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Therapeutic Uses of Videogames in Mental Health: An Expanded Literature Review


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The notion that video games extend beyond mere entertainment and possess the capacity to serve as potent tools for mental health treatment and therapy has garnered increasing attention from researchers and clinicians alike. This report expands upon a foundational review of this topic, incorporating recent studies and evidence-based information to provide a comprehensive understanding of the therapeutic potential of video games. The aim is to offer an accessible yet scientifically relevant resource for both the general public and mental health scholars interested in this evolving field.


Unlocking the Therapeutic Potential: Advantages of Video Games

Video games present several unique advantages that position them as promising tools for therapeutic interventions. Their design inherently fosters engagement, captivating a patient's attention in a way that can be particularly beneficial for individuals who find traditional talk therapy challenging. This high level of engagement can improve adherence to therapeutic exercises and increase the likelihood of positive outcomes.


Many games create immersive environments, allowing individuals to experience various scenarios within a safe and controlled virtual space. This feature is particularly valuable for therapeutic techniques such as exposure therapy, where patients can gradually confront their fears, or for practicing social skills in a low-stakes setting. The sense of presence within a virtual environment can elicit physiological and emotional responses akin to real-world scenarios.1


The interactivity inherent in video games requires active participation from the player, which can empower individuals and instill a sense of control. This can be especially beneficial for those grappling with feelings of helplessness or anxiety. The immediate feedback provided within games can also reinforce positive behaviors and track progress objectively.3


Furthermore, video games boast broad accessibility, with many individuals already enjoying them as a leisure activity [initial article]. This widespread familiarity can reduce the stigma often associated with seeking mental health treatment and make therapy a more appealing and approachable option. The increasing availability of games across various platforms, including consoles, PCs, smartphones, and VR headsets, further enhances their accessibility.4


A Spectrum of Applications: Therapeutic Uses of Gaming in Mental Health

The potential of video games extends across a wide range of mental health conditions, with research exploring their applications for anxiety, depression, PTSD, ADHD, autism, schizophrenia, and addiction.


For anxiety disorders, both casual video games and exergames have demonstrated the ability to reduce stress and anxiety levels.4 These include simple puzzle games like Tetris and Angry Birds, as well as physically engaging games such as those available on the Nintendo Wii Fit.4 Online interventions have also shown promising results in alleviating anxiety symptoms, with meta-analyses indicating a significant medium overall effect.6 Virtual Reality Therapy (VRT) has emerged as a particularly effective approach, significantly improving anxiety symptoms in patients compared to conventional treatments.7 Action video games and augmented reality games like Left 4 Dead and Pokémon Go have also shown efficacy in stress and anxiety reduction.4 The diverse range of game genres and platforms suggests that various options can cater to individual preferences and therapeutic needs.


In the realm of depression, casual video games can decrease negative affect by promoting enjoyment and inducing a state of flow.4 Examples of such games include Candy Crush and Angry Birds.5 Online interventions have also demonstrated a large significant effect in reducing depression symptoms.6 Furthermore, gaming interventions have shown preliminary evidence as an effective treatment for depression in youth.8 Therapeutic games specifically designed to focus on rational emotional behavior have also shown significant improvements in depression. While these findings are encouraging, further research is needed to identify the most effective types of games and interventions for specific demographics and varying levels of depression severity.


The therapeutic potential of video games is particularly notable in the treatment of PTSD. Virtual Reality Exposure Therapy (VRET) is increasingly recognized as a transformative tool, offering a "lifeline" for veterans and others who have experienced trauma.10 The New Orleans VA, for instance, utilizes VR to treat PTSD by creating safe environments where patients can confront their traumatic experiences.10 VR therapy is helpful in healing from past traumas and PTSD by allowing clients to gradually face distressing memories in a controlled and guided manner.11 Research suggests that VRET may be as effective as active comparators in reducing PTSD symptoms.12 The controlled nature of VR allows therapists to customize the intensity and pacing of exposure, facilitating a gradual and manageable confrontation of triggers.11


For individuals with ADHD, everyday casual video games show potential as therapeutic tools.13 Research by Eckardt (2024) highlights the possibility of embedding brief mental health messages and exercises within these games.13 Structured games can improve focus and attention, aiding in the management of ADHD symptoms.14 A review of game-based therapeutic interventions suggests their general effectiveness in boosting cognitive function and reducing ADHD symptoms.15 Specially designed video games may also benefit the mental health of children and teenagers with ADHD.16 Notably, the FDA has approved EndeavorRx, an action video game, as a digital medicine treatment for pediatric patients with ADHD, signifying a growing acceptance of video games as a legitimate therapeutic modality.3


In addressing autism, casual video games have shown potential benefits.13 Social video games can contribute to improved social behavior.17 Virtual Reality offers a platform for individuals with autism to learn and practice skills in simulated real-world environments.2 Video games can also provide structured environments that reduce social pressure, which can be particularly beneficial for individuals with ASD, especially games that focus on social skills and communication.14


For individuals with schizophrenia, casual video games may offer therapeutic potential.13 VR can provide opportunities to learn and practice skills in safe, virtual environments.2 Research indicates that video games can boost cognitive function and improve mental health in patients with schizophrenia by enhancing attention and brain connectivity.18


The therapeutic potential of video games also extends to addiction treatment. The Video Game Therapy® (VGT®) approach has shown promise in treating various forms of addiction.19 Research has demonstrated that video games can be utilized as a therapeutic tool for addiction.3 Furthermore, VR applications and Virtual Reality Exposure Therapy (VRET) have shown effectiveness in treating substance abuse and other addiction disorders.21 The area of gaming disorder itself is also under active research, with interventions like group counseling and cognitive behavioral therapy showing significant effects.22


Diverse Approaches to Harnessing Gaming Power

The integration of video games into mental health therapy occurs through various approaches. Video Game Therapy® (VGT®), introduced by Bocci et al. (2023), centers the gaming experience within the therapeutic process.3 This method involves tailoring the game to the individual's personality, therapy goals, and the specific type of video game used, often utilizing the Myers-Briggs Type Indicator (MBTI) to facilitate this matching process.3 VGT® aims to create optimal conditions for traditional therapeutic techniques to be more effective.19


Another classification distinguishes between Electronic Games for Therapeutic Purposes (EGP), which are games specifically designed for therapy, and Electronic Games as Adjuncts to Psychotherapy (EGE), where commercial games are used alongside traditional therapy.24 Research suggests that both EGPs and EGEs can be as effective as traditional treatments and may be more enjoyable for patients, leading to better participation and outcomes.24


Furthermore, there is a growing interest in the potential of commercial off-the-shelf (COTS) video games for therapeutic use.4 These games, designed primarily for entertainment, offer engaging and realistic interactive environments and often include built-in social support networks through multiplayer features.25 Researchers are exploring ways to adapt these popular games for therapeutic interventions, leveraging their widespread accessibility and motivational qualities.25


Beyond Clinical Settings: The Wider Benefits of Gaming

The positive impact of video games on mental well-being extends beyond formal therapeutic interventions. Many individuals utilize video games as a means of stress relief. The immersive nature of games can provide a temporary escape from daily worries and stressors.4 Open-world games, characterized by their expansive environments and player autonomy, have been found to significantly improve relaxation and mental well-being.35 Playing video games can also induce a "flow state," a feeling of deep immersion and focus that can shut off stress and worries.37


Video games can also offer significant cognitive benefits, improving skills such as problem-solving, strategic thinking, and reaction time.5 Studies have shown that frequent video gaming can boost cognitive abilities, with gamers performing cognitively like people many years younger.70


Online multiplayer games provide opportunities for social connection and community, which can be especially important for individuals who struggle with social isolation.34 These online interactions can foster a sense of camaraderie and belonging, potentially mitigating feelings of loneliness.34


Furthermore, some games allow players to explore complex emotions and narratives, which can be a way to engage in emotional processing.


The Immersive World of Virtual Reality in Mental Health

Virtual Reality (VR) therapy represents a cutting-edge approach in mental healthcare, offering immersive experiences that can transform how individuals engage with therapy.90 VR creates compelling and immersive experiences for clients, often feeling very real due to specialized headsets. This technology allows therapists to monitor and control the virtual environment, even remotely, enabling personalized and gradual exposure to anxiety-provoking situations. VR therapy facilitates repeatable and quick exposure, which is highly beneficial for techniques like exposure therapy. The virtual environment provides a safe and controlled space for clients to confront their fears without real-world risks. VR is frequently used as part of Cognitive Behavioral Therapy (CBT), particularly for the exposure component, where clients practice facing anxiety triggers while applying new coping mechanisms. VR can be utilized during various parts of therapy, including diagnosis, skills training, reward, relaxation, exposure, and relapse prevention.91 Often referred to as "fear therapy," VR is especially effective for conditions like phobias, PTSD, and social anxiety, but is also being applied to mindfulness, stress management, and even pain reduction.11 By engaging multiple senses, VR stimulates the brain in ways that closely mirror real-world experiences, facilitating cognitive restructuring, emotional regulation, behavioral activation, and neuroplasticity.90


Specific VR platforms and games are being used for therapeutic purposes. For instance, "Virtual Iraq" has been developed for treating PTSD in veterans, allowing them to safely confront combat-related trauma.10 Various VR applications focus on relaxation and meditation, such as Hoame Meditation Studio, TRIPP, and Nature Treks VR.93 Platforms like oVRcome and PsyTech VR offer comprehensive solutions for VR exposure therapy, particularly for anxiety and phobias.96


Decoding the Brain: Neurobiological Mechanisms at Play

Playing video games triggers a cascade of neurobiological responses in the brain. Notably, gaming can activate brain regions associated with reward, such as the striatum, through the release of dopamine, a neurotransmitter linked to pleasure and motivation.98 This reward mechanism reinforces gaming behaviors and contributes to their engaging nature. Conversely, excessive gaming can lead to reduced activity in brain regions responsible for impulse control and decision-making, such as the prefrontal cortex (PFC).82


Different genres of video games can elicit distinct neurobiological effects. Action video games have been shown to enhance attention and spatial cognition 17, potentially leading to increased efficiency in brain regions associated with these skills.17 While gaming can offer cognitive benefits, excessive engagement and the rewarding nature of games can also lead to dopamine dependence and serotonergic aversion, particularly in competitive online multiplayer games.116 Furthermore, prolonged and excessive gaming may result in structural changes in the brain, including reductions in gray matter volume and white matter density, similar to what is observed in other addictive behaviors.99 The brain's reward system, involving dopamine and areas like the striatum, plays a crucial role in the neurological basis of gaming, highlighting the importance of understanding the balance between the pleasurable and potentially addictive aspects of video games for therapeutic applications.82


Navigating the Landscape: Potential Downsides and Ethical Considerations

While video game therapy offers significant potential benefits, it is essential to acknowledge and navigate potential downsides and ethical considerations. One primary concern is the risk of addiction and overuse. Therapists must carefully monitor gaming time, establish clear limits, and encourage a healthy balance with other activities.14 Excessive screen time associated with video games can also have adverse effects on physical and mental well-being, necessitating the incorporation of breaks and encouragement of physical activity and offline social interactions.14


The quality and content of the games used in therapy are paramount. Therapists must select age-appropriate and beneficial games, avoiding those with harmful or triggering content. Regular evaluation and feedback are necessary to ensure the maintenance of high therapeutic standards.14


Ethical considerations are integral to the responsible implementation of video game therapy. Therapists must adhere to professional guidelines, including obtaining informed consent, especially from minors, and ensuring the privacy and confidentiality of patient information.14 Researchers exploring the therapeutic uses of video games in online environments may encounter ethical challenges related to gaining access and trust within gaming communities, potential harassment, and the blurring of personal and professional boundaries.121 Highlighting potentially harmful behaviors observed in gaming communities also presents an ethical dilemma, as it risks reinforcing negative stereotypes about gamers.121 The field requires ongoing ethical reflection to address concerns related to data privacy, potential exclusion of certain groups, and the regulatory landscape surrounding digital gaming interventions.122 It is crucial to distinguish between healthy engagement with video games and problematic gaming behaviors that may require intervention.103


Video Game Therapy in Action: Current Use and Adoption

The adoption of digital mental health interventions, including video game therapy, is steadily growing, although it faces certain barriers. In pediatric rehabilitation, Virtual Reality and Active Video Games (VR/AVGs) are being utilized to target physical, cognitive, and psychosocial goals.133 The Video Game Therapy® (VGT®) approach is currently being used in various associations in Italy, focusing on areas like social isolation, emotional regulation, and cognitive skills. Video games are also finding their place in clinical care for youth in mental health settings.134 However, the adoption rate of new digital mental health tools within NHS Child and Adolescent Mental Health Services (CAMHS) in England has been reported as low, with a significant percentage of services not having adopted any new tools since the onset of COVID-19.135 This slow adoption is attributed to factors such as limited knowledge of available interventions, cost, and a perceived lack of clinical evidence.135 Despite these challenges, there is a growing interest in leveraging digital innovations, including therapeutic gaming, to meet the increasing demand for mental health support and address issues of accessibility and stigma.136


In the UK, the NHS National Centre for Gaming Disorders provides treatment for individuals struggling with excessive video game use.137 While specific adoption rates for video game therapy for general mental health conditions within NHS Birmingham are not explicitly available, services like Birmingham Healthy Minds offer NHS talking therapies that could potentially incorporate digital tools.140 Compass Birmingham MHST supports mental health and wellbeing in educational settings across Birmingham and may utilize digital resources.141 Forward Thinking Birmingham provides mental health services for individuals aged 0-25, indicating a local infrastructure that could potentially integrate video game-based interventions.142 Birmingham Children's Hospital utilizes VR technology, which can include therapeutic games, to enhance patient experiences and outcomes.143


Training the Professionals: Education and Skill Development

The effective and ethical use of video games in mental health therapy necessitates specialized training for professionals. Compass Birmingham MHST offers training programs related to mental health and wellbeing within educational settings.141 The University of Birmingham has hosted events exploring the intersection of gaming, wellbeing, and escapism, indicating an academic interest in the field.144 Organizations like Geek Therapeutics provide certification programs focused on integrating "geek culture," including video games, into therapeutic practice.145 Game to Grow offers training specifically on the therapeutic applications of role-playing games.149 Newman University in Birmingham offers programs in counselling and psychotherapy, which could provide a foundation for incorporating game-based approaches.151 The University of Birmingham also offers a Postgraduate Diploma in Cognitive Behaviour Therapy, equipping professionals with skills that can be adapted for digital interventions.152 These emerging training opportunities reflect a growing recognition of the potential of video games in therapy and the need for qualified professionals to implement them effectively.


Voices from the Field: Perspectives of Patients and Therapists

Qualitative research offers valuable insights into the experiences and perspectives of both patients and therapists regarding video game therapy. Patients often report positive experiences, highlighting increased engagement, reduced symptoms of anxiety and depression, and a greater sense of accomplishment during and after game-based therapy sessions.50 Therapists also observe numerous benefits, including improved rapport with clients, enhanced ability to teach coping skills, and the creation of a safe and interactive platform for emotional expression.154 Some therapists find that playing video games alongside clients, particularly adolescents, can lower defenses and facilitate more open communication.154


However, some mental health professionals express reservations about the therapeutic use of video games, viewing them primarily as recreational activities or harboring concerns about their potential for harm or addiction.159 Challenges identified by therapists include navigating ethical boundaries, particularly regarding playing games with clients outside of therapy sessions, and addressing the potential for video game addiction.158 The importance of careful game selection, ensuring age-appropriateness and alignment with therapeutic goals, is also emphasized by therapists utilizing these methods.163


The Horizon of Play: Future Research Directions and Recommendations

While current research provides a promising foundation for the therapeutic use of video games in mental health, several gaps remain that necessitate further investigation. A significant area for future research is the exploration of online video game therapy, given the increasing accessibility and potential reach of online platforms.164 There is also a need for more comprehensive research into the therapeutic potential of readily available commercial video games, as opposed to solely focusing on games specifically designed for therapy.5


Methodologically, future studies should aim for better designs, including larger sample sizes and longer follow-up periods, to establish the long-term effectiveness of video game interventions.136 Understanding the specific mechanisms of action through which video games exert their therapeutic effects is another crucial area for future research.32 More targeted studies are needed to determine the effectiveness of video game therapy for specific mental health disorders, allowing for the development of tailored interventions.169


The current body of research, while promising, is likely not yet adequate for a full-scale mass rollout of video game therapy for all mental health conditions. To move towards widespread implementation, several steps are necessary. Firstly, more rigorous research, particularly randomized controlled trials, is needed to further validate the findings and establish clear evidence-based protocols for different conditions and populations. Secondly, the field needs to develop standardized terminology and ethical guidelines to ensure responsible and effective use of video games in therapeutic settings.32 Thirdly, there needs to be increased investment in training programs for mental health professionals to equip them with the necessary skills and knowledge to integrate video game therapy into their practice. Finally, ongoing monitoring and evaluation of the effectiveness and potential downsides of video game therapy will be crucial for its successful and ethical implementation on a larger scale.


Conclusion: Integrating Play into the Future of Mental Health Care

The evidence reviewed strongly suggests that video games hold significant therapeutic potential in the realm of mental health. Their unique advantages in terms of engagement, immersion, interactivity, and accessibility make them valuable tools for a wide array of therapeutic applications, ranging from anxiety and depression to PTSD, ADHD, autism, schizophrenia, and addiction. While diverse approaches exist for harnessing the power of gaming, including specifically designed therapeutic games and the adaptation of commercial titles, the immersive capabilities of virtual reality offer particularly promising avenues for treatment, especially in areas like exposure therapy. Understanding the neurobiological mechanisms underlying the effects of gaming on the brain provides further insight into its potential benefits and risks. As the field continues to evolve, addressing potential downsides through ethical guidelines and investing in professional training will be crucial for responsible innovation. While current research shows considerable promise, further rigorous investigation is needed to fully unlock the therapeutic potential of video games and integrate them effectively into mainstream mental health care, offering a more engaging and accessible future for mental well-being.


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