“Who moved my heart brush?” Realms of the Heart: A Human-AI Collaborative Gamified Adjuvant Treatment Application for Depressed Teens Based on Painting Therapy

Paper Title

“Who moved my heart brush?” Realms of the Heart: A Human-AI Collaborative Gamified Adjuvant Treatment Application for Depressed Teens Based on Painting Therapy

Publication Info

• Topic area: Human-AI collaboration in gamified digital painting therapy for adolescent depression
• Keywords: human-AI collaboration, digital painting therapy, adolescent depression, gamification, nature-based intervention, behavioral activation, ControlNet, YOLOv5, randomized controlled trial, art therapy

Background and Problem

• Problem / challenge: Traditional painting therapy for depressed adolescents faces challenges such as limited accessibility, low self-confidence, low engagement, and self-isolation. Existing digital painting therapy tools lack interactive gamification and fail to fully utilize AI’s potential.
• Significance: Depression in adolescents is a critical mental health issue, often leading to long-term consequences and even suicide. Effective, accessible, and engaging interventions are urgently needed.
• Motivation and related work: Prior studies have shown the benefits of painting therapy and the potential of digital tools and AI in enhancing accessibility and creativity. However, current solutions lack specialized AI tools for art therapy, fail to integrate nature-based interventions, and do not adequately address the psychological needs of depressed teens. This study builds on these gaps to explore a novel human-AI collaborative approach.

Solution

• Proposed approach: Realms of the Heart – a gamified, human-AI collaborative painting therapy application combining outdoor nature-based activities, AI-assisted drawing, and therapist-guided reflection.
• Novelty:
  1. Development of a multi-component therapeutic framework integrating gamification, nature-based interventions, and AI-assisted painting.
  2. Use of YOLOv5 for outdoor object recognition and ControlNet with Stable Diffusion for precise, high-quality image generation.
  3. A randomized controlled trial (RCT) combining quantitative and qualitative methods to evaluate the system’s efficacy.
• Procedure and key techniques:
  1. Outdoor exploration: Teens photograph natural objects, which are identified by YOLOv5 to unlock corresponding "heart brushes."
  2. AI-assisted painting: Teens use brushes to draw color blocks, which AI transforms into high-quality patterns using ControlNet and Stable Diffusion.
  3. Reflection: Therapists guide teens to reflect on their creative process and emotional experiences.

Results

• Concrete findings:
  • Experimental group’s CDI (Children’s Depression Inventory) scores decreased significantly from 26.33 to 21.67 (p=0.000), compared to 27.07 to 24.73 (p=0.012) in the control group.
  • Anxiety (GAD-7) scores improved more in the experimental group (14.07 to 11.47, p=0.025) than in the control group (15.60 to 14.20, p=0.277).
  • No significant improvement in well-being (WHO-5) scores was observed between groups.
• Advantage over baselines:
  • Superior image generation quality and brush diversity compared to GAN-based tools.
  • Enhanced engagement, self-confidence, and reduced pressure reported by participants.
• Experiments / evaluation:
  • Participants: 30 adolescents (12–17 years old) with mild to moderate depression, randomized into experimental (n=15) and control (n=15) groups.
  • Intervention: Experimental group used Realms of the Heart alongside standard therapy; control group received standard therapy only.
  • Metrics: CDI, GAD-7, WHO-5, and qualitative interviews.
• Limitations and future work:
  • Unable to isolate the effects of individual components (e.g., outdoor activities vs. AI-assisted painting).
  • High hardware costs (iPads) limit accessibility.
  • Small sample size and limited temporal assessment.
  • Future work: Larger, more diverse samples; longitudinal studies; cost-effective hardware; integration of pre-assessment tools for early depression detection.

Summary

The study introduces Realms of the Heart, a gamified, human-AI collaborative painting therapy application designed to support depressed adolescents. By integrating outdoor exploration, AI-assisted painting, and therapist-guided reflection, the system significantly reduced depression and anxiety levels in a randomized controlled trial. Participants reported enhanced self-confidence, engagement, and reduced stress. The study highlights the potential of combining AI, nature, and gamification in digital art therapy, while addressing limitations such as hardware costs and the need for more granular evaluations. Future research aims to expand accessibility and refine the intervention’s components.