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Video Games and Mental Health: Do our gaming habits deserve a red card?

NOTE: This commentary article discusses video games and mental health in respect to casual games, games which are readily available. It does not discuss serious games which use technology as an intervention to treat people with mental illnesses.


INTRODUCTION AND MY EXPERIENCES

Last year the World Health Organisation (WHO) classified gaming disorder as a mental illness and in the same year I was diagnosed with generalised anxiety disorder (GAD), social anxiety and later depression. During my cognitive behavioural therapy (CBT), I worked through my social anxieties after initially hypothesising on the cause of these horrible conditions. It seemed alien to me when symptoms of anxiety began, such as panic attacks, irrational thoughts and many of the awful associated physical symptoms such as daily headaches, nausea and my least favourite – fatigue. For that reason it was difficult to identify a root cause. While there probably isn’t a single reason why my mental health conditions started I did however, begin to question actions in my life that could have had a negative effect, such as video games.


Growing up I played a lot of games, sometimes alone and sometimes with friends. Some of my fondest memories growing up are associated with these times. Playing Gears of War with three friends or having private lobbies in Halo 3, populated entirely by people in my school year were some of my favourites. The majority of my friends growing up were made through playing video games and the same was true at University. There would be regular FIFA tournaments which brought people together and later co-op Ultimate Team with housemates in my final year. But when I saw gaming disorder had made the headlines, my anxious self took over and I began to worry.


If we look at gaming disorder it is defined as follows­ [1]:


“Priority given to gaming over other daily activities”…“resulting in impairment in personal, family, social, educational, occupational or other important areas of functionality over at least 12 months”.


If you play a lot of video games you will likely identify with some of these criteria. There are admittedly times when I have put off housework to have “one more game”, but of course we would rather be entertained than do housework, or homework or stay late at work a few evenings a week. It doesn’t necessarily indicate a gaming disorder. Moreover daily tasks such as cleaning, ringing someone to pay a bill or going shopping can often seem overwhelming to me, and I know other people with similar conditions that say the same. Under these broad criteria it seems difficult to get a definite diagnosis and it seems that clinicians also agree [2].

THE POSITIVE EFFECTS AND HOW VIDEO GAMES HELP ME

I would argue that there are many elements of video games that contribute to positive mental health which can be highlighted by examining three reasons we play games; achievement, social and immersion[3]. Games provide us with a sense of developing a skill through mastery of a game and its mechanics and provide us with a safe place to compete against other players. If somebody can play a game where they feel like an expert, it promotes feelings of empowerment and self-worth, contrary to many of the negative emotions associated with anxiety and depression.


Online games provide social interaction by playing with other people, joining communities (clans or guilds) or simply seeing real people in the online game world, which can help alleviate feelings of loneliness. Many online games have built in gestures or set phrases which can be used at the push of a button. This bypasses the need for direct conversation with strangers or with groups, something which I find difficult because of social anxiety. I personally love playing Destiny because of this reason. It’s hilarious doing a stupid gesture or doing over the top dances next to a team mate. I recently unlocked the dance from Pulp Fiction which is just ridiculous, especially during a serious mission. It’s like being in a meeting at work, getting up from your chair half way through and dancing only for a colleague to do the same. It’s such a simple thing, but it always makes me laugh. Online games also allow me to connect with my brother who lives in a different city. By playing games over Xbox Live we can laugh, joke around and act like we’re children again.


Being immersed in a game also helps me to cope with some of the negative thought associated with anxiety and depression. Switching on my Xbox and playing for a couple hours after work allows my brain to rest, recuperate and become distracted. Distraction is an important technique for coping with anxiety as shifting focus away from a racing heart beat, light headiness or blurred vision can reduce their intensity.

Doing the Pulp Fiction dance in Destiny 2 at the end of a serious mission, so ridiculous, but it always makes me laugh…

DYSFUNCTION THROUGH PATHALOGICAL GAMING

I am aware that excessive gaming has the potential to have negative side effects on mental health. It’s clear that if a person becomes dysfunctional, by avoiding relationships, occupation or school, then a problem may arise. Under these circumstances there is a risk of ‘pathological gaming’ (or compulsive gaming). Currently pathological gaming is diagnosed using the same criteria as pathological gambling. It’s thought that they both start as entertainment, but can lead to people becoming addicted due to the release of dopamine in the brain[4]. This is especially apparent in today’s gaming climate which has seen a significant increase in loot-box style gambling (using in game currency or real money to buy packs/boxes which have a random chance of giving something valuable in game).


Unfortunately the gaming industry is evolving into something that is anti-consumerism and uses gambling tactics to manipulate vulnerable people out of real world money such as children (who are below the legal gambling age) or people with addictive personalities. I have accepted loot-boxes in games as long as they are not pay-to-win and most people seemingly agree. This is evident by the Star Wars Battlefront 2 controversy last year where players united and pushed back against EA against their pay-to-win style loot box system. In my mind this is unacceptable and doesn’t have a place in any video game.


So, if gambling has some overlap with modern video games, is it actually possible to become addicted?


A study undertaken by the University of Singapore[4] in 2010, investigated this in 3,000 local primary and secondary school children over a two year period. The results showed that 9% of children were classified as pathological gamers at some point over the length of the study. Their school grades dropped and symptoms of anxiety and depression worsened. It was suggested that children who spent more time gaming and had lower social competence were at a greater risk of becoming pathological gamers.


However, there are issues of using pathological gambling as diagnosis criteria[5].Questions used during a diagnosis such as “I think about games even when I’m not playing them” or “I use video games to relax” aren’t conclusive over their pathological implications. If a person is functional in life and their relationships and don’t experience any negative impacts from their gaming habits, the label of pathological simply doesn’t stick. It may simply indicate they enjoy playing video games.

EVIDENCE AGAINST VIDEO GAMES AND WHY ITS NOT CONCLUSIVE

Other evidence shows that increased video game usage increases symptoms of attention deficit hyperactivity disorder (ADHD)[6] and anxiety [7]. But in all the studies I’ve read there seems to be no clear cause and effect analysis, making it impossible to determine which one is affecting the other, if any. I use video games partly to alleviate symptoms of anxiety and depression so naturally this is going to drive me towards playing them, rather than the other way around. Furthermore, moving to a new city or working in a large open office are at the top of my list of causes (as identified during CBT) and video games are firmly placed at the bottom. Unfortunately, as research associated with the topic is in its infancy, we are currently presented with a chicken and egg scenario with no definite conclusion.

Red Dead Redemption 2 John Marston
Being immersed in the story of Red Dead Redemption 2 last year allowed me to switch off, relax and genuinely become invested in these brilliantly written fictional characters.

On a basic level excessive gaming goes against self-help strategies which reduce the intensity of certain mental health conditions. Being active is essential for alleviating symptoms of anxiety and depression as endorphins are released following a period of intense exercise. In contrast, by playing video games for an extended period the body remains inactive, endorphins aren’t released and lethargy may set in (although the same could be said about other sedentary activities such as watching television or working in an office as examples). Playing video games late at night may also affect natural sleeping patterns. Blue light emitted by modern electronic devices blocks the production of melatonin which is an important hormone in allowing the body to sleep [8]. Mental health conditions are often exacerbated when somebody is sleep deprived making it much harder to deal with stress and function in everyday life. Sometimes when playing video games late at night I do find it hard to sleep, but other times I don’t. Whether or not this is associated with gaming or associated with my mental health is difficult to say.

FINAL THOUGHTS

From previous studies and my own experiences there is evidence for and against video games affecting mental health. Correlations exist between the two, but as people with mental health conditions use video games as a coping strategy it’s unclear which factor is fuelling the other, if any. I don’t consider my gaming habits to have a negative effect on my mental health; I would in fact say the opposite. Playing video games is one of my favourite hobbies and I would always encourage people to play them if they don’t already. They have so much to offer, from being part of a community to experiencing stories in a way that no other medium can rival.


Many video games also handle issues of mental health in a mature and empathetic way. Hellblade: Senua’s Sacrifice has been praised for the way it examines psychosis. The main character has hallucinations, experiences voices in her head and because of this believes she has been cursed by the darkness – it’s easy to see the parallels here. Because you control Senua it’s easy to empathise with her and understand what other people with similar conditions may be going through. Dark Souls examines feelings of depression by placing the player in a world which is destroyed, hopeless and sets you on a quest that seems destined to fail. It’s an extremely difficult game which faces you against huge, grotesque and monstrous bosses. As each boss falls and you progress through the game against all odds, you feel empowered and learn to push forward no matter what. I’ve read testimonials from multiple people thanking the game for helping them through depressive periods or helping them come to terms with bereavement.

Dark Sols Gaping Dragon Boss
One of the bosses from Dark Souls. Look at this monstrosity – if you can beat this, you can beat anything. Source: Games Radar (https://www.gamesradar.com/dark-souls-boss-guide/)

However, if video games are used solely as a coping strategy there is a risk self-help strategies are put to one side as a result. On top of this, conventional therapy such as CBT, counselling and/or medication should be implemented above all else, with individuals seeking help through their own merit or through encouragement from local support networks if they are available. I personally know that I would never have got professional help without encouragement from my partner, which is sometimes the kick we need.

With all things considered it seems that video games, like with most things, are best enjoyed in moderation and should not be used at the expense of functionality in everyday life. If you can have a healthy relationship with video games, then I encourage you to do so. They have helped me through some difficult times and I’m sure they may have helped you too.


Bibliography


[1] https://www.who.int/features/qa/gaming-disorder/en/


[2] Van Rooij. A.J., Ferguson, C.J., Carras Colder. M., Kardefelt-Winther. D., Shi. J., Aarseth. E., Bean. A.M., Helmersson Bergark. K., Brus., A. Coulson. M., Deleuze. J., Dullur. P., Dunkels. E., Edman. J., Elson. M., Etchells. P. J., Fiskaali. A., Granic. I., Jansz. J., Karlsen. F., Kaye. L. K., Kirsh. B., Lieberoth. A., Markey. P., Mills. K. L., Kristian Lundedal Nielsan. R., Orben. A., Poulsen. A., Prause. N., Prax. P., Quandt. T., Schimmenti. A., Starcevic. V., Stutman. G., Turner. N. E., Van Looy. J. & Przybylski. A. K. 2018. A weak scientific basis for gaming disorder: Let us err on the side of caution. Journal of Behavioural Additcions, 7(1), 1-9.


[3] Chang S.M. & Lin. S.S.J. Online gaming motive profiles in late adolescence and the related longitudinal stress, depression, and problematic Internet use. 2019. Computers and Education. doi: https://doi.org/10.1016/j.compedu.2019.02.003.


[4] Gentile. D. A. & Hyekyung. C., Liau. A., Sim T., Dongdong. L., Fung. D. & Khoo. A. 2010. Pahtological Video Game Use Among Youths: A Two-Year Longitudinal Study. Pediatrics, 127.


[5] Ferguson. C. J., Coulson. M. & Barnett. J. 2011. A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. Journal of Psychiatric Research. 45, 1573-1578


[6] Chan. P.A. & Rabinowitz. T. 2006. A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents. Annals of General Psychiatry, 5, 16.


[7] Maras. D., Flament. M. F., Murray. M., Buchholz. A., Henderson. K. A. Obeid. & Goldfield. G. S. 2015. Screen time associated with depression and anxiety in Canadian Youth. Preventative Medicine. 73, 133-138.


[8] Altintas. E., Karaca. Y., Hullaert. T. & Tassi. P. 2019. Sleep quality and video game playing: Effect of intensity of video game playing and mental health. Psychiatry Research, 273, 487-492.

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