Introduction
Positive Behaviour Support (PBS) is a cornerstone of contemporary disability practice under the National Disability Insurance Scheme (NDIS). PBS focuses on improving quality of life, increasing skill development, and reducing behaviours of concern through person-centred, evidence-informed, and rights-based approaches. Central to effective PBS is the ability to engage participants meaningfully in therapeutic processes that build autonomy, emotional regulation, and independence.
Gamification — the application of game-based elements such as points, levels, challenges, rewards, and immersive environments — is emerging as a valuable tool within PBS. When implemented thoughtfully and ethically, gamification can enhance participant engagement, support skill acquisition, and promote behaviour change while remaining aligned with the NDIS Practice Standards, the NDIS Quality and Safeguards Framework, and the principles of least restrictive practice.
This paper explores key gamification methods relevant to PBS, including Virtual Reality
Exposure Therapy (VRET), mobile health applications with gamified elements, and cognitive-behavioural game-based interventions. It also examines why gamification can improve PBS outcomes for participants, and how these approaches can be safely integrated within NDIS-compliant practice.
Gamification and Alignment with PBS and the NDIS Framework
Under the NDIS, behaviour support must be:
- Person-centred and strengths-based
- Focused on improving quality of life
- Aimed at reducing behaviours of concern through proactive strategies
- Designed to minimise and eliminate restrictive practices
- Delivered in a way that respects participant dignity, choice, and control
Gamification aligns strongly with these principles when it is used as a means to teach replacement skills, enhance motivation, and increase engagement, rather than as a compliance or control mechanism. By leveraging intrinsic motivation and personalised engagement, gamification supports participants to take an active role in their own development, consistent with the NDIS emphasis on participant choice and control.
Virtual Reality Exposure Therapy (VRET)
Overview
Virtual Reality Exposure Therapy (VRET) involves the use of immersive virtual environments to support individuals to safely engage with anxiety-provoking situations in a controlled and graded manner. Using VR technology, participants can experience realistic scenarios that replicate real-world environments while remaining physically safe and therapeutically supported.
VRET is particularly effective for individuals who experience anxiety, phobias, trauma-related responses, or avoidance behaviours that limit participation in daily activities. The ability to adjust the intensity, duration, and complexity of exposure allows practitioners to tailor the intervention to the participant’s emotional regulation capacity and therapeutic goals.
PBS and NDIS Applications
Within PBS, VRET can be used to support:
- Anxiety related to community access (e.g. shopping centres, public transport, medical appointments)
- Avoidance behaviours that reduce independence and participation
- Skill-building prior to real-world exposure
- Emotional regulation and coping strategy rehearsal
From an NDIS perspective, VRET supports outcomes related to:
- Increased community participation
- Improved emotional regulation and wellbeing
- Reduced reliance on restrictive or reactive interventions
- Greater independence and confidence
Importantly, VRET aligns with the NDIS requirement to use the least restrictive approach by providing a proactive alternative to managing anxiety-driven behaviours that may otherwise escalate into behaviours of concern.
Ethical and Practice Considerations
To remain NDIS-compliant, VRET must:
- Be implemented with informed consent
- Be trauma-informed and emotionally safe
- Be guided by a qualified practitioner
- Be aligned with goals documented in the participant’s Behaviour Support Plan
- Be monitored and adjusted based on participant response
When used appropriately, VRET can reduce environmental triggers, support skill generalisation, and enhance quality of life without increasing restriction or coercion.
Mobile Health Apps with Gamified Elements
Overview
Mobile health applications that incorporate gamified elements are increasingly used to support emotional regulation, mental health, and behaviour change. These apps may include features such as points, rewards, streaks, reminders, progress tracking, and interactive exercises.
The portability and accessibility of mobile apps make them particularly valuable for participants who benefit from consistent, low-intensity support outside of direct service delivery hours.
PBS and NDIS Applications
Within PBS, gamified mobile apps can support:
- Emotional self-monitoring and awareness of triggers
- Development of regulation routines (e.g. breathing, grounding, mindfulness)
- Increased independence in managing emotions and behaviour
- Generalisation of skills across environments
These applications align with NDIS goals by:
- Promoting participant autonomy and self-management
- Reducing reliance on direct staff intervention
- Supporting continuity of support across settings
- Encouraging proactive rather than reactive strategies
Gamified feedback systems also provide visual reinforcement of progress, supporting self-efficacy and motivation — key outcomes under the NDIS focus on capacity building.
Ethical and Compliance Considerations
When integrating mobile apps into PBS:
- Participation must remain voluntary
- Data privacy and confidentiality must be ensured
- App use should be documented within the Behaviour Support Plan where relevant
- The tool must support, not replace, therapeutic oversight
Used appropriately, mobile health apps complement PBS by reinforcing skill practice and supporting independence without increasing restriction.
Cognitive-Behavioural Game-Based Interventions
(Including Telehealth Delivery Models such as PBS3)
Overview
Cognitive-behavioural game-based interventions integrate CBT principles into interactive digital games. These interventions teach skills such as emotional regulation, problem-solving, social communication, and cognitive flexibility through engaging scenarios and challenges.
For participants who struggle with traditional talk-based therapy — including children, adolescents, and individuals with neurodivergent learning styles — game-based interventions offer an accessible and motivating alternative.
PBS and NDIS Applications
Within PBS, cognitive-behavioural games can:
- Teach replacement behaviours
- Improve impulse control and emotional regulation
- Support social skill development
- Increase insight into behaviour and consequences
Telehealth delivery of these interventions aligns with NDIS requirements for:
- Accessibility and equity of service delivery
- Continuity of support in regional or remote areas
- Innovation in capacity-building supports
Game-based CBT interventions also support the NDIS objective of reducing restrictive practices by proactively teaching skills that prevent escalation.
Practice Considerations
To remain compliant:
- Interventions must align with documented participant goals
- Progress must be monitored and reviewed
- Games must be developmentally appropriate and emotionally safe
- Participation must remain collaborative and voluntary
Why Gamification Improves PBS Outcomes
Personal Relevance and Autonomy
Gamification is most effective when it is personalised. PBS and the NDIS both emphasise individual choice, strengths, and preferences. Customising gamified elements to align with a participant’s interests increases engagement and reduces resistance, supporting intrinsic motivation rather than compliance-driven behaviour.
Feedback and Progress Tracking
Immediate, visible feedback through points, levels, or progress indicators reinforces positive behaviour and supports motivation. For many participants, seeing tangible evidence of improvement builds confidence and encourages persistence. This aligns with PBS principles of reinforcement and skill-building rather than punishment.
Social Interaction and Connection
Some gamified interventions include social elements such as shared goals or peer
interaction. When implemented ethically, these features can:
- Reduce isolation
- Build social skills
- Increase engagement and accountability
Social gamification must always be used carefully to avoid pressure, comparison, or distress, and should be tailored to individual preferences.
Safeguards and NDIS Considerations
Gamification must never:
- Replace human support and therapeutic oversight
- Be used coercively or as a condition of access to support
- Increase restriction or control
Instead, it should:
- Enhance engagement
- Build capacity
- Support quality of life
- Align with Behaviour
Support Plans and NDIS Practice Standards
Conclusion
Gamification offers a powerful and innovative enhancement to Positive Behaviour Support when applied ethically, person-centredly, and in alignment with NDIS requirements. Through approaches such as Virtual Reality Exposure Therapy, gamified mobile health applications, and cognitive-behavioural game-based interventions, participants can build emotional regulation skills, confidence, and independence in ways that are engaging, meaningful, and accessible.
By maintaining a strong focus on participant choice, dignity, and least restrictive practice, gamification can support improved PBS outcomes while contributing to the broader NDIS goals of inclusion, capacity building, and quality of life.
