Gamification didn’t make health apps engaging

For decades, internet-based mental health interventions have come and gone. ELIZA, the very first therapy chatbot, was introduced back in 1966.

Although traditional barriers to participation like location and cost are being hypothetically reduced, low retention rates (industry average <4%) reduce the likelihood that users will receive the intervention dosage intended to produce beneficial effects.

Chatbots feel like the answer. You open one when you’re spiraling. You get instant relief. A sense of being heard. And then… three days later, it’s collecting dust just like the motivational books we ordered after a late-night TikTok scroll.

That’s when gamification for health became the buzzword. More and more of us are realizing that in today’s dopamine-driven world, good content alone isn’t enough. We don’t just need better plans we need environments that will help us complete them.

Fast-forward to today’s therapy chatbots. It’s tempting to think we’re close to “the winner.” We’re not. Because a chatbot alone still doesn’t create the space required for change. And no adding streaks doesn’t fix that.

𝗚𝗮𝗺𝗶𝗳𝗶𝗰𝗮𝘁𝗶𝗼𝗻 𝗶𝘀 𝗻𝗼𝘄𝗵𝗲𝗿𝗲 𝗻𝗲𝗮𝗿 𝘄𝗵𝗮𝘁 𝗶𝘁’𝘀 𝗰𝗮𝗽𝗮𝗯𝗹𝗲 𝗼𝗳.

True gamification isn’t about points, badges, or doing more. It’s a 𝗿𝗼𝗼𝘁-𝘁𝗼-𝗵𝗲𝗮𝗱 process. It doesn’t reward doing. It rewards understanding.

It creates an insight loop where people recognize their own patterns, regain agency, and feel connected in the process.

Not sequentially. Simultaneously.

What's is not engagement

Engagement isn’t minutes spent or days logged. It’s clarity gained, skills built, and isolation reduced.

Streaks, badges, and step counts feel like gamification, but they measure repetition, not transformation. They create a shallow loop: do the task → get a point → protect the streak → repeat until motivation fades. No understanding. No mastery. No lasting change.

Surface rewards keep users in motion. Insights move them forward. That’s the difference between apps people quit  and apps that change lives.

What Real Engagement Actually Means

Decades of behavioral science, anchored by Self-Determination Theory, reveal what creates durable motivation: three psychological needs working together:

• Autonomy: Your choices feel self-directed, not controlled
• Competence: You sense real, intelligible progress toward mastery
• Relatedness: You feel connected to others or a larger purpose

Surface rewards systematically undermine all three:

• No autonomy: Streaks nag “Don’t break your streak!” Behavior feels dictated.
• No competence: Numbers climbing ≠ “I’m better at handling stress.” It’s activity, not skill.
• No relatedness: A badge that say “You’re not alone” or “Others struggle like you.” does’t actually help us feel supported.

The Insight Loop: True Gamification

Real gamification rewards understanding, not just doing. It creates an insight loop that builds all three needs simultaneously:

Do the task → See a pattern → Understand what it means (Aha! moment) → Try a new strategy → Feel more capable → Repeat.

Simply put, these aha-moments activate reward systems differently than streaks. They create intrinsic motivation the kind that lasts when external pressure disappears.

Think of it like a real game

Change is far more complex than simple repetition. Decades of cognitive psychology and behavioral science research reveal that the human mind is wired to seek meaningful understanding and mastery, not arbitrary point accumulation.

So if you want to call that gamification, think of it like a real game: you don’t play Fortnite to collect streaks you play to understand the system, improve your strategy, and win. health shouldn’t be different.

Surface rewards = motion without progress. Unloop = progress that compounds. Choose wisely.