Can This Founder Solve Japan’s Hidden Mental Health Problem? – Hikari Labs

Seeking help for even minor mental health problems still carries a stigma in Japan. This is particularly unfortunate because clinical research shows that a significant portion of Japanese adults suffer from depression or other mental illnesses.

Ayako Shimizu, the founder of Hikari Labs, has an innovative approach that represents a huge step forward in addressing this problem. Hikari Labs develops and distributes video games based on cognitive behavior therapy, and these games enable players to literally train their brains out of depression.

Her approach bypasses both the stigma and costs involved in seeking treatment. Even in conservative Japan, she is seeing increasing and enthusiastic adoption by corporate wellness programs. But this whole project was almost shut down by the very people who should have been helping her.

Ayako has a fascinating story, and I think you’ll really enjoy it.

Show Notes for Startups

How gaming can treat depression and reduce suicide rates Why marketing mental health games is so challenging The changing profiles of Japanese who suffer depression Why women have higher rates of depression, but lower rates of suicide How Ayako's University tried to put a stop to this project How to build a business model around mental health Why conservative corporations are on the forefront of improving mental health in Japan

Links from the Founder

Hikari Labs homepage

Online counseling YouTube video Todai Shinbun article

Follow Ayako on Twitter @Hikari_Lab_Inc Friend her on Facebook Try out SPARX

SPARX for iPhone/iPad SPARX for Android Clinical Journal on SPARX

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Transcript from Japan

Disrupting Japan, episode 85. Welcome to Disrupting Japan, straight talk from Japan’s most successful entrepreneurs. I'm Tim Romero and thanks for joining me.

Welcome to Disrupting Japan, straight talk from Japan’s most successful entrepreneurs. I'm Tim Romero and thanks for joining me.

Now long-term listeners know that this show is not really about start-ups. Well, of course it’s about start-ups, but it’s about so much more than that. Japanese start-ups give us a unique perspective on Japanese society. Looking at the problems that need to be solved, the path people are taking to try to solve them, and seeing what challenges society throw up against them can tell us more about a country or a society than mountains of surveys and piles of longitudinal studies.

Start-ups tell us the kind of future that people envision, and how the present plans on resisting the future. Nowhere is this more true than with today’s guest. Ayako Shimizu, founder of Hikari Labs. Ayako is developing and marketing video games to treat mental illness, and she has the clinical data that shows the approach has real therapeutic value. And yet, perhaps unsurprisingly, Japanese academia and the medical industry as a whole have been—Well, let’s just say less supportive of her efforts. But still she’s seen steady increases in both the number of users and growing interest from a surprising segment of corporate Japan. But you know, Ayako tells that story much better than I can. So let’s here from our sponsor and get right to the interview.

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[Interview]

Tim: So I’m sitting here with Ayako Shimizu of Hikari Labs, and thanks for sitting down with me.

Ayako: Thank you, Tim, for inviting me here.

Tim: Now Hikari Labs is focused on improving mental health through software, I guess. But why don’t you tell us a bit about what Hikari Labs does and what it’s mission is.

Ayako: Okay, well Hikari Labs currently have two services. One is online counseling called Kokoro Works, and another one is this game application called Sparx, which was developed at the University of Auckland in New Zealand. And our mission is to help shape a society that’s the psychological care is more reachable to people.

Tim: Let’s talk about each of these individually.

Ayako: Yeah.

Tim: And later on, we’re also going to talk about your new AI project.

Ayako: Okay, okay.

Tim: But the Sparx project is really interesting. It’s a role-playing game that’s based on behavioral therapy. So what exactly is cognitive behavioral therapy?

Ayako: Cognitive behavioral therapy is one kind of counseling, which effect has been proven in many studies for depression and for anxiety disorders. It’s basic level. Cognitive behavioral therapy considers that thoughts, emotion, and behavior are interconnected. So it aims to change one’s emotional behavior through altering one’s thought. So for example, if you say, ‘Well, there are several bad things that happened today, and today wasn’t a good thing at all.’, which is one cognitive distortion called over-generalization. Having a few bad things that day, doesn’t make our entire bad day. It’s your cognition that makes that entire day a bad day. If that’s—

Tim: No, it’s you’re focusing on the bad things that happened.

Ayako: Yeah, yeah, yeah, yeah, yeah. So cognitive-behavioral therapy, or CBT, tries to adjust people’s thought in a little bit more positive world or in a more realistic way.

Tim: So I could see how that would work in a counseling session where you would have a therapist that would just kind of guide the patient towards the more positive things. But how does that work in the Sparx role-playing game?

Ayako: Yeah, so Sparx is a role-playing game, and it’s based on CBT methodology. All of its works is very unique. So your avatar is in a fantasy would, which balance of mood was destroyed. So it’s a very negative world, and your avatar goes in the world and saves the world through learning CBT. So those negative feeling character attack you, and you have to defend yourself by giving more positive comments or realistic comments.

Tim: I see. So in a sense, the game play is having the character counteract these negative thoughts and negative directions—

Ayako: Yeah, yeah, yeah, yeah, yeah.

Tim: —and that trains the person to do the same things?

Ayako: And it makes you learn different kinds of cognitive distortions. So through playing game, you learn a different kind of cognitive distortion, and in real life you kind of notice, ‘I’m feeling down, but this might be that kind of cognitive distortion I’m having. I can maybe adjust the way I feel.’

Tim: That’s a really interesting idea. Is there any clinical data or studies that back whether it’s effective or not?

Ayako: Yeah, actually this was created by the medical team of the University of Auckland in New Zealand. The suicidal rate among the teen is very high in New Zealand, so it was originally a national project. The developers of Sparx found that the remission rate of depression was 43.7%, which is pretty high. And they concluded that Sparx was as effective as face-to-face therapy.

Tim: So you brought this game to Japan last year in 2016, right?

Ayako: Yeah, yeah, yeah, yeah, yeah.

Tim: So how has it been received in Japan?

Ayako: Well, I haven’t been started advertisement a lot. So even though I haven’t done much advertisement, I think it’s been spreading among those people who need help.

Tim: So how many users do you have?

Ayako: Forgive me, it’s very small proportion. It’s around 2,000 users, but it was originally 1,000 yen. And now we changed it to 2,000 yen. But most of the applications are free these days. I think 2,000 users is pretty good without any advertisement.

Tim: This is interesting. To try to market this as a game, which—in one sense it is, but the game business model doesn’t really apply as well.

Ayako: Yeah, it doesn’t. No.

Tim: Are you marketing this as a game? Are you marketing this as therapy, or kind of self-help? Or how do you present it?

Ayako: Yeah, I’m marketing this as a self-help tool. But a lot of times, many kinds of self-help applications are ready. But then those applications seems too serious for some people. So by saying this is a self-help but still a role-playing game, then those people are a little bit still hesitant to reach some therapy, they’re more open to use.

Tim: So who are you targeting with the game? Is it teens? Is it young adults? Is it the whole spectrum of everyone that plays games?

Ayako: No it was—I was open to anyone, but then I found out most of the users are male aged from 30 to 50, which is very interesting because those are the age that has high rate of depression. And plus those are the age that are used to using smart phones.

Tim: So in New Zealand, it was targeting teens, but in Japan you’ve seen the biggest used among 30 to 50. That’s interesting.

Ayako: That is interesting, and what’s more interesting is that depression rate is much higher in female than male. But at the same time, the suicidal rate in Japan— the male rate of suicide is twice as female. Which means is that a lot of male who have depression doesn’t seek any care but decides to suicide. So what I see is since it’s a game, and it seems more lighter than all the other treatment, I think a lot of males are open to using it. If that makes since?

Tim: I think that does make sense. A little later on I want to talk about kind of the social stigma about depression in Japan. But why is it that women in Japan have a higher rate of depression but the suicide rate is higher among men? Do women seek out help more?

Ayako: Yeah, yeah, yeah. They do. They are more talkative. So that’s what researchers say women are more open to talk about their problems, but male are not. Even though male have a lot of friends, they don’t talk about themselves that much.

Tim: Okay. That’s pretty universal?

Ayako: Yeah, it is. It is a very universal thing.

Tim: Okay,