Sparking Creativity Through the Digital Reimagining of Pain Psychology Care
By Grace Kao, PhD, ABPP, Pain Psychologist | Associate Professor, MD Anderson Cancer Center
Chronic pain remains one of the most complex and costly conditions in medicine, affecting over 50 million adults in the U.S. alone1. Cognitive Behavioral Therapy (CBT) has long been established as an evidence-based intervention for chronic pain, yet access remains limited by provider shortages, stigma, and engagement challenges.
As a pain psychologist, I’ve witnessed both the profound benefits of behavioral health approaches and the barriers to delivering them at scale. So when I was approached by a digital health company to help reimagine CBT for pediatric pain patients through gamification, I appreciated the compelling opportunity not only to support access to care for pain patients, but also to grow professionally through a hands-on creative venture.
In clinical settings, pain psychology expertise often unfolds in the intimate, structured space of one-on-one therapy sessions. The chance to partner with a multidisciplinary team to translate CBT into a gamified digital experience challenged me to think differently about my clinical role. Collaborating with the team (of developers, designers, and behavioral scientists) sparked new perspectives and promoted deeper thinking about how to explain pain psychology concepts to patients and non-clinical stakeholders alike. In bringing psychological interventions to life through digital design, we endeavored to step beyond traditional therapy and enter more fully into the realms of storytelling, behavior modeling, and systems-level thinking. The goal was still quality pain psychology care delivery, but in a new and compelling format.
Gamifying CBT for chronic pain was more than a product challenge. It was an opportunity to reimagine care delivery, rediscover creativity, and contribute to a future where behavioral healthcare is not only more accessible but also more imaginative.
Clinician as Co-Designer: A New Mode of Care Delivery
To gamify CBT effectively, the team worked to deconstruct the pain psychology intervention process: identify key therapy components and rebuild them as engaging and self-directed digital experiences. This meant reimagining how pain science is explained, how coping skills may be digitally modeled, and how behavior change may be encouraged without the benefit of real-time clinical interactions.
For me, perhaps the most transformative part of this work was combining a clinician with a co-designer mindset and considering how psychological principles could be taught visually and interactively without a provider’s physical presence. This change in perspective stretched my clinical thinking in new, enriching ways.
Some energizing design questions the design team addressed included:
- How can we explain the biopsychosocial model of chronic pain through an engaging, child-friendly narrative?
- How can we teach and encourage application of biobehavioral and cognitive strategies using simple, inviting scripts and interactive feedback?
- How can we shape the user journey to encourage consistent skills practice, even after initial strategies are introduced?
- How do we create an alluring game world that houses all the above?
To answer these, we mapped key CBT for chronic pain components—psychoeducation, biobehavioral strategies, cognitive strategies, and lifestyle enhancement onto game mechanics:
- Psychoeducation was delivered through immersive narrative arcs integrated into the introduction of the game world.
- Biobehavioral strategies were embedded as daily challenges and practice sets tied to rewards associated with the player’s avatar and journey.
- Cognitive strategies teaching took the form of interactive games where players actively participated in guided thought reframing.
- Lifestyle habits like sleep, movement, and nutrition were integrated into progress tracking platforms to encourage completion of daily goals.
- Modules were then connected via friendly game world guides that accompany the user through their journey.
In summary, the process of gamifying CBT helped to highlight professional capacities that encouraged big-picture, creative thinking:
- Narrative crafting: How to integrate psychoeducation and clinical interventions into cohesive, resonant stories.
- Design-based thinking: How to translate teaching and practice of nuanced skills (e.g., cognitive reframing) into intuitive, individualized, game-like experiences.
- Behavioral design: How to develop interactive feedback that reinforces healthy behavior changes in both short-term learning and long-term practice.
Why This Work Matters for Clinicians
In an era of clinician burnout, administrative burden, and constrained clinical bandwidth, projects like these offer rare professional nourishment. They allow us as clinicians to innovate further, not in opposition to in-person care, but as a complement to it.
For pain psychologists in particular, digital collaboration creates space to:
- Reimagine how we teach pain and behavior change
- Expand access to evidence-based pain psychology interventions
- Utilize our skills at the population level, beyond the therapy room
Perhaps most meaningfully, this work reminds us that psychologists are not just service providers. We are educators, designers, and systems thinkers capable of shaping care in new, creative ways in a world of increasing demand for psychological services.
Digital Tools as Amplifiers of Clinical Care and Clinician Creativity
Importantly, digital therapeutics are not replacements for human connection. Still, they can meaningfully extend access to psychological care, reinforce critical skills, and engage patients, especially pediatric and young adult populations, through dynamic, age-appropriate platforms. When thoughtfully designed and guided by clinical expertise, they can serve as amplifiers of clinical care and clinician creativity, with the potential to significantly enhance therapeutic impact.
Gamifying CBT for chronic pain was more than a product challenge. It was an opportunity to reimagine care delivery, rediscover creativity, and contribute to a future where behavioral healthcare is not only more accessible but also more imaginative.
1. Yong RJ, Mullins PM, Bhattacharyya N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163(2):e328-e332. doi:10.1097/j.pain.0000000000002291
About the Author:
Grace Kao, Ph.D., ABPP is a board-certified pain psychologist and associate professor at The University of Texas MD Anderson Cancer Center. She is also the founding psychologist of the interdisciplinary chronic pain clinic at Texas Children’s Hospital and former faculty clinician at Baylor College of Medicine. Professionally, she spends her time supporting patients and families who are navigating the journey of chronic pain, providing instruction, consultation, and advisory board service in the area of pain psychology, and writing about health and healing.