Introduction
In the UK, it is said that up to 88% of children aged 5 to 15 play video games at home, each playing an average of 8.7 hours a week (Ofcom, 2013). A significant amount of attention has been given to the gaming habits of children and youth both in the media and in academic research. In the last few years, video games have caused moral panics, with the popular press regularly publishing warnings against gaming, deeming it a dangerously addictive activity which turns children into violent (Ferguson, 2007) and socially incompetent (Durkin and Barber, 2002) individuals. Similarly, research within the field of psychology has predominantly focused on the negative effects of gaming such as increases in aggression, social isolation (Grüsser et al, 2007) and depression (Ferguson, 2007). It can be argued that this predominantly negative stance is fuelled by a small number of freak events such as mass killings associated with youth who play violent video games. Examples include the Columbine High School massacre in 1999 (Ferguson, 2007), and the case of Tyrone Spellman who killed his infant daughter after she tugged the wires of his Xbox, causing it to stop (The Times, 2008). Clearly, from these examples it can be argued that video games do not promote sound mental health. But while these heinous incidents are attributed to video game playing, the link is correlational. Casual relationships are difficult to identify in such circumstances and it must be considered that there are a wide range of factors at play (Ferguson, 2010). Media depictions often fail to offer accurate and representative arguments and it should not be forgotten that such crimes took place before the dawn of video games. Despite these concerns, recent research has shown that moderate amounts of video game play may in fact be promoting good mental health and wellbeing in young people. Approximately one in four people in the UK suffer from mental health conditions every year (McManus et al, 2009). Notably, for many, these conditions will start during their teenage years. Research has found that 50% cases of mental health disorders start before the age of 14, and 75% before the age of 24 (Kessler et al, 2005). Because video gaming is so common to this demographic, it important to take a balanced look at the influence it has on mental health and wellbeing.
Video game '"addiction"
Video games are commonly accused of being addictive. Ryan and Deci’s (1985) motivational model, Self Determination Theory (SDT), can be applied to video games to help us to understand their magnetism. The Player Experience of Need Satisfaction (PENS) model, a sub-theory of SDT, states that gamers try to find opportunities within the gaming world which reflect their basic psychological needs in the real world. These needs are feelings of competence, relatedness and autonomy (Przybylski et al, 2010). The competence people experience from playing video games comes from the feeling of mastery: the growth and learning felt as the game progresses. The feeling of autonomy occurs when games allow users to feel in control. The games which do this most successfully provide gamers with multiple routes to an end so that gamers can experience power and influence. Finally, relatedness refers to the feeling that you are appreciated and needed by others and that you play a key part in a wider network of users (Przybylski et al, 2010). According to Self Determination Theorists, the most emotionally and cognitively engaging, and potentially addictive, video games are those that are able to offer satisfaction of all three of these intrinsic psychological nourishments (Rapp, 2015).
The addictive nature of video games can lead to excessive amounts of play, as well as play at antisocial hours, both of which can be detrimental to mental health. There is debate as to whether avid video gamers can be referred to as addicts, a label which gives connotations of psychiatric disorder, or whether they are simply “engaged players” (Kirby, Jones, & Copello, 2014). One study looking at the internet role-playing game World of Warcraft (WoW) found that late night habitual computer game playing between 10 pm and 6 am was related to an increased risk of high depression scores independent of the total amount of playing (Lemola et al, 2011). Researchers of this study argued that this may be due to disturbances of the individual circadian rhythm with the exogenous day-night cycle (Lemola et al, 2011). This research mirrors similar research which has shown that delayed sleep phase is linked with depression and lower estimates of quality of life (Gangwisch et al., 2010; Okawa and Uchiyama, 2007). These studies have suggested that this can be partially rectified by entrainment of the individual circadian rhythm with the exogenous day-light cycle by taking melatonin orally (Rahman et al., 2010) and/or by exposure to bright light (Okawa and Uchiyama, 2007). Further research carried out in the UK by NatCen (2008) also found a link between the number of hours played and the effects on mental health and wellbeing. The study found that moderate amounts of game playing (which they categorised as being between one and three hours a day) was associated with greater wellbeing than for game playing of above four hours or no game playing at all. Young people who play games on their computer were found to have greater belief in their intelligence, and lower incidence of substance use than those who played no games at all (Durkin and Barber, 2002). There are a number of other studies which also find that addictive play is associated with a wide range of adverse outcomes such as loneliness, depression and low self-esteem (e.g. Liu & Peng, 2009; Stetina et al., 2011). In this way it can be argued that the positive effects that video games have on mental health and wellbeing are effectively reversed when children spend too long playing them (showing signs of an addition), and/or if they play them late at night.
However, the addictive nature of video games, and our knowledge of Ryan and Deci’s work, can be harnessed and used to support those suffering from mental health issues. Because video gaming is already familiar, enjoyable and easily accessible to young people, some game designers have looked into and developed games which can help to combat mental health issues. Such games mostly appear outside of the horror genre, and focus on more common diagnoses. These include titles such as Depression Quest, Elude, and Actual Sunlight, which tell very personal stories on a much smaller scale than most games. They are said to handle the topics of depression and anxiety well and encourage their audience to empathise with the characters by putting them in their shoes (Garwood, 2015). With a focus on empathy rather than violence, these games give gamers a greater understanding of mental illness, how it’s diagnosed, and how it can be treated. This can help those with similar conditions to feel less alone and more likely to reach out, and also can help other players to become more aware of disorders (Garwood, 2015). Despite this, It could be argued that some young people may be embarrassed or disinterested in purchasing a game named “Depression Quest”, for example, and therefore the beneficial effects of such games may not be able overly accessible. However, it can be argued that more popular, mainstream games also potentially play a role in helping people to experience enhanced empathy and understanding, and thus promote wellbeing and a decrease in mental health ailments. One more subtle game that touches upon the feeling of depression is Unravel, which centres on a protagonist named Yarny. Yarny is a very small creature made of red yarn. Players become Yarny and explore the world through his eyes, battling against an unravelling body as you try to progress. Games like Unravel let gamers to see the world from someone else’s perspective and enhance levels of empathy, while simultaneously promoting development of Theory of Mind (ToM). ToM refers to a person’s ability to see the world from another’s perspective (Astington, 1993). Researchers have found that those with mental health conditions, such as depression and schizophrenia (Bora et al, 2009), have lower than average levels of ToM. In this way it can be said that role-playing games such as Unravel can combat some symptoms of mental conditions.
Video games and emotional wellbeing
More generally, studies have shown that a wide range of games play a role in promoting happiness and wellbeing. Research (e.g. Cole et al, 2012) using brain scans has shown that, when people play video games, the most active parts of the brain are the rewards pathway system, which is associated with motivation and goal orientation, and the hippocampus, which is associated with learning and memory. It has been found that these areas are the mains parts of the brain that do not activate in people who suffer from depression (Cole et al, 2012). According to gaming advocate McGonigal (in Berenson, 2015), when we play video games we have a “real sense of optimism in our abilities and our opportunities to get better and succeed, and more physical and mental energy to engage with difficult problems”. In addition, a number of positive emotions are said to be experienced during gameplay. For example, fiero, which is an Italian word referring to “intense pride after succeeding against great adversity” is an emotion often reported by gamers (Granic et al, 2014). A second emotional experience, known as flow or transportation, is said to make players feel as though they are “immersed in an intrinsically rewarding activity that elicits a high sense of control while simultaneously evoking a loss of self-consciousness” (Sherry, 2004). Significantly, experiences of flow or transportation have been linked to a number of positive outcomes for children and young people such as higher self-esteem and decreased anxiety (Csikszentmihalyi, Rathunde, & Whalen, 1993). Furthermore, puzzle games such as Angry Birds have been shown to improve players’ moods, facilitate relaxation, and ward off anxiety (Russoniello et al., 2009). Children often turn to games when issues arise at home or at school so that they can ‘let off steam’. Initial feelings of anger, guilt or frustration can be dissipated healthily as a result of playing games, which in turn results in players feeling a lot happier (Colwell, 2007). In this way it can be seen that a diverse range of games can be therapeutic and lead to an increase in wellbeing, including violent ones (McGonigal, 2011).
Representation and stereotyping
Unfortunately mental illness is often misrepresented in the media. Video games are particularly guilty of this, leaning on lazy stereotypes which in turn serve to reinforce the existing stigma and shame surrounding mental health issues (Garwood, 2015). Many game creators rely on villains who are insane, or “crazy”. It has been argued that this is a cop-out used to easily explain their villainous characters’ motivations for evil. It is inaccurate to equate mental illness with violence and it is damaging to those with conditions. It has been pointed out by James Harris (2015, in Garwood, 2015) who is the head of communications at the Mental Health Foundation, “In gaming, the backdrop of an abandoned asylum or casting a psychiatric patient as the principal villain is a common theme. Whilst acknowledging that the creator’s intention is not to increase stigma but rather to entertain, by default they are helping to perpetuate the stereotype that there is a correlation between people living with mental health problems and violent behaviour. The reality is, however, that people with mental health problems are more likely to be victims of violence.” This is significant because it has been found that young people find it hard to open up about mental health. One study has shown that 26% of 9-16 year olds and 67% of 17-25 year olds felt that it was easier to tell someone that they did not feel well physically rather than reporting feelings of distress or mental illness (YoungMinds, 2011). These findings have been supported by the mental health charity Mind (2014, in Garwood, 2015) who stated that “many people who experience mental health problems don’t seek help.” Mind argues that “this is often because they fear being stigmatised, or locked up if they talk about violent thoughts or urges.” Considering that one in four people in the UK suffer from mental health issues every year, it’s important that game creators show respect and care to those suffering from mental health conditions, instead of contributing further to discrimination and dangerous typecasting.
Biofeedback
Studies have shown that the ability to regulate emotions is a requirement of maintaining good mental health and wellbeing (e.g. Gross & Muñoz, 1995). Recently, research looking at both video games and wellbeing has been looking at a technology known as biofeedback (Stoll & Collett, 2013). Biofeedback has been used in games and monitors bodily activity such as heart rate and skin temperature (BCIA, 2012). It has traditionally been used to try to improve users’ health and physical performance. The information is sometimes then used to help to form interventions (Stoll & Collett, 2013). Biofeedback has also been used in wellbeing interventions which aim to help individuals suffering with issues such as stress (Lemaire, 2011), anxiety (Henriques, 2011) and depression (Karavidas, 2008). Some developers look at biofeedback as another way to lure people to play their games, whereas others are beginning to look beyond just the entertainment value of biofeedback and wish to help people to regulate their emotions. Studies have revealed that heart rate variance (HRV), defined as “variation in the inter-beat intervals of our heart”, is a psychophysiological marker of mental and physical wellbeing (Kemp and Quintana, 2013). It is said that low levels of HRV indicate an increased likelihood of presence of a mental health condition such as anxiety disorder (Kemp and Quintana, 2013). There are some games already on the market that have incorporated the biofeedback technology. One such game is Wild Divine whereby players can attach a sensor, which measures both HRV and skin conductivity, to three fingers. This allows players to monitor their bodily activity on screen. In turn, the game encourages players to direct in-game play by making alterations using the biofeedback, for example, by relaxing and keeping calm to move a feather. Another game called Nevermind, which is actually in the horror genre, has integrated HRV biofeedback into its plot. Through the biofeedback sensors, the game can detect when the player is scared and when their levels of arousal are too high, the game becomes more difficult. While this game is popular among children and young people, one issue with it is that it does not offer players with any advice or techniques on how to improve their HRV. Instead, players are left to figure out ways of calming down in stressful scenarios for themselves. One game which is directly aimed at those interested in wellbeing and does offer tips is Zen Journey. This game features a coach who teachers meditation and relaxation techniques (Stoll & Collett, 2013). New innovations are being developed all of the time which can be used to help combat mental health issues and improve wellbeing.
Video games and friendships
Contrary to the popular belief that gamers are isolated ‘nerds’, many studies have found that a significant amount of time spent gaming is spent with friends or family members (Cuppitt & Stockbridge, 1996, in Durkin and Barber, 2002; Phillips et al., 1995). Video games are said to facilitate friendships both in-game and in the real world. Studies have found this to be particularly true in the case of those who play Massively Multiplayer Online Role Playing Games (MMORPGs) such as World of Warcraft (WoW) (Cole & Griffiths 2007; Yee 2006). In fact, one study showed that gamers who were younger than 18 reported that the friendships they formed through gaming online were as good as, if not better than, their friendships in the real world (Yee, 2006). MMORPGs and other games which allow users to connect with players via the internet allow players to interact with people they have not met before. It has been found that positive interactions with those you do not know enhance social trust and make you feel safer and more satisfied in the world you live in, which ultimately increases happiness and wellbeing (Bjørnskov, 2008; Layard, 2005). WoW players have said that friendships made online have extended into real life relationships (Williams et al, 2006). A study conducted by Cole and Griffiths (2007) found that 76.2% of their male participants and 74.7 of their female participants had made strong friendships through online gaming which further supports the power of MMORPGs in facilitating social interaction. Many studies have highlighted the positive benefits of strong friendships on the wellbeing of children, teenagers and adults. For example, Layard (2005) found social relations to be one of the most important determinants of wellbeing, behind personality and genetic factors. While video games can help people to make new relationships, they can also strengthen existing ones (e.g. Durkin & Barber, 2002) People who have strong and supportive friendships have been found to be able to manage various types of stress, including job loss and illness, better (Halpern, 2005; Myers 2000). Video games play a role in facilitating friendships and strengthening relationships which, in turn, supports good mental health and wellbeing.
Conclusion
Many studies support the idea that video games are a powerful tool to help children and young people to manage their mental health disorders and promote wellbeing. Video games can be seen as a way of letting off steam, and as a way of facilitating new friendships and strengthening existing ones. Strong friendships play an important part in helping us to maintain good mental health. Playing video games is associated with a number of other positive emotions such as fiero and flow which help to promote wellbeing. Role playing games have been found to help people to strengthen their ToM. This is important because low levels of ToM are associated with mental health issues. Video games are highly appealing to children, particularly those which offer high levels of competence, autonomy and relatedness, in line with SDT. Because of this, video games provide game developers, and those working to improve children’s mental health, with the perfect platform by which interventions and technologies to improve the head space of children can be administered. Equally, while the magnetic appeal of video games can be utilised in a positive way, it is often abused by sloppy game developers who cannot look beyond profits. They often neglect to consider the impact they are having when they add to existing stereotyping and stigma surrounding mental health disorders. Furthermore, it has been found that too much game play can lead to adverse effects, as can playing in the early hours of the morning. While there will still continue to be warnings in the news when someone who plays video games decides to go on a murderous rampage, the true mechanisms behind these behaviours still remain an enigma. So, on the whole, a wide spectrum of video games -including violent ones - can promote good mental health and wellbeing of users when played in moderation. Yet, unfortunately a minority of these games simultaneously perpetuate a harmful stereotype which may deter sufferers from seeking help and may contribute to victimisation. Video games should not be considered as a replacement for exercise and play in the real world which are essential for maintaining good wellbeing, mental health and also physical health.