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Video gaming can benefit mental health, find Oxford academics

Research based on playing time data showed gamers reported greater wellbeing

Playing video games can be good for your mental health, a study from Oxford University has suggested, following a breakthrough collaboration in which academics at the university worked with actual gameplay data for the first time.

The study, which focused on players of Nintendo’s springtime craze Animal Crossing , as well as EA’s shooter Plants vs. Zombies: Battle for Neighborville, found that people who played more games tended to report greater “wellbeing”, casting further doubt on reports that video gaming can harm mental health.

Crucially, the study was one of the first to be done using actual play-time data. Thanks to the internet-connected nature of the games, the Oxford University team was able to link up psychological questionnaires with true records of time spent playing games. Previous studies had tended to focus on self-reported time playing, which is, the study found, only weakly correlated with reality.

“This is about bringing games into the fold of psychology research that’s not a dumpster fire,” said Andrew Przybylski, the lead researcher on the project. “This lets us explain and understand games as a leisure activity .

“It was a quest to figure out is data collected by gaming companies vaguely useful for academic and health policy research?”

Przybylski said at the start of the project he was surprised by how little data gaming companies actually had about their players – but also by how little hard data had been used by previous studies into the potential harms or benefits of gaming. The study, he said, “shows that if you play four hours a day of Animal Crossing, you’re a much happier human being, but that’s only interesting because all of the other research before this is done so badly.”

The researchers are keen to emphasise that the findings are not a carte blanche pass for games. “I’m very confident that if the research goes on, we will learn about the things that we think of as toxic in games,” Przybylski said, “and we will have evidence for those things as well.”

The research only studied two all-ages games, and other modes of play could potentially be less wholesome. Similarly, the attitude one takes to gaming could affect the mental impact it has. The paper contrasts “intrinsic” enjoyment – playing a game because it’s fun – with “extrinsic”, more concerning behaviours, such as feeling bullied into playing, either by other players or the game mechanics themselves.

The researchers hope the study will introduce a higher standard of evidence to discussions about the concept of video game addiction, or digital harms in general. “You have really respected, important bodies, like the World Health Organization and the NHS, allocating attention and resources to something that there’s literally no good data on. And it’s shocking to me, the reputational risk that everyone’s taking, given the stakes. For them to turn around and be like, ‘hey, this thing that 95% of teenagers do? Yeah, that’s addictive, no, we don’t have any data,’ that makes no sense,” Przybylski said.

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Video Games Could Hold Untapped Potential in Treatment of Mental Illness

Joni Sweet is an experienced writer who specializes in health, wellness, travel, and finance.

Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years’ experience in consumer-oriented health and wellness content. He keeps a DSM-5 on hand just in case.

Key Takeaways

• A new report found mounting evidence that commercial video games, typically used for entertainment, could help alleviate depression and anxiety.
• Video games tend to be more affordable and accessible than traditional mental health services, which may help more people get essential care.
• Experts note that video games probably won’t replace traditional therapy, but could be used as a helpful addition.

Think video games are just entertainment? It might be time to take a second look at this popular hobby. A new paper suggests that video games might hold the key to providing affordable, stigma-free mental health treatment around the globe. 

A report published in the journal JMIR Serious Games reviewed research on the impact of commercial video games on depression, anxiety, and other mental health concerns. It found that there’s mounting scientific evidence supporting the potential for video games to improve mental health outcomes, especially for people who can’t access other types of treatment due to cost or location. That could give the world’s 2.7 billion gamers opportunities for major emotional wellness benefits.

Are video games the future of mental health treatment? Here’s what the latest research shows.

Research on Video Games and Mental Health

For this report, researchers from Lero, the Science Foundation Ireland Research Centre for Software, looked at earlier studies to see whether commercial video games (not just specialized therapeutic games) could fill in existing gaps in mental health treatment, particularly for depression and anxiety.

The research found evidence that video games could help alleviate symptoms of depression, such as the loss of pleasure. The video games “Minecraft” and “Animal Crossing: New Horizons” also fostered social connectedness and reduced loneliness.

Glenn Platt, PhD

Video games provide connection, a critical aspect of mental health, feeling like you are part of a community of like-minded people who value your participation and share your goal within the game.

“Video games provide connection, a critical aspect of mental health, feeling like you are part of a community of like-minded people who value your participation and share your goal within the game,” says Glenn Platt, PhD , professor of emerging technology and director of the interactive media studies program at Miami University in Ohio. “Isolation, as the authors outline, plays a significant role in anxiety and depressive disorders. The support of a community within a game ecosystem mitigates this.”

Certain video games provide mood regulation benefits, as well. In one study, adolescents who played “Mario Kart” had better emotional regulation skills than peers who didn’t play the game.

Plus, video games could be used as a therapeutic distraction that could help regulate moods, reduce rumination, and even evoke joy.

Studies reviewed by the researchers also showed that video games can help address and treat symptoms of anxiety. In one experiment, people with anxiety who played the tower defense game “Plants vs. Zombies” four times a week for at least a half hour each session experienced better mental health outcomes than those who took medication. In some experiments, video games like “Max and the Magic Marker” were also shown to help prevent elevated anxiety in kids .

“As a licensed professional counselor and personal gamer myself, I am ecstatic to see more research studies and resources such as this one start proliferating around serious psychological discussions,” says Drew Lightfoot, LPC, clinical director at Thriveworks Philadelphia . “The study is correct when it states that video games can be used to help effectively treat anxiety, depression, and social anxiety.”

Commercial Video Games vs. Therapy Games

Overall, the researchers found that commercial video games (typically intended for entertainment) are as effective at providing mental health benefits as bespoke video games designed for therapeutic effects. This may be explained, at least in part, by people’s desire to play commercial video games.

“The problem with bespoke video games (like ‘brain games’) is that they generally aren’t really games. When you are told to click things on a screen to improve your mental health, that is also not a game—it is a therapy,” says Platt.

He continues: “A critical quality of a game—what makes it a game—is that it is played voluntarily. Research has repeatedly validated the importance of intrinsic motivation for effective behavior change, which is what leads us to the critical insight from this article: that people play commercial video games because they want to. And as such, the beneficial aspects of these games (in terms of anxiety and depression) are bestowed as a byproduct of their fun and not the outcome of their game ‘homework.’”

Video Games May Expand Access to Care

In addition to uncovering therapeutic benefits of commercial video games, the report also found that these games could help deliver mental health support where it’s most needed.

The authors note that playing video games is already popular among people age 18 to 54, who also tend to face high rates of mental health issues. As acceptance of the emotional benefits of video games grows, it could help break down stigmas against both gaming and mental illnesses.

“We need to stop inaccurately stereotyping gamers and acknowledge that we are all gamers now,” says Platt. “In much the same way that other media, like books, television, and movies, were not taken seriously when first introduced, society needs to accept video games as a legitimate media that can actually improve the lives of those who engage.”

Access to video games is also free of many of the barriers that prevent people from getting traditional mental health care.

“Video games could offer greater access to adjunctive therapeutic intervention as they can be played at home and at any time, as opposed to traditional care, which typically occurs less frequently and can be prohibitively expensive,” explains Michael L. Birnbaum, MD , assistant professor at the Feinstein Institutes for Medical Research and program director of the early treatment program at Northwell Health’s behavioral health services.

However, he adds that he doesn’t think that video games will ever be able to replace clinicians—a statement echoed by other experts.

Drew Lightfoot, LPC

Video games can be a great addition to fill the gap, but they're not sufficient enough to be an alternative.

“We should be wary of suggesting that gaming could be an alternative to therapy. Video games can be a great addition to fill the gap, but they're not sufficient enough to be an alternative,” says Lightfoot. “The research documents the accurate representation of the difficulty for individuals to find and afford treatment, but video games should be an add-on—not an alternative.”

Lightfoot adds, “We need to continue to focus and fight for the core of the issue: Both public and private sectors worldwide are struggling to provide affordable, accessible, and effective mental health treatment for their populations.”

What This Means For You

Have you been playing a lot of video games during the pandemic? That might be time well spent, according to a new report, which found that gaming can help reduce symptoms of depression and anxiety. These games help foster feelings of social connectedness, a sense of achievement, and emotional regulation skills, among other benefits.

However, playing video games for mental health benefits should not be considered a replacement for traditional therapy, experts say. While costly, conventional mental health services offer support you may not be able to get through a game. Instead, experts say we need to find ways to make traditional therapy more affordable and accessible so more people can get the care they need.

Kowal M, Conroy E, Ramsbottom N, Smithies T, Toth A, Campbell M. Gaming your mental health: a narrative review on mitigating symptoms of depression and anxiety using commercial video games .  JMIR Serious Games . 2021;9(2):e26575. doi:10.2196/26575

By Joni Sweet Joni Sweet is an experienced writer who specializes in health, wellness, travel, and finance.

Gaming does not appear harmful to mental health, unless the gamer can't stop - Oxford study

Societies may tremble when a hot new video game is released, but the hours spent playing popular video games do not appear to be damaging players’ mental health, according to the largest-ever survey of nearly 40,000 gamers and their gaming habits, which was conducted over six weeks by a team from Oxford’s Internet Institute . That does not mean, however, that the research did not throw up some concerns – and, the team argues, much more information is needed before tech regulators, can really rest easy.

The research, published in the journal Royal Society Open Science, found no ‘causal link’ between gaming and poor mental health – whatever sort of games are being played. But Professor Andrew K. Przybylski , OII Senior Research Fellow, says the research did show a distinct difference in the experience of gamers who play ‘because they want to’ and those who play ‘because they feel they have to’.  

He maintains, ‘We found it really does not matter how much gamers played [in terms of their sense of well-being]. It wasn’t the quantity of gaming, but the quality that counted…if they felt they had to play, they felt worse.  If they played because they loved it, then the data did not suggest it affected their mental health. It seemed to give them a strong positive feeling.’

It wasn’t the quantity of gaming, but the quality that counted…if they felt they  had  to play, they felt worse.  If they played because they loved it, then the data did not suggest it affected their mental health   Professor Andrew K. Przybylski

The ground-breaking survey of gamers was the most comprehensive to date, taking in multiple platforms and seven different games, including basic games, such as Animal Crossing: New Horizons, racing simulators such as Gran Turismo Sport and more competitive games, such as Apex Legends and Eve Online.  And, says Professor Przybylski, there was no difference in impact on mental health – whether game involved moving to a new town with talking animals, as in Animal Crossing, or taking part in a battle royal-style game, such as Apex Legends.

Players own their gaming data, which is accumulated by the platforms, and nearly 40,000 people gave permission for it to be used for this research. Previous studies have often involved players keeping diaries of their reactions to gaming. The access to real-time gaming data gave only a tantalising insight into the impact of gaming, though, says Professor Przybylski. And, although the OII has made the data available to other academics, it is a drop in the ocean in terms of possible available data and only offers limited access.

Professor Przybylski explains, ‘About one billion people are playing video games worldwide. There are 3,000 games on the Nintendo platform alone. People play multiple games - and we were able to access information about 39,000 people playing just seven popular games.’

There was no difference in impact on mental health – whether game involved moving to a new town with talking animals, as in Animal Crossing, or taking part in a battle royal-style game, such as Apex Legends

In order to answer the questions that parents, such as he, want answered, Professor Przybylski says, ‘We need to collect large representative samples and we need to do it at the platform level. Looking at just seven games, is like looking at seven foodstuffs – when you know Tesco's and the other supermarkets, sell thousands of different foods and shoppers fill diverse trollies’

As well as being a parent, Professor Przybylski has grown up playing games himself and, he says, such research is essential to understanding the real impact of gaming on the individual.  Although today’s research suggests gaming may only be a negative influence only for those who feel compelled to game, rather than all users, there is much more to be learned.

‘These are just the first steps into the world of understanding how gaming fits into gamers’ lives,’ he says.  ‘And it seems that why you are playing is the key factor. This is an exciting study, but there is a lot of work still to do.’

About one billion people are playing video games worldwide. There are 3,000 games on the Nintendo platform alone. People play multiple games - and we were able to access information about 39,000 people playing just seven popular games...If the big gaming platforms care about their players’ well-being, they need to empower players and scientists to learn about how their products influence us, for good or ill

But months of negotiations with the gaming platforms, about the use of the data, preceded the research, followed by months of analysis. Analysing the data itself was the easy bit, says Professor Przybylski.  The Sony, Microsoft, and Nintendo platforms have complex relationships with hundreds of game developers and it is tricky to get everyone to agree that independent and rigorous science is in their players’ best interests. But, Professor Przybylski points out, the data belongs to the gamers – not to the platforms and not to the game developers, ‘Gamers have the legal right to donate their data…it would be an amazing step forward if we collected data at the platform level.’

He adds, ‘Players want to know what impact gaming has. Scientists want to know. Parents want to know. The Government wants to know. I want to know…and the information is there. This data needs to be open and it needs to be easy to share.’

Professor Przybylski concludes, ‘If the big gaming platforms care about their players’ well-being, they need to empower players and scientists to learn about how their products influence us, for good or ill.'

The report can be see here:  https://royalsocietypublishing.org/doi/10.1098/rsos.220411

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News releases.

News Release

Monday, October 24, 2022

Video gaming may be associated with better cognitive performance in children

Additional research necessary to parse potential benefits and harms of video games on the developing brain.

On Monday, April 10, 2023, a Notice of Retraction and Replacement published for the article featured below . The key findings remain the same. The press release has been updated, in line with the retracted and replacement article, to clarify that attention problems, depression symptoms, and attention-deficit/hyperactivity disorder (ADHD) scores were significantly higher among children who played three hours per day or more compared to children who had never played video games.

A study of nearly 2,000 children found that those who reported playing video games for three hours per day or more performed better on cognitive skills tests involving impulse control and working memory compared to children who had never played video games. Published today in JAMA Network Open , this study analyzed data from the ongoing  Adolescent Brain Cognitive Development (ABCD) Study , which is supported by the National Institute on Drug Abuse (NIDA) and other entities of the National Institutes of Health.

“This study adds to our growing understanding of the associations between playing video games and brain development,” said NIDA Director Nora Volkow, M.D. “Numerous studies have linked video gaming to behavior and mental health problems. This study suggests that there may also be cognitive benefits associated with this popular pastime, which are worthy of further investigation.”

Although a number of studies have investigated the relationship between video gaming and cognitive behavior, the neurobiological mechanisms underlying the associations are not well understood. Only a handful of neuroimaging studies have addressed this topic, and the sample sizes for those studies have been small, with fewer than 80 participants.

To address this research gap, scientists at the University of Vermont, Burlington, analyzed data obtained when children entered the ABCD Study at ages 9 and 10 years old. The research team examined survey, cognitive, and brain imaging data from nearly 2,000 participants from within the bigger study cohort. They separated these children into two groups, those who reported playing no video games at all and those who reported playing video games for three hours per day or more. This threshold was selected as it exceeds the American Academy of Pediatrics screen time guidelines , which recommend that videogaming time be limited to one to two hours per day for older children. For each group, the investigators evaluated the children’s performance on two tasks that reflected their ability to control impulsive behavior and to memorize information, as well as the children’s brain activity while performing the tasks.

The researchers found that the children who reported playing video games for three or more hours per day were faster and more accurate on both cognitive tasks than those who never played. They also observed that the differences in cognitive function observed between the two groups was accompanied by differences in brain activity. Functional MRI brain imaging analyses found that children who played video games for three or more hours per day showed higher brain activity in regions of the brain associated with attention and memory than did those who never played. At the same time, those children who played at least three hours of videogames per day showed more brain activity in frontal brain regions that are associated with more cognitively demanding tasks and less brain activity in brain regions related to vision.  

The researchers think these patterns may stem from practicing tasks related to impulse control and memory while playing videogames, which can be cognitively demanding, and that these changes may lead to improved performance on related tasks. Furthermore, the comparatively low activity in visual areas among children who reported playing video games may reflect that this area of the brain may become more efficient at visual processing as a result of repeated practice through video games.

While prior studies have reported associations between video gaming and increases in violence and aggressive behavior, this study did not find that to be the case. Though children who reported playing video games for three or more hours per day scored higher on measures of attention problems, depression symptoms, and attention-deficit/hyperactivity disorder (ADHD) compared to children who played no video games, the researchers found that these mental health and behavioral scores did not reach clinical significance in either group, meaning, they did not meet the thresholds for risk of problem behaviors or clinical symptoms. The authors note that these will be important measures to continue to track and understand as the children mature.

Further, the researchers stress that this cross-sectional study does not allow for cause-and-effect analyses, and that it could be that children who are good at these types of cognitive tasks may choose to play video games. The authors also emphasize that their findings do not mean that children should spend unlimited time on their computers, mobile phones, or TVs, and that the outcomes likely depend largely on the specific activities children engage in. For instance, they hypothesize that the specific genre of video games, such as action-adventure, puzzle solving, sports, or shooting games, may have different effects for neurocognitive development, and this level of specificity on the type of video game played was not assessed by the study.

“While we cannot say whether playing video games regularly caused superior neurocognitive performance, it is an encouraging finding, and one that we must continue to investigate in these children as they transition into adolescence and young adulthood,” said Bader Chaarani, Ph.D., assistant professor of psychiatry at the University of Vermont and the lead author on the study. “Many parents today are concerned about the effects of video games on their children’s health and development, and as these games continue to proliferate among young people, it is crucial that we better understand both the positive and negative impact that such games may have.”

Through the ABCD Study, researchers will be able to conduct similar analyses for the same children over time into early adulthood, to see if changes in video gaming behavior are linked to changes in cognitive skills, brain activity, behavior, and mental health. The longitudinal study design and comprehensive data set will also enable them to better account for various other factors in the children’s families and environment that may influence their cognitive and behavioral development, such as exercise, sleep quality, and other influences.

The ABCD Study, the largest of its kind in the United States, is tracking nearly 12,000 youth as they grow into young adults. Investigators regularly measure participants’ brain structure and activity using magnetic resonance imaging (MRI) and collect psychological, environmental, and cognitive information, as well as biological samples. The goal of the study is to understand the factors that influence brain, cognitive, and social-emotional development, to inform the development of interventions to enhance a young person’s life trajectory.

The Adolescent Brain Cognitive Development Study and ABCD Study are registered service marks and trademarks, respectively, of the U.S. Department of Health and Human Services

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

NIH…Turning Discovery Into Health ®

  B Chaarani, et al.  Association of video gaming with cognitive performance among children .  JAMA Open Network.  DOI: 10.1001/jamanetworkopen.2022.35721 (2022).

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Can Video Games Cause Depression?

Turning on your gaming console at the end of a long day may feel like stress relief, but can video games also cause depression?

When people think of the consequences of video games, they often think specifically of video game violence. Is it affecting children? And if so, what’s too much?

In truth, the world of video games is vast. Violent games make up a small portion of what’s available. Puzzle, adventure, survival, and exploration games all have large followings.

What you play may not be as important as how intensely you play. But can playing video games really cause depression ?

Can video games affect your mental health?

Video games can impact your mental health in both positive and negative ways.

When you pick up that controller or log into your gaming system, game selection is just a small factor in the overall gaming experience.

Your current mindset, how long or intensely you play, and why you play are all factors contributing to how a video game affects you.

According to a 2019 survey of people who play video games, approximately 80% responded that gaming provides them with mental stimulation, relaxation, and stress relief .

Gaming and the brain

Excessive gaming, also referred to as problematic gaming, is commonly associated with adverse mental health outcomes.

It’s a level of gaming characterized by an abundance of time spent in-game, often at the expense of other basic life necessities, like eating, sleeping, or using the bathroom.

One systematic review from 2017 links excessive gaming to psychological conditions such as depression, anxiety , and obsessive-compulsive disorder (OCD) , particularly in young adults and adults.

But it’s important to note that a link doesn’t necessarily mean gaming causes these things.

People living with certain mental health conditions may also gravitate toward introverted activities like gaming.

And there’s evidence that playing video games can be good for you.

In another 2017 systematic review on gaming and the brain, findings suggested that playing video games creates several functional and structural changes in the brain, including alterations to neural reward pathways and heightened visuospatial thinking.

How does gaming cause depression?

Research hasn’t established a direct cause-and-effect relationship between gaming and depression, but gaming and depression can overlap.

Internet gaming disorder

Internet gaming disorder (IGD) is a diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) .

Though it’s a recognized mental health condition, the inclusion of IGD in the DSM-5-TR is still heavily debated, as some experts believe that it’s a condition with features similar to addictive disorders .

As in other substance use conditions, gaming in IGD may trigger your brain’s reward system, creating a cycle of addictive behaviors.

IGD also often occurs with depression, hostility, and social anxiety.

The use of virtual worlds to escape is aptly called escapism, which has links to both positive and negative psychological outcomes.

Like many things, too much escapism can become problematic. Data from a 2021 meta-analysis suggested that excessive escapism can lead to depression and addictive gaming behaviors.

Social dependency

One 2021 study involving a sample of 457 Chinese players from a massively multiplayer online (MMO) game suggested that playing with a social network online can fulfill a human need for support and affiliation.

It can build lasting relationships and fill social gaps that may exist in the offline world.

But social belonging can become problematic when a game provides a sense of fulfillment that encourages excessive gaming, or IGD, which may have links to depression .

Negative social engagement

Not all online interactions are supportive. Some gaming environments may subject you to more open negativity and confrontation than others.

There may also be pressure to perform within a team dynamic. Failure to meet your expectations — or those of your teammates — can create the same negative feelings as letting someone down in the offline world.

Excessive screen time

There’s also evidence that too much screen time can profoundly impact your mental health.

A 2017 report on two national surveys of U.S. teens suggested that the more time teenagers spend looking at electronic devices, the more likely they are to experience depression or suicidal ideation .

While “screen time” can involve television and smartphone use, it also applies to the world of video gaming.

What are the mental health benefits of gaming?

Gaming isn’t all gore and conflict, but even when it contains those elements, you may still benefit from gaming time.

Depression and anxiety relief

Casual gaming, which involves playing in short bursts of time, may have the opposite effect of excessive gaming and help with depression and anxiety.

According to a 2020 systematic review , easy-to-use, casual video games offer a fun mood boost that can be beneficial for mental health, particularly in relation to anxiety, depression, and low mood.

Improved self-esteem

A review of studies from 2021 links 10 and 90 minutes of activity-based video gaming per day to positive mental health, improved self-esteem, increased energy expenditure, and improved physical activity.

Brain training

Findings from a 2018 systematic review suggested that playing action and puzzle videos games may help train your brain in emotional skills and areas of cognition, such as:

• reaction time
• task-switching
• multitasking
• mental spatial rotation

How to care for your mental health while gaming

The following tips can help you safeguard your mental health while continuing to enjoy your favorite hobby:

• getting plenty of quality sleep
• taking regular breaks
• not neglecting basic needs, like eating
• keeping online interactions positive
• offering consideration when loved ones express concern about time spent gaming
• participating in other non-gaming activities you enjoy
• cultivating additional stress-relief strategies, like exercise or meditation
• assessing how you feel during and when you’re not playing video games
• staying social with offline family and friends
• setting alarms for scheduled offline time
• limiting electronic screen time

When to get help

If gaming interferes with your relationships or impairs your daily function, speaking with a mental health professional may be helpful.

In addition to exploring internet gaming addiction and the impact games have on your life, a professional can help you manage symptoms of depression and other mental health disorders.

Let’s recap

Video games are a gratifying source of entertainment for many people. Gaming is an interactive experience that can positively and negatively affect mental health.

While there’s no direct cause-and-effect relationship between video games and depression, research does support an association.

How long you play games, who you play with, and why you reach for games are all factors that can influence the role gaming has on your mental health.

Last medically reviewed on June 15, 2022

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Video Games and Their Impact on Teens’ Mental Health

• First Online: 02 March 2018

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• Melissa E. DeRosier Ph.D. 3 &
• James M. Thomas Ph.D. 3  

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The role that video games play in the lives of teenagers has grown dramatically and without pause for the past generation or two. Between computers, smart phones, and dedicated game consoles, not only are individual adolescents spending more of their days playing video games, but the percentage of teens whose daily lives include video games is quickly approaching universality. In this chapter, we first review recent trends in video gaming and explore the various and myriad video games that teens tend to play as well as their motivations to play video games. Then, we review the literature regarding the influence of playing different types of commercial video games on mental health. And last, we explore recent innovations in game development whereby video games are specifically developed to improve mental health symptoms or psychosocial adjustment, including a review of the research supporting use of these “impactful video games.” It is hoped that the information presented in this chapter will provide practitioners with greater understanding of the diversity and breadth of experiences that fall under the umbrella term “video gaming” in order to help foster more open and productive conversations with teens about their video gaming behavior. We also hope the research evidence presented in this chapter will encourage practitioners to integrate the use of video games into their treatment of teen patients, both as a means of fostering the therapeutic alliance and as an innovative accompaniment to traditional therapeutic methods to enhance teens’ mental and behavioral health.

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Acknowledgments

The authors would like to thank their three sons—Jefferson Thomas, Benjamin Thomas, and Lincoln Thomas—who provided considerable input (and fact-checking) for this chapter regarding popular commercial video games, video game genres, and video gaming experiences. Their feedback and sharing were integral in helping the authors conceptualize teens’ gameplay experiences when writing the first section of this chapter. The authors would also like to thank Mary Whatley who aided considerably in conducting a literature search and compiling the citations included in this chapter.

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DeRosier, M.E., Thomas, J.M. (2018). Video Games and Their Impact on Teens’ Mental Health. In: Moreno, M., Radovic, A. (eds) Technology and Adolescent Mental Health . Springer, Cham. https://doi.org/10.1007/978-3-319-69638-6_17

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Published on 25.4.2024 in Vol 12 (2024)

Therapeutic Uses of Gaming in Mental Health: An Untapped Potential

Authors of this article:

Letter to the Editor

• Jens Peter Eckardt, BSW, MSc  

Bedre Psykiatri Research Unit (Videnscenter), Copenhagen, Denmark

Corresponding Author:

Jens Peter Eckardt, BSW, MSc

Bedre Psykiatri Research Unit (Videnscenter)

Gammeltorv 14. 2 sal

Copenhagen, 1457

Phone: 45 28943288

Email: [email protected]

In their exploratory study, Pine et al [ 1 ] unveil promising results indicating the potential therapeutic benefits of using casual video games. While caution is necessary, particularly concerning the interpretation of student feedback, self-assessment effectiveness, recruitment, pandemic effects, and the absence of mental distress screening, the study demonstrates that video games integrating brief mental health messages provide a promising approach to merging digital intervention with the accessibility of commercial gaming. Although a randomized controlled trial is also required for precise clinical impact assessment, these preliminary findings bolster the notion that “gaming” (primarily commercial video games, serious games, and exergames) within mental health services is validated as a viable alternative or complement to conventional methods of prevention, assessment, and treatment.

Gaming, in a broad sense, is one of the most popular leisure activities globally, estimated to involve millions of gamers worldwide [ 2 ], making it ubiquitous and omnipresent, regardless of whether one has a mental illness or not. Considering the growing disparity between demand and supply for mental health assistance, combined with factors such as high disease burden, treatment costs, and long waiting lists, new alternative solutions must be explored. Coupled with accelerating technology-based game development and popularity, it may just be a matter of time before gaming truly disrupts several aspects of psychiatric work.

At present, gaming research has been conducted in the context of different psychiatric disorders such as anxiety, depression, eating disorders, attention-deficit/hyperactivity disorder (ADHD), stress symptoms, posttraumatic stress disorder (PTSD), autism, phobias, and schizophrenia, as well as in forensic psychiatry. The results vary, but reduced symptomatology, improved social, executive, and cognitive functions, as well as improved attention processes and problem-solving, have been reported. Gaming has also proven effective in offering temporary distraction from serious events, and it fosters social communities [ 3 ].

However, there are several challenges to research and practical application of gaming in mental health services. Moreover, there are critical concerns regarding the limited number of high-quality studies; weak research designs; methodological issues; and questions about generalizability, causality, mechanisms of action, control groups, effect sizes, definitions, terminology, comparability, theoretical strength, harmful effects, and transferability [ 2 , 3 ]. In addition, critics highlight concerns, such as gaming disorders as outlined in the ICD-11 (International Classification of Diseases 11th Revision) , prolonged sedentary screen time, exposure to violence, and instances of excessive or problematic gaming behavior [ 2 , 4 ]. Furthermore, critics argue that gaming encourages avoidance tactics, hindering physical interactions within communities. This challenge is compounded by distant communication, escapism, isolation, loneliness, emotional detachment, addiction, sleep disturbances, and physical inactivity, all posing risks of worsening the individual’s condition. Critics argue gaming is not a treatment strategy but rather a tool for enhancing communication and presence among individuals.

Research and applications of gaming in psychiatry are expanding and proving beneficial for specific patient demographics, yet there is a pressing need for a more robust knowledge base to fully grasp both the potentials and challenges involved [ 5 ]. Capitalizing on these opportunities for clinical use will demand innovative thinking within multidisciplinary research environments [ 2 ]. In conclusion, it is evident that gaming, which is deeply embedded in our culture, possesses promising yet unexplored avenues to emerge as a vital component in forthcoming treatments for mental disorders.

Conflicts of Interest

None declared.

Editorial Notice

The corresponding author of “A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study” declined to respond to this letter.

• Pine R, Mbinta J, Te Morenga L, Fleming T. A novel casual video game with simple mental health and well-being concepts (Match Emoji): mixed methods feasibility study. JMIR Serious Games. Feb 12, 2024;12:e46697. [ CrossRef ] [ Medline ]
• Colder Carras M, Van Rooij AJ, Spruijt-Metz D, Kvedar J, Griffiths MD, Carabas Y, et al. Commercial video games as therapy: a new research agenda to unlock the potential of a global pastime. Front Psychiatry. Jan 22, 2017;8:300. [ CrossRef ] [ Medline ]
• Zayeni D, Raynaud J, Revet A. Therapeutic and preventive use of video games in child and adolescent psychiatry: a systematic review. Front Psychiatry. 2020;11:36. [ CrossRef ] [ Medline ]
• Darvesh N, Radhakrishnan A, Lachance CC, Nincic V, Sharpe JP, Ghassemi M, et al. Exploring the prevalence of gaming disorder and internet gaming disorder: a rapid scoping review. Syst Rev. Apr 02, 2020;9(1):68. [ CrossRef ] [ Medline ]
• Poppelaars M, Lichtwarck-Aschoff A, Otten R, Granic I. Can a commercial video game prevent depression? null results and whole sample action mechanisms in a randomized controlled trial. Front Psychol. Jan 12, 2020;11:575962. [ CrossRef ] [ Medline ]

Abbreviations

Edited by T Leung; This is a non–peer-reviewed article. submitted 24.02.24; accepted 16.04.24; published 25.04.24.

©Jens Peter Eckardt. Originally published in JMIR Serious Games (https://games.jmir.org), 25.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on https://games.jmir.org, as well as this copyright and license information must be included.

The Potential for Video Games to Improve Mental Health Care Access

See the remediation.

My primary audience is American counselors because they can educate the public about the lack of access to mental health care in the United States and support the use of video games to supplement such services. It is critical that this audience reads this paper so they become aware of gaming’s psychological benefits, which are less known than those of face-to-face counseling. While the latter is more popular for treating depression and anxiety, it cannot reach everyone who needs counseling, nor is it always effective. Counselors are also gatekeepers to receiving treatment. If gaming gains enough credibility from them, then they may refer it as another resource to patients they believe will express interest in and benefit from it. My secondary audience consists of families whose loved ones are unable to receive traditional counseling, as they may find video games created for therapy helpful. I hope that after reading this paper, my audiences engage in more research on gaming’s counseling potential.

I first became aware how difficult it was for Americans to access mental health care when my brother began suffering from depression. It was after our family moved to Massachusetts and he transferred to a new high school where grades seemed to define success. Because he struggled to keep up with his peers, he perceived himself as a failure and lost motivation to complete work. He eventually succeeded in getting an appointment with his school counselor, but he found it was tough for him to open up in the sessions. Meanwhile at home, he appeared to find consolation in video games like Pokémon, which lifted his spirits and made him more talkative. Was it possible that, for my brother, video games instilled in him confidence and the desire to seek out relationships whereas conventional therapy did not?

I have since learned that my brother’s story is part of a much larger narrative about untreated mental illness in the U.S. and the toll it has taken on Americans. According to the National Alliance on Mental Health, nearly one in five Americans experiences mental illness each year, but about 55% of American adults with treatable disorders failed to receive treatment in 2019 (“Mental Health By the Numbers”); for American children, that percentage was 49% in 2016 (Whitney). Many have no other choice but to engage in a trial and error approach to treatment for mental health challenges, when what is needed are innovative approaches that have the potential to more easily reach individual patients.

My brother’s experience with video games is evocative of their potential to address this issue. This paper demonstrates that video games used for therapy can help people with mild to moderate depression and anxiety cope with their mental illnesses and achieve greater independence and happiness. Since access to mental health care is difficult due to financial and geographical barriers, I also promote the use of specialty games to fulfill Americans’ unmet counseling needs. After analyzing different forms of gaming and their psychological benefits, I argue that specialty video games should be considered as a supplement to traditional counseling. While they are neither a panacea nor the only solution to America’s mental health crisis, specialized video games should be incorporated into our approaches to mental health care because they empower patients, foster resilience, and build rapport. I conclude by discussing how the U.S. can mitigate any concerns about gamifying mental health via collaboration between counselors, individuals with mental illnesses, and video game developers.

Despite strong demand for mental health care in the U.S., financial barriers to access remain. Historically, medical insurers have been a major contributor to inaccessibility because before the Affordable Care Act (ACA), they failed to provide the same level of support for patients with mental illnesses as they did for those with physical ailments. Insurance companies either denied coverage to applicants who had histories of mental health conditions or increased the cost of their premiums by 20-50% while excluding important treatments like therapies (“Mental Health Parity at Risk”). Moreover, even though the ACA lifted coverage restrictions for mental health, research shows that discrepancies still exist, disadvantaging those who suffer from mental illnesses. For example, Americans with mental health disorders still pay an average of $341 more for treatment than diabetics do for insulin (Carroll). Access for unemployed and underemployed Americans is even more concerning. Researchers at Canada’s Universities of Manitoba and Regina found that in the U.S., “low levels of household income are associated with several lifetime mental disorders and suicide attempts,” and with health insurance often tied to employment, mental health care for this group is often inaccessible (Sareen, et al.). These barriers highlight how the U.S. insurance system disproportionately raises costs of and hinders access to mental health services for Americans who may need them the most.

In addition to financial hurdles, Americans must overcome geographical ones since location determines the availability of mental health care. As of April 2020, 113 million Americans live in areas with shortages of mental health providers, with more than 60% of rural Americans residing in these understaffed locations (“Mental Health Care Health Professional Shortage Areas”). Meanwhile, over 90% of psychologists and psychiatrists “work exclusively in metropolitan areas” (“Mental Health and Rural America: Challenges and Opportunities”). This disparity indicates that millions of Americans must travel further to find a mental health professional—let alone one in their insurance network with a sustainable staff-to-patient ratio. Otherwise, some may rather visit an outside provider and pay more for quicker access to services. These sacrifices to minimize expenses and long wait times underscore that more needs to be done to help overburdened Americans receive the care they need.

Yet the growing popularity of teletherapy situates gaming as a supplemental form of treatment alongside counseling because such online alternatives to in-person services can provide much-needed support to Americans affordably and remotely. Even before people began spending more time at home during the coronavirus pandemic and playing more video games for enjoyment and social connection, psychologists have long recognized gaming as possessing potential medical benefits. Since 1975, psychologists have studied gamification—the use of recreational games and their design elements in counseling—through board and arcade games, finding that they can offer therapeutic effects to players, such as greater freedom of expression and reduced stress (Crocker and Wroblewski). The British Medical Journal’s 2012 finding that the e-therapy game SPARX was as effective as standard counseling in 12-19 year-olds with mild to moderate depression further legitimized gamification (Merry, et al.). Additionally, the emotional fitness game eQuoo gained the U.K. National Health Services’ approval in 2019, meaning that U.K. doctors can “formally refer [the app] to patients to improve their mental health” (Butcher). Along with the current use of gaming to cope with isolation, gamification shows promise in fulfilling unmet counseling needs, but unless it receives more national attention, America’s mental health crisis will continue to worsen.

Specialty games should become an aid to counseling because they empower people with depression to drive the treatment process, which can accelerate their recovery. Studies have shown that when patients believe they can control their response to depressive thoughts, they can stop the rumination that perpetuates their depression (Aggarwal). With this dynamic in mind, researchers at the University of Auckland developed the specialty game SPARX to help adolescents fight depression. In the game, players’ objective is for their avatars to restore balance to a fantasy world by vanquishing GNATs, or “gloomy negative automatic thoughts,” using “smart, positive, active, realistic, and x-factor” strategies that reframe these GNATs as healthy ones (Szalavitz). As players advance through seven provinces in SPARX, they learn more of these cognitive behavioral therapy (CBT) techniques that they can apply in real life, building confidence in their ability to better manage their depression. SPARX also incorporates game elements like purpose, mastery, and customization into therapy to produce greater improvements in players’ mental health than conventional counseling does. A study of 168 teens with an average age of 15 who had sought help for depression from youth clinics concluded that “about 44% of adolescent participants recovered completely from depression” after playing SPARX, “compared to 26% of those in regular treatment” (Szalavitz). This difference is significant because the former group played a more active role in their recovery by using coping skills they learned from SPARX to help themselves, while the latter group received support from counselors. The group of SPARX players experienced greater increases in wellbeing as well, with depressive symptoms decreasing by 30%, since they saw themselves reflected in avatars and felt more connected to their progress towards recovery (Merry, et al.). Therefore, the empowerment players gain from gaming can counter the helplessness they may feel about their depression and translate into real life results.

Besides SPARX, other forms of gaming could supplement standard counseling. Specialty virtual reality (VR) simulations such as BraveMind encourage players to persist in learning how to manage their anxiety disorders so they can focus on their happiness instead. To motivate individuals to undergo exposure therapy (ET), these systems employ a multi-level structure similar to that of commercial games. Through gradual exposure to their most distressing stimuli in-game, players train themselves to confront anxiety-inducing situations until they can voluntarily subject themselves to them in real life. This in turn helps these players realize that if they can overcome their fears, then they can regain agency and their sense of self by spending more time doing what they enjoy versus being held captive by their anxiety. Concerning virtual reality games, university studies have shown that ET is particularly beneficial for people with anxiety from post-traumatic stress disorders (PTSD). For their pilot study of the VRET system BraveMind, University of Southern California researchers studied ten Vietnam veterans still suffering from PTSD in 2001 to experience vivid war scenes closely simulating their specific traumas for two 90-minute sessions per week for two weeks. After being reassessed six months later, the veterans showed “significantly reduced PTSD symptoms,” inspiring larger VRET studies (Waldrop). A follow-up study in 2010 using brain scans found VRET to have effectiveness comparable to imaginal exposure therapy—visualizing and talking through traumatic stimuli with a counselor—through reducing neural activity responsible for flashbacks and social withdrawal that PTSD and other anxiety disorders augment (Boeldt, et al.). Such findings support that gamification develops players’ resilience by challenging them to face their anxiety while also helping them endure it and feel relief afterwards, enabling them to move on.

While complementing standard counseling, video games can build rapport as well, which enhances individual and community well-being. Research has found that commercial video games played for entertainment have similar psychological benefits to games designed for therapy because patients are intrinsically motivated to make behavioral changes when engaging in enjoyable activities (Kowal, et al.). By integrating commercial games into therapy, mental health service providers can also foster trust and gain deeper insight into patients’ emotions. For instance, family counselor Gilbert E. Franco, Ph.D., observed that playing a racing video game with his client reminded them of gaming with their late father and compelled them to open up about their grief, whereas they had not in previous sessions without gameplay (Franco, et al.). This progress hints at multiplayer games’ potential to help other clients in family and group therapy thrive, as cooperative gameplay encourages sharing versus internalization of pain, offering intervention before mental illness progresses. Furthermore, supportive connections reinforce the transfer of healthy habits in games like Wii Sports to real-world settings, while replacing risky behaviors like self-harm (Colder Carras, et al.). If implemented properly, gamification makes patients feel less alone in their struggles.

In spite of gamification’s potential to support mental health services, skeptics worry that it does more harm than good. Many parents of school-age children may fear that if incorporated into mental health intervention, gaming may escalate into addiction by promoting escapism versus progress towards achieving counseling goals (Hurst). However, gaming addiction is rare in any circumstance. Oxford University psychologist Andy Przybylski’s findings showed that only 0.3% of gamers might struggle with controlling their screen time (Judge). Even more factors mitigate risk of addiction with therapeutic gaming, which no research shows there is correlation between. Because clinicians understand the seriousness of mental illness, they screen patients before implementing this approach. Additionally, to improve the safety and design of video games integrated into therapy, therapists have suggested remotely supporting patients and adding features like time restrictions and personalized levels (Annema, et al.). Overgeneralizing gaming detracts from these efforts to align gameplay with players’ mental health objectives.

Some clinicians may also argue that gamification limits access to services instead of improving it. Psychiatrist Kalpana Srivastava and her colleagues note that equipment creates substantial cost barriers for patients (Srivastava, et al.). While devices like VR headsets are expensive, more research evidence of gaming’s potential to augment mental health care could compel the government to fund or subsidize them. Gamification eliminates other impediments to access too. E-therapy games like SPARX offer free computer and mobile versions that operate without Wi-Fi (Lau, et al.). Moreover, since most Americans own smartphones, they can access such games instantaneously, which cuts travel and wait time. Given its appeal among players ranging from younger than twelve to adults in their 80’s, gaming also engages demographics reluctant to seek traditional counseling (Barnett and Coulson). Games especially cater to people with social anxiety who prefer low-pressure environments to practice coping strategies. If patients require technical or emotional assistance, nonprofits like Stack-Up provide safe spaces to interact with professionals online and in-person, maintaining players’ rapport with mental health providers (Colder Carras, et al.). Should counselors, patients, and developers collaborate to create high quality therapeutic games, mental health services would reach even more people.

Counselors practicing in and beyond schools need to investigate and formally integrate specialty video games like SPARX and BraveMind as supplemental forms of counseling support for their child and adolescent patients because these games build rapport and empower them to manage their mental illnesses through tools that build resilience, allowing them to pursue their happiness. These patients can then use these therapeutic resources into their adulthood and recommend such games to their peers who are struggling with mental health matters. As video games have provided us with purpose, happiness, and connection even in isolation, I hope that we recognize how they can help us help ourselves and each other.

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Disparities of Mental Health Care Use in Children.” JAMA Pediatrics , American Medical Association, 1 Apr. 2019, jamanetwork.com/journals/jamapediatrics/fullarticle/2724377?guestAccessKey=f689aa19-31f1-481d-878a-6bf83844536a.

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Exploring the possible mental health and wellbeing benefits of video games for adult players: A cross-sectional study

Associated data.

Supplementary Material for Exploring the possible mental health and wellbeing benefits of video games for adult players: A cross-sectional study by Jennifer Hazel, Alice Kim, and Susanna Every-Palmer in Australasian Psychiatry.

There is mixed evidence on the psychological effects of video games. While excessive use can be harmful, moderate use can have emotional, psychological and social benefits, with games successfully used in treating anxiety and depression. More data are required to understand how and for whom these benefits occur. This paper aims to identify correlations between video game genre, player demographics, wellbeing, and the in-play psychological processes for adult players.

Adult gamers ( n = 2107) completed an anonymous cross-sectional survey canvassing play style, genre, perception of psychological impact and mechanisms (wellbeing, self-determination and flow). A multivariate multiple regression model explored correlations.

88.4% of participants experienced emotional benefits from gaming, with stronger benefits experienced by younger players in all categories. The genres most strongly correlated with psychological benefits were music games, role-playing games and survival horror games. Multiplayer online battle arena games had lower scores for psychological and emotional wellbeing.

Conclusions

Certain genres have stronger correlations with beneficial mechanisms, while some may be detrimental to players. These results may guide experimental studies to measure the directionality and strength of these correlations and can also impact practical aspects in development of therapeutic games to treat mental distress.

With the inclusion of Gaming Disorder in ICD-11, it is important that mental health clinicians gain a balanced understanding of their patients’ gaming. This means focussing not only on the potential harms but also exploring the potential benefits and therapeutic opportunities of video games.

Researchers, politicians and public commentators typically associate video games with negative outcomes, such as violence and addictiveness. Overall, meta-analyses show that playing video games in and of itself does not involve negative consequences. 1 Indeed, gaming can be a healthy coping mechanism. A review of the literature shows moderate amounts of play are linked to positive mood, relaxation, reduced stress and anxiety, improved emotional regulation, reduced depression and increases in self-confidence and self-esteem. 2 – 4 Games can also promote healthy socialising and assist with social integration. 2

Other psychological mechanisms which have been explored include self-determination theory 3 (comprised of autonomy, competence and relatedness) and the concept of flow. 5 Autonomy can be experienced by relating to the in-game avatar and controlling its actions, personality and often destiny to match one’s own agenda. Competence describes the cycle of challenge, skill testing and achievement. This teaches the player to endure frustration, and to persevere to overcome the obstacles before them. Relatedness refers to social integration, and can involve relating to in-game characters, or playing with others. Online games can fulfil a need to belong to a community, to be valued, validated and recognised as a source of social support. 6

Flow is a state of mind characterised by immersion, accomplishment, focus and loss of time awareness. It is inherently pleasurable and linked to positive affect, better performance, lower anxiety and increased self-esteem. 5 Video games engage multiple senses simultaneously; by their nature they require significant concentration. 5

Given the potential benefits to player mental health and wellbeing, it has been proposed that video games could be used as therapeutic interventions and adjuncts. Using games in this way has a number of benefits; video games are relatively cheap, can reach a large audience, and are acceptable to many – especially young adults. Therapeutic video games became increasingly appealing options during the COVID pandemic where psychological distress increased, especially among young people, and traditional therapies were compromised by social distancing restrictions. Video games have been accepted and enjoyed treatment options by young people with depression 7 , 8 and may be particularly useful in remote communities where health care is less accessible. 8

In order to best design and deliver therapeutic games, developers must understand the relationship between gaming and psychological and emotional outcomes. It is important to consider not just the general act of ‘play’, but who is playing, how they are playing, why they are playing and what they get out of it. Understanding these concepts can provide direction for the development of games that maximise wellbeing, and potentially for the development of therapeutic games.

The study received ethical approval from the Human Research Ethics Committee of South Western Sydney Local Health District (HE16/151).

Data from adult (>18 years) gamers were collected through an anonymous cross-sectional survey hosted on Google Forms. Participants were recruited via invitations on relevant Twitter and Facebook groups. The survey was open 27 March–31 August 2017. Only fully completed surveys were included in the analysis.

Data were collected across 117 variables, including participant demographics, which genres participants played (see Table 1 ), duration of play, who they played with, whether they perceived a psychological impact from video games (and, if so, which genres) and questions investigating mechanisms of benefit. Mechanisms of benefit were explored using three established psychological theories with connections to video game play: wellbeing theory, 9 self-determination theory 10 and flow. 5

Play time, per week, by gender (%)

Survey questions were derived from validated tools with reliable psychometric properties. Psychological, emotional, and social wellbeing, were assessed using the Warwick-Edinburgh Mental Wellbeing Scale 11 and the Flourishing Scale. 12 The Basic Psychological Needs Scale 13 assessed autonomy, competence and relatedness and the Flow Short Scale 14 assessed flow.

Summary statistics and correlations were reported for key demographic data, game genre and psychological scale outcomes. A multivariate multiple regression model was used, with the seven score variables as the response variables. Demographic variables, perceived benefit and genre were predictor variables that simultaneously explained multiple outcomes.

There were 2107 valid responses; 69.5% were male, 26.4% female, 3.9% gender diverse, with 0.2% missing. The majority (81.8%) were aged 18–34 years, with 13.2% aged 35–44 and 3.4% over 45 years old. Most participants were in Australia (31%), the USA (29.5%) and the UK (25.4%), the remainder from various other countries. Almost all participants (98.1%) played single-player games, 74.5% played co-operative multiplayer and 58.8% played competitive multiplayer. A glossary of gaming genres, terms and abbreviations is available ( Supplementary file 1 ).

The time participants spent playing is summarised in Table 1 .

Most participants (88.4%) considered video games had psychological or emotional benefits for them. Nine percent were unsure and 2.4% did not experience psychological/emotional benefits. Psychological outcome scores were higher across all domains for those perceiving benefits ( Figure 1 ). Those who perceived benefits scored higher in terms of flow state, competence, autonomy and relatedness. Younger adults identified significantly greater psychological benefits. Increasing age was negatively correlated with psychological benefits.

Relative difference (with 95% Confidence Intervals) in psychological outcome variables for people who believed that video games have a psychological benefit (88.4%) compared with those who were unsure or who did not experience a benefit after adjusting for age, gender, perceived gaming benefit, time spent playing, genre, interaction terms for gender and genre and benefit and genre. * = p < .001. Only the significant results are shown.

There were no significant correlations between time spent playing and the psychological mechanisms investigated, apart from competence. There were significant correlations between individual games genres and psychological outcome variables ( Figure 2 and ​ and3 3 ).

Relative difference (with 95% Confidence Intervals) in scores across psychological outcome variables if participant plays genre; statistically significant correlations after adjusting for age, gender, perceived gaming benefit, time spent playing, genre, interaction terms for gender and genre and benefit and genre. All = p < .05; ** = p < .001. (RPG = Role-Playing Game). Only the significant results are shown.

Relative difference (with 95% Confidence Intervals) in scores across psychological outcome variables if participant believes genre has a psychological benefit; statistically significant correlations after adjusting for age, gender, perceived gaming benefit, time spent playing, genre, interaction terms for gender and genre and benefit and genre. All = p < .05; ** = p < .001. Only the significant results are shown. (TPS = Third Person Shooter; RPG = Role Playing Game; Simulation CMS = Simulation Construction and Management Simulation; MMORPG = Massively Multiplayer Online Role Playing Game; MOBA = Multiplayer Online Battle Arena).

Perceived psychological benefits differed by genre and gender, with key findings summarised in Table 2 . Role-playing games (RPGs) scored highly across participants, but men were more likely to perceive first-person shooters and stealth titles as having psychological benefits; while more women perceived mobile and life sim games as beneficial.

Subgroup analysis of genre impact by demographic

Note. RGP = Role-playing games; MOBA = Multiplayer online battle arena.

Supplementary datafile S2 describes genre outcomes in greater depth. Overall, RPGs were the most frequently played genre, with RPG-players scoring significantly higher in autonomy and relatedness domains. Survival horror games also performed well, with players rating them highly on emotional wellbeing, competence and relatedness. Male and non-binary respondents were most likely to both play survival horror games, and to perceive benefit in them.

The data from Multiplayer online battle arena (MOBA)-players were mixed. Interestingly, participants who believed that MOBAs had psychological benefits scored lower in emotional wellbeing and psychological wellbeing domains ( Figure 3 ).

Strengths and limitations

A strength is the large sample size, with over 2000 adult gamers participating. The data captured correlations between genre and psychological mechanisms but cannot prove causation. Data were subjective, describing gamers’ perceptions of benefits. However, subjective experiences are important because people are unlikely to use game-based therapy if they do not perceive benefits.

Data were limited by selection bias. For example, participants may have been those most interested in links between video games and psychology. Other sources of bias were mitigated by including negatively weighted statements to account for acquiescence bias, and judgement statements were removed to reduce social desirability bias. Validated scales reduced the risk of measurement bias.

Discussion of key findings

All genders (male, female and other) perceived psychological benefits from video games. There was an inverse relationship between age and perceived benefit. This might have been because younger players were more familiar with the digital world and hence more receptive to the idea of deriving tangible, real-life benefits from gaming. Older adults might consider video games less acceptable and associate play with feelings of guilt or self-stigma.

Participants playing multiplayer games scored higher on social wellbeing and relatedness measures than respondents who only played single-player games. RPGs were perceived as the most beneficial genre, particularly by female gamers, with the highest correlation to positive psychological outcomes. This could inform the choice of genre for therapeutic games. There are examples of such work underway, such as SPARX, 7 , 8 a New Zealand developed RPG to improve mild-to-moderate depression and anxiety in young people. These results might also guide the design of experimental studies to investigate causality and directionality of video games and their potential benefits.

In MOBA games, players manage resources within a game world in real time with players working together and against each other in teams. This would seem to predict social connectivity and relatedness. However, MOBA games are renowned for negative player interactions, with toxic behaviour appearing in an estimated 60% of game matches. 15 There is an emerging lexicography of associated terms, such the gaming ‘toxicity index’, and ‘griefing’; deliberately hassling another player with no in-game benefit to either party; a form of cyber-bullying. Toxicity is one explanatory model for the reduction of wellbeing scores observed in MOBAs.

Perceived psychological benefits from video games were correlated with self-determination theory domains: autonomy, competence and relatedness; and with wellbeing theory. Despite players’ beliefs, MOBA-players had lower psychological wellbeing scores, disproportionately impacting male players. As the consequences of gaming toxicity and online harassment become more apparent, this connection may warrant further investigation. RPGs were perceived to be the most beneficial genre, particularly by female gamers. Interestingly, survival horror games, most often played by men, might be of benefit to all genders. These findings may influence the design of therapeutic games to promote wellbeing and treat aspects of mental distress.

Supplemental Material

Authors’ note: The first author (JH) is the co-founder of a non-profit organisation, which provides mental health resources for gamers.

Author contributions: JH conceived and designed the study, collected the data, performed the analysis and wrote the paper. HK provided statistical guidance. SEP provided supervision, guidance on methodology and reviewed and edited drafts of the manuscript. All authors reviewed and approved the final manuscript

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental material: Supplemental material for this article is available online.

Susanna Every-Palmer https://orcid.org/0000-0001-6455-9741

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How The Aftermath Of Natural Disasters Affects Mental Health

Hurricane Ian is gone and recovery has started. But the mental health harm for many hurricane survivors is just beginning.  

Paul Benedetti rode out the storm with his two elderly parents and one of their elderly friends during the storm.  

"It was scary as hell. We were all ready to die here and we were literally saying goodbye to each other," said Benedetti. 

He says they floated on mattresses as water filled the house up to their necks. 

Alison Holman and Dana Rose Garfin both research  hurricanes'  psychological impacts. 

"I just want to cry thinking about it. Scary. Very scary. That was one way I never wanted to die. I was drowning and I couldn't do anything to help anybody. The variability in response to these kinds of events is very vast," said Holman. They say acute stress disorder is the most common negative mental health  response after hurricanes. Think of it as early PTSD where it is hard for someone to function. 

"You might experience being startled, anxiety, nightmares, re-experiencing, feeling like the events happening again. You could experience it with dissociation symptoms, so feeling like you're out of your body and so forth," said Garfin.

That can eventually lead to long-term anxiety or depression, PTSD or even suicide in some cases. A 2020 study found overall suicide rates increased by 23% in the months after natural disasters. Hurricane news consumption contributes to mental health damage, too. 

"People who were at the event, who knew people at the event, and to people who were only exposed via the media. And we have found that all of those types of exposures are associated with increased mental health problems over time," said Garfin. 

Someone with a mental health diagnosis or a person who's lived through a hurricane is more at risk for negative mental health impacts. Secondary trauma, which is suffering after witnessing others' distress is also common in first responders, health care providers and journalists. 

For those on the ground now: experts say they should be letting stressed survivors process that in time, but have compassion and help should someone need it in the moment.  

"We don't want it to broadly force people to be reliving a traumatic event when they're still in that early phase and they may recover or heal over time. You know, at the same time, we want to have resources available to people," said Garfin. "It's really important that people have mental health first aid available to them. Especially if it's done in a really compassionate way. It's going to help bring people back from the edge of having too many symptoms, mental health symptoms." 

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