Cleveland Clinic Enters the Metaverse to Support Mental Wellbeing

From doom scrolling and fear of missing out to gaming-related anxiety, the stresses that can result when people interact with and in the digital realm have the potential to affect wellbeing.

Mindfulness-based interventions are effective at reducing stress and improving mental health. However, such therapies aren’t necessarily a top priority — or readily accessible — when people are immersed in digital technology.

Decreasing screen time, and thus exposure to digital stressors, is a logical mitigation strategy, but not one that many people are willing or able to undertake.

In an effort to engage with digital technology users on their terms and turf, Cleveland Clinic has developed an interactive online experience that allows participants to take a mental health break and learn and practice positive, relaxing and restorative behaviors.

The activity, called Zen Quest, A Mindful Retreat, is an interactive experience combining gaming and mindfulness techniques to support mental wellness. It is intended for users of any age, both gamers and nongamers, who are seeking relaxation help. It is available on Roblox, a digital platform that allows users to create, play and share games in the metaverse. Roblox is accessible on computers, phones and tablets and has more than 70 million daily users across the globe.

With Zen Quest, “you're meeting people where they are and giving them an extended-reality environment to allow their mind to reach places they wouldn't have been able to do physically. In this way, we are removing the geographic barriers to mental health assistance,” says Dominic King, DO, a Cleveland Clinic sports medicine physician and Director of the Esports Medicine Program, which provides care for competitive video gamers.

Details of the experience

Zen Quest was developed based on guidance from Cleveland Clinic physicians and content from Cleveland Clinic’s online Health Library.

The Zen Quest experience uses animation, sound and interactive tools to lead a user’s avatar through a 3-D landscape populated with mindfulness activities. (Mindfulness is a purposeful awareness of one’s state of mind and surroundings)

Zen Quest’s guided exercises include breathing techniques to relieve stress and anxiety; meditation to improve focus and encourage calmness; and walks through an affirmation area with encouraging messages, and an art appreciation area with images curated from Cleveland Clinic’s art collection.

Mindfulness/gaming research

Although the causal mechanisms are uncertain, some randomized controlled trials have shown that mindfulness-based interventions (MBIs) can improve a variety of psychological conditions including stress, anxiety and depression.

Typically, MBIs involve formal instruction in the techniques in a clinical or educational setting. While self-supervised, game-based mindfulness activities may seem unconventional, there is some recent evidence of their effectiveness.

Researchers at the University of Wisconsin–Madison and the University of California, Irvine, created and assessed a video game called Tenacity intended to improve mindfulness and attention in middle school students. Players who successfully controlled their breathing pattern were able to advance through the game’s landscapes. A control group played a different video game that didn’t involve breathing control and mindfulness activities.

After two weeks of daily gameplay, participants in the randomized control trial underwent resting-state functional connectivity and diffusion tensor imaging studies. Adolescents in the group that played the Tenacity breathing/mindfulness game showed increases in connectivity between the left dorsolateral prefrontal cortex and the left inferior parietal cortex — two areas critical for attention. The brain connectivity changes in the experimental group were associated with improvements in the students’ performance on an attention task administered in the lab.

Although Tenacity has not been publicly deployed, the Wisconsin and California researchers asserted that video games could be a powerful means of improving attention and achieving other positive outcomes.

Entering the metaverse

Zen Quest is Cleveland Clinic’s initial foray into the metaverse, a loosely defined and still-evolving collective of artificial worlds that participants encounter via extended-reality computer headsets and other gear. In the public portion of the metaverse, users represented by avatars explore and interact in various fully immersive 3-D virtual settings, including games, social experiences and e-commerce.

The metaverse’s implications for medical providers and consumers are yet to be determined, although some healthcare organizations are beginning to investigate uses.

If regulatory and data privacy concerns can be resolved, “the metaverse has the potential to revolutionize healthcare, providing a virtual environment that transcends the limitations of traditional physical institutions,” a recent report by the global professional services network PricewaterhouseCoopers concludes.

Possible benefits include improving and democratizing access to medical advice and care; reducing environmental impacts by deploying virtual clinics when appropriate; and providing virtual education and training simulation opportunities for caregivers.

Developing a healthcare presence in the metaverse is part of Cleveland Clinic’s strategy to embrace new technologies to reach and help more patients, says Chief Marketing Officer Paul Matsen.

“From kidney dialysis and artificial hearts to robot-assisted surgeries and quantum computing, Cleveland Clinic has a long history of healthcare innovation,” Matsen says. “Once we saw that mental health as it pertains to gaming and digital interactions was an area not many people have tackled, we homed in on a way we could tangibly make an impact in people’s lives and wellness.”

‘Changing the game’

According to the National Institute of Mental Health, nearly 58 million people in the U.S. experience mental, behavioral, or emotional disorders. Many more grapple with stress and anxiety. Yet worldwide, a 2018 study found that only about one-fourth of people who met the diagnostic criteria for anxiety disorder received treatment in the previous year. The authors attributed the gap to scarce mental health resources, lack of awareness, and the costs and stigma of treatment.

Zen Quest isn’t a treatment, but it is an introduction to mindfulness techniques for people who may not have considered their need or known where or how to get guidance.

"This is how we approach all conditions — by meeting our patients where they are and guiding them toward their goals," Dr. King says. "With the launch of Zen Quest, we are extending the reach of Cleveland Clinic into the metaverse, creating immersive environments that enhance mental wellness. By integrating our expertise in both physical and virtual realities, we are not just playing the game; we are changing the game."