Contributors to this article were Michelle Bertoli, MA (director of content for iThrive Games), Kelli Dunlap, PsyD (game developer, psychologist, and research consultant for iThrive Games), and Susan Rivers, PhD (executive director and chief scientist for iThrive Games).


Heidi McDonald, iThrive’s senior creative director, felt inspired at the start of a recent virtual reality (VR) innovators meetup. In line with iThrive’s mission, Heidi was eager to explore with the group how VR can create new opportunities to build positive practices like empathy — connecting and engaging with others’ feelings and perspectives to prompt more caring, responsible behavior in the world.

Conversations began to verge on uncomfortable when some attendees got excited about how VR could be used to immerse people in intense experiences they don’t typically have. “Men could see what it’s like to get an abortion!” and “People could experience illegal deportation, natural disasters, or living in a war zone!” were some examples.

VR can open the door for audiences to have novel experiences and bear witness to deeply emotional circumstances. But is asking someone to experience another person’s trauma necessary for developing empathy? As VR design and use takes off, how are we thinking about the ethics around creating immersive, potentially traumatic experiences?

Distress doesn’t equal empathy
Just because you can drop someone into the thick of (simulated) loss, fear, pain, and chaos using VR, it doesn’t mean you should. When you immerse players in a violent, intensely emotional, or graphic event that feels real, it’s possible you’ll cause them distress or trauma. Immediate reactions to trauma include shock and denial, meaning that a person shuts down and disconnects emotionally. Isn’t that precisely the opposite of what we’d want an empathy game to do — engage and connect people?

Playing a game is different from how we engage with other media. As game developer Lindsay Grace likes to say: “Readers read, viewers watch, and players do.” VR technology adds to this “doing” a deep level of immersion, complicity, and embodiment — the sometimes unsettling sense that you’re really there in the thing you’re doing. We don’t yet know how psychologically powerful that immersion might be. In fact, VR’s ability to blur the line between fantasy and reality is one reason for the continuing concern, unfounded or not, over whether VR is safe for kids.

Careful planning and a clear goal are essential when designing and deploying VR experiences meant to evoke strong and potentially distressing emotions in the name of building empathy.

VR and empathy: A process for intentional design
At iThrive, there is a set of questions we encourage all VR devs to ask before designing in the name of empathy:

1) Who are my players?
2) What do I really want my players to do?
3) What does the science say?

A graphic depicting iThrive's approach to designing for empathy in VR.

1. Who are my players?
Take a participatory co-design approach to build empathy with your end users.

Earlier this year, we featured on our blog an interview with Dr. Doris C. Rusch, a game developer with expertise in wielding empathy as a design tool. She created the game Elude to give people who don’t suffer from depression a window into what it feels like. Accordingly, the co-designers and playtesters who informed Elude were people with depression, their loved ones without depression, and clinicians who understand and treat the disorder.

At iThrive, we do something similar in Game Design Studio: we use a participatory, co-design approach when we invite teens to lead our design process. Over several sessions, we encourage teens’ self-expression, identify themes that are meaningful for them, and constantly elicit their reactions to what we’ve created. That’s a key way we ensure that the experiences we create are ones that are valuable — and not distressing — to the players we want to reach.

Kinful offers another helpful model in which the end users are the content creators. Kinful uses VR technology in schools to support students’ empathy through cross-cultural exchanges. Students who participate in the Kinful curriculum create 360° immersive videos of their own lives to share with peers around the world.

If you understand who your players are and include them in every step of the design process, you’ll be better able to design for what you want your players to do and ensure that you’re getting the intended results.

2. What do I really want my players to do?  
Set a clear goal and consistently revisit it.

Why are you motivated to create an empathy game in the first place? What change do you want to see in your players, and what kind of experience do you want them to have?

There are many valid reasons for making a meaningful game: self-expression; helping players realize they’re not alone; encouraging players to understand and care for others who are far away in distance or life experience from themselves; prompting activism. Some — but not all — of these motivations require that players feel empathy.

Whichever of these or other goals you are designing for, be specific and revisit the goal consistently. Getting players to feel something is a very different undertaking from getting them to do something in the real world. And remember that just because a game lets players experience something new, intense, or shocking, it won’t necessarily promote empathy.

Consider Dys4ia, a short web-based game that Anna Anthropy made to express her experience with gender dysphoria and hormone replacement therapy. The game was praised as an “empathy game” that could help players understand the experience of a transgender person. But Anthropy pushed back on this categorization:

“If you’ve played a 10-minute game about being a transwoman don’t pat yourself on the back for feeling like you understand a marginalized experience.” – Anna Anthropy

It’s far from a given that someone who plays a game like Dys4ia suddenly understands what it’s like to be transgender or is equipped to act in a meaningfully better way towards and about transgender individuals as a result. And, in this case, Anthropy says that’s not why the game was made.

Make sure you design and test your experience for the specific outcome you want. To support that process, you need to understand how changes in feelings, attitudes, and behaviors come about. That’s where the science comes in.

3. What does the science say?
Create a multidisciplinary design team to weave in content expertise.

When creating a game to evoke feelings of empathy, make research a part of your design process from the very beginning. There are at least two ways to do that.

First, explore and understand empathy. Empathy is a set of complex thought processes and emotions that enable us to identify — and identify with — another’s thoughts and feelings. In the best-case scenario, that identification helps us act in more considerate, kind, and helpful ways towards others. Empathy is different from sympathy (pitying or feeling bad for someone) and has two distinct types: cognitive empathy and affective empathy. These types (and their subtypes) can align with specific design goals, so ensure you choose and learn as much as you can about the type you’re seeking to influence.

Second, include researchers, clinicians, and other content experts in the design process from the start. Someone with clinical training can help you assess and plan for meaningful change in players, monitor whether an immersive experience has crossed a line into overly distressing territory, and decide whether players might need additional resources to process what they have seen and felt. Games intended to have some positive social impact can only benefit from a multidisciplinary design team that represents a range of likely perspectives and responses.


VR is an exciting medium and one we should use to its fullest potential for great entertainment and education. Given its relative newness, there are many unknowns. As developers, tread cautiously, plan, and seek good information and partners. By infusing empathy — both for your players and what they’ll experience, as well as a deep knowledge of what empathy is — into your design process from the beginning, you stand a greater chance that empathy, not trauma, will result.

Have a concept for an empathy game — VR or another medium? iThrive Games can help! Check out our resources on empathy and contact us for consultation.