Video gaming for mental health
by Jennifer Ball
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Exploring the benefits of video game therapy for mental well-being
Thirty-four-year-old Charon Gladfelter, an academic administrator at a university, has played video games for most of her life. “I remember getting a Nintendo 64 for Christmas in the ‘90s,” Gladfelter says. Gladfelter, who has siblings that are much older than her, often felt like an only child. “It was a nice pastime for me and a really cool way to connect with my parents,” she says.
At a certain point, Gladfelter stopped playing video games. Recently, she received a Nintendo Switch as a Christmas gift, and it reignited her love for gameplay. “It brings me a lot of joy to be able to just escape for a little while and, in a healthy way, not have to constantly be thinking about other things that are bringing me stress or anxiety.”
In fact, heaps of recent research exist regarding how video games can improve anything from anxiety to treatment-resistant depression. More than ever, people have started joining the video game therapy trend in hopes that it’s a more approachable, community-based way to support mental health issues.
According to the World Health Organization, one in every eight people in the world live with a mental health disorder, including anxiety, depression, post-traumatic stress disorder (PTSD), and more. Those who are exposed to adversity such as poverty and violence may be at greater risk of developing these mental health challenges. This is in addition to a significant gap in providing covered mental health care to those who need it— for example, only one-third of those with depression receive formal mental health care. Video game therapy can be a viable way to close the gap for people who either do not want to seek formal therapy or for those who would like to supplement their formal mental health care.
How therapists use video games in practice
Monet Goldman, a licensed marriage and family therapist from San Francisco and founder of Video Game Counseling, says that video game therapy is just a modern version of play therapy, which has been around for decades.
He works with all ages of clients and, for kids, he says he plays popular games, such as Minecraft, Fortnite, and Roblox. For the younger crowd, he can work on self-esteem when the kids teach him things about the game. They can also practice life skills like turn-taking and making new friends.
“It's really accessible, it’s really engaging, and I think you can get a lot of authenticity out of it,” Goldman says. When a child has an angry outburst from a video game in session, it is more beneficial to deal with it as it’s happening, rather than talking about it retrospectively while the child is calm. He says that video games can also strengthen bonds between couples and parents and children.
Aimee Daramus, PsyD, a licensed clinical psychologist in Chicago, uses video games out of session for an enhanced therapy experience in adults. She cited a study about Tetris and PTSD, where intrusive thoughts disappeared or became easier. In the same way, she says it can help patients with obsessive-compulsive disorder (OCD). “If the mind is busy with the game, it’s not as busy with intrusive thoughts,” Daramus explains.
Daramus also uses several games for patients with depression — Depression Quest, Night in the Woods, and GRIS (for grief). Senua’s Sacrifice, a warrior quest game where the character has hallucinations, gives people with schizophrenia the opportunity to decipher what is real and what is a hallucination.
One of the other benefits of gaming, Daramus says, is that video games can provide a social outlet. For people with social anxiety, it can help patients socialize who would otherwise feel nervous in person.
Although video games have shown that they carry potential benefits for people with a variety of mental health issues, they sometimes get a bad reputation for inciting violence or causing gaming addiction. Daramus says that unless someone already has violent tendencies in real life, playing video games will not incite violence. She also acknowledges that gaming addiction is real, an impulse control disorder, but often it represents an underlying problem, like escaping from depression, anxiety, or a difficult home life.
Tim Alexander
Science-backed video games
Anxiety and depression
The following games were included in a systematic review of the effects of casual gaming on anxiety, stress, and low mood:
Bejeweled 2, Peggle, and Bookworm Adventures. Gameplay was shown to decrease anxiety. After one month, gameplay reduced symptoms of clinical depression in patients. Research also showed that Bejeweled 2 “decreased left alpha brain waves associated with a decrease in… depressive-type behaviors” and improved mood; Peggle “increased right alpha brain wave activity associated with excitement or euphoric behaviors;” and Bookworm Adventures “increased the stability of alpha brain waves between the left and right sides of the brain.”
Personal Zen. Research found that a single session of gameplay “improved performance on an anxiety-related stress task” in female participants. Lab results showed lower levels of cortisol among pregnant people who played the game versus the placebo group. In undergraduates with high anxiety, the game was associated with reduced anxiety and stress reactivity.
Plants vs Zombies. Prescribed gameplay for one month of Plants vs Zombies significantly decreased anxiety compared to a medication-only group. The game was also found to significantly improve depressive symptoms in those with treatment-resistant depression compared with pharmaceutical treatment.
Pediatric ADHD
In one randomized clinical trial (RCT) by Akili Interactive, children were divided into two groups: one played a video game and the other did not. The average change in scores of focus in children who played the video game was approximately 30 times as high as the children in the control group, who saw little change, if any at all.
In 2020, the US Food and Drug Administration (FDA) permitted the marketing of the first video game therapy for children with ADHD called endeavorRx (developed by Akili Interactive), which works by activating specific neural pathways.
Pediatric emotion regulation
Mightier, a group of video games for emotion regulation, was found to reduce outbursts by 62 percent and oppositional behavior by 40 percent in kids. Mightier also lowered parent stress by 19 percent and 87 percent of families reported positive behavior changes within 90 days.
Mightier uses biofeedback (a heart rate monitor), and when the player’s heart rate is high, indicating anger, they start to do worse at the game. For example, in a shooting game, they’ll start shooting blanks. In a racing game, it will be hard to steer.
The improvements in children’s emotion regulation have been validated by an RCT, a high standard of evidence, which was replicated by a separate group of researchers that found similar results. In the double-masked study, half the kids wore a functioning heart rate monitor, and half the kids wore a heart rate monitor that was turned off. They used validated surveys to measure the improvements in children and family life.
“If you think about video games as a playground, they are just really powerful,” says Jason Kahn, PhD, chief science officer of Mightier, instructor at Harvard Medical School, and research associate at Boston Children’s Hospital, who led the study. “We have built so much evidence that kids learn through exploration, and video games build an environment where kids can play with certain ideas in a safe way.”
PTSD in veterans
In November 2023, a game called With Them: Frontlines will launch. It is “a first-person shooter that tells the stories of real veterans and real combat missions, aimed at helping veterans overcome and find solutions for PTSD.” The game is being developed by ORE.
Lucas Hamrick, co-founder and CEO of ORE, is a 22-year military retiree and former Army Green Beret. ORE developers are working with psychologists to “gain therapeutics similar to EMDR where there's a rhythmic combination of lights and muscle movements or some potential overlays of frequencies that reduce tinnitus or ease anxiety and depression, Hamrick says.”
Hamrick notes that developers are also working with wearable biofeedback technology (like Fitbit) to learn what works and what triggers stress responses in the game. He hopes that With Them: Frontlines “[makes] it easier for check-ins and accountability amongst a community versus the rigidity that comes with seeing mental health clinicians or therapists.” When I asked him why a veteran might want to play a combat game rather than a game for beauty and calm, he responded, “It’s being comfortable with the chaos… ”
Mining for more game ideas
Beauty, calm, and fun
Stardew Valley. The game plot involves inheriting your grandfather's old farm plot in Stardew Valley. Each day lasts only a few minutes. You can tend to your own farm plot and plants.
Proteus. Another beauty and calm game without prescribed goals where the world’s plants and animal life release musical signals.
Katamari. A game where you can build a large ball of objects by rolling your Katamari through town.
Our very first story shared one writer’s experience using the game for these benefits.
Moving and emotional games
Bound. The main actor is a princess who dances ballet in a surrealist setting. The game “delve[s] into very personal emotions and memories. These are not necessarily good memories and deal with a broken family and broken childhood.”
Papo & Yo. This game deals with a child escaping from a parent with alcohol use disorder; it can be an emotional release for children experiencing something similar at home.
Journey. Like Bound, this game has been praised for its visual and auditory art and has been considered moving and emotional.
Horizon. Beautiful visuals and a gripping storyline detailing a man-vs-machine dystopian future make the game engaging.
For couples or teams
Lovers in a Dangerous Spacetime. A space shooter video game that “can be stressful and hectic, but it’s all about co-op with very bright happy visuals.”
Unravel. Two yarn characters work together to overcome obstacles.
How this works in real life
More and more people are taking up video games and having positive experiences. Amanda Vesely, a law clerk from Joliet, IL, started playing video games in her free time seven years ago. “It’s been a stress relief for sure,” she said. In addition to relieving stress, Vesely said gaming can provide camaraderie and a sense of belonging. She also appreciates the storylines: “It's just nice to get out of self and get involved in a different world for a period of time.”
Gladfelter’s favorite games are the Mario games and Zelda: Breath of the Wild. She’s even played a game called Battletoads with her kids, who were adorably excited to bond with her over “beating the next boss.” She finds people are surprised when she gushes about video games. “There's a specific type of person that people think of when they play video games, but I guess I don't fit that.”
It’s time to forget the stereotype of the loner gamer holed up in a basement. Gaming can help people of all ages and all walks of life. It truly is a playground for everyone.