them into their international locations as well, surveying their employee bases. We started off in the U.S. and now we’re going to be supporting their employees globally. We’re very excited about that too. We’ve hired a new chief revenue officer, Taraneh Fultz. She’s great.

GamesBeat: How many people do you have altogether now?

Surve: We’re still about the same, about 10 people across the whole organization. We have a new board member who’s been very instrumental in helping us get to our new successes. We may be bringing a new lead clinician on board from the University of Washington, doing a postdoc in the psychiatric department there. That’s not finalized yet, though.

We’re just super excited. We continue to innovate. We continue to learn about how technology can make a difference in someone’s mental health. There are a lot of applications. You see VR mental health. You see apps for meditation. But how do you actually move that needle and create a tool that people trust to the point where we literally are used at the point of crisis? We run the gamut from prevention to crisis intervention to maintenance as well.

GamesBeat: What do you have that’s still going from the apps you’ve worked on in the past?

Surve: We have the one, Sinasprite. We have clinical validation on that. The structure of the game is that we have a variety of mini-games in the world. Our Gratitude module or mini-game is the latest one we added. We have Meditation and Journaling as well. It’s all part of the same app. It’s creating a richer experience within Sinasprite, which is focused on mental health. But we’ve seen cancer patients use it. We’ve seen patients with diabetes. Anybody who has a chronic condition typically has a mental health challenge. But everybody these days has a mental health challenge. These are just really rough times.

That’s why we’ve been seeing a lot of employers looking for alternative solutions. The current solutions aren’t really helping their employees.

GamesBeat: What’s worked best as far as getting this into the hands of users? How does it circulate?

Surve: We have strong word of mouth. We don’t actively–we mainly sell to enterprises. We haven’t done a lot of what you would see in traditional games, where you monetize through a freemium model. Prior to the pandemic, we worked with insurance companies and health systems. Post-pandemic, we saw the demand coming from employers because people were burning out. They’re still struggling. We’ve seen statistics where 42 percent of all Americans are reporting some sort of behavioral health challenge. We’ve been supporting employers, and that’s where the traction comes in from a business perspective. Which is unusual, since most games are direct to consumers. It makes for a different sales cycle, though, and a completely different user.

Sinasprite’s homescreen.

GamesBeat: How does pricing work?

Surve: Monthly subscription, volume-based, for enterprise-wide. It depends on how many seats they want, and then we do a volume-based calculation. There are also discounts for longer-term contracts. We have preferred payment terms as well. But mainly the number of seats and how long they want to subscribe.

The other interesting thing we’re seeing now, which I was talking about several years ago–employers want data. And not in a Big Brother way. They genuinely want to help. They want to understand what their employees are struggling with. That’s another key differentiator for us, and that’s why we’re getting a lot of response. What we can do is help the HR teams be more efficient and more responsive to the employees’ needs without having to send these surveys all the time. No one ever replies and they don’t know what’s going on.

We can help the HR teams be more supportive in the way they want to be for their employees, and help them understand what other parts of the benefits they have are there to utilize. That’s another thing employers say they’ve been asking for. I’ve been on a lot of forums and webinars where people say, “I wish we understood what the triggers were so we could help.”

GamesBeat: How many years have you been working on this now?

Surve: I went full-time in 2014 after launching in 2013. I had started researching it back in 2011 and 2012. I’d been tracking this area, and I wasn’t seeing a lot of–it’s still an evolution. We’re still considered a frontier technology.

We also have a new strategic investor after Bayer, by the way. We have AARP now. We have several strategic relationships with key benefits brokers like Aon, Mercer, Lockton, which is one of the largest benefits brokers. We’re working through that channel and we’re a preferred vendor. I don’t think there are many video games that are preferred vendors for HR benefits.

GamesBeat: Breaking new ground there.

Surve: Yeah! But it’s so hard. We have to do so much education. To me, a video game is the most complicated software you could ever build. I was talking to people here. How many spreadsheet programs do you know that actually hook people up to sensors to make sure the user doesn’t get too stressed out? All the triple-A games do that now. They factor emotional and physiological reactions into the design. When you talk about narrative and so many things that games bring together – community, currency, building, levels, visual representations – it’s very complicated. All of us in the games industry understand that. But when you go outside? Five-year-olds play those games. That can’t be serious.

Sinasprite’s assessment tool.

GamesBeat: Do you have peers among other games and apps that have been developed for mental health? Something like Nanea Reeves’s project, Tripp? They’re working on a VR app for wellness and mindfulness.

Surve: Oh, yeah, I’ve seen that. Their target market is interesting. We track progress, and so we look at two other clinical markers, which are clinical relevance – that’s a two-point improvement on either the GAD for anxiety or the PHQ for depression – and then there’s also a term called Minimally Clinically Important Difference, MCID. That’s a change where a patient or an individual can perceive that they’re getting better.

I can give you the specific stats, the direct numbers, but we’re seeing that we’re moving the needle for anxiety and depression–for anxiety I think it was 18% showing a Minimally Clinically Important Difference, and then 12% on the depression angle. And then about 35% were showing clinically relevant improvements on both. That’s the kind of stuff, when you go to a payer or a provider–but now employers are asking for that as well. They want to see engagement. They want to know about retention, the standard metrics. But then they also want to know, what’s the health outcome? We’re looking to also do some prospective studies, which could give us some very good data on our ability to be a self-help tool.

Sometimes, with certain cohorts–when we do cohort analysis, there’s a disproportionate number of older men who will contact and want to use the game format, because it doesn’t look like anything medical. It gives them the relief that they need in a private outlet.

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