With COVID-19 shuttering schools and putting a temporary halt to face-to-face interactions, children and adolescents have a void in their schedules and social lives. Many are apparently turning to video games to fill it, with recent data showing an unprecedented spike in online gaming since the pandemic took hold globally.
It’s not just escapism that’s being offered to gamers, but also tangible psychological benefits, according to Isabela Granic, PhD, director of the Games for Emotional and Mental Health (GEMH) Lab, and professor and chair of the developmental psychopathology department in the Behavioural Science Institute at Radboud University in the Netherlands.
Medscape recently spoke with Dr Granic about the potential upsides of gaming in a pandemic and why video games are an ideal delivery system for mental healthcare.
This transcript has been edited for clarity.
What role — if any — do commercial video games have to play in potentially alleviating the anxiety, depression, and other mental health issues caused by the pandemic and extended isolation?
We should separate what we knew before and what we know right now. There’s no research on what happens when you’re locked up for 3 months and have no face-to-face interaction whatsoever.
However, our prior research suggests that a healthy diet of both digital interactions and offline interactions is probably what we’re going for. From a 2014 review we conducted, we know that there were emotional, social, motivational, and cognitive impacts of playing commercial video games. Right now, we have to ask ourselves what impact 12 hours a day has.
Talking about video games is like talking about the impact of food: It totally depends.
Do multiplayer games, where you can interact with friends while playing, have more psychological value than games you play by yourself?
They have different functions. There are lots of games that kids play alone where they learn to problem-solve. They persevere though many repeated failures to get to that “aha” moment of figuring out the problem. There really are cognitive benefits to that perseverance and immersive play that helps young people focus. Problem-solving and spatial reasoning are improved by some of these video games that kids play alone.
We also know that young people are getting lots of social benefits from interacting with multiplayer games. Competitive games have mental health benefits for young people, as we’ve known for offline sports as well. And cooperative games have some really great mental health benefits.
Especially now, most young people playing these social video games are not always focusing on the gameplay itself. If you’ve hung out with kids while they’re playing Fortnite, the game is almost like a distraction tool for them to also talk to one another about their friends, who they have a crush on, why they’re mad at their mother, and so on. It’s a sort of background playground for them to socialize while they happen to have a joystick in their hands.
Is there a chance that video games are also reinforcing the anxiety, isolation, and depression of the present moment?
It really depends. Purely from the science, we know there is no direct link between video games and negative impact. When those studies find any kind of link, there are tiny prediction levels — like 0.01%. There are so many other factors predicting for anxiety or depression that the video games don’t even have a shot at making a contribution. Meta-analyses have shown that there is no negative impact on mental health, even when they are playing 4-5 hours of video games per day.
We’re in a very different context right now, though. If, for the next year, people are not having face-to-face interactions or learning all the ways we have evolved to communicate with one another, we can then ask whether there may be a negative impact. There may well be. We have no science around that.
Making a Game of Evidence-Based Therapy
At GEMH Lab, you’ve created and tested several video games for mental health. What do they offer that can’t be accomplished with conventional therapeutic approaches?
We take evidence-based techniques in the mental health clinical world or developmental research, such as cognitive-behavioral therapy (CBT) or exposure therapy, and then embed them in games to use a different engine for delivering something we otherwise know works.
Is there an element of mixing the medicine in with the applesauce, so to speak? Are they benefiting because children don’t really view it as therapy?
Kids know exactly what an educational game looks like versus something like Minecraft, which, while simple-looking, gives them an opportunity for fun that is very different from most educational games. So we don’t think about it really as trying to even hide it.
We’ve done studies where we’ve shown people two trailers of exactly the same game. One trailer says, this could help you with your mental health struggles, depression, and anxiety; the other one says, this is the award-winning most fun game ever. They will pick the mental health messaging one at the same rate as the other one, and they will play it for as long as they would play the other one — as long as the game is really good.
So you’re not even turning young people off by saying that these games could be beneficial.
MindLight is one of the games you’ve developed for addressing anxiety. How does it work?
MindLight is a game for younger kids, 8-12 years old, but we’ve gone up to 14 years. They put on this one-channel electroencephalography headset that you can get on Amazon and is not expensive. The more relaxed they are, the more light shines in the haunted house mansion within the game. The more anxious they get, the darker it is in this game. They have this intense feedback loop of their literal mind space being represented outside in a game context.
We often try to teach kids in conventional CBT that your thoughts change the way you feel and the way the outside world reacts to you, but they never believe us; they think that we’re full of it. But when they have a game that actually shows that as they do deep breathing or reappraise a situation in the game context, the light goes on and they are more powerful, that lesson really gets there. It’s exposure therapy and cognitive retraining and reappraisal underlying this game.
We have randomized controlled trials showing that we can cut young people’s anxiety in half after they have as little as five 1-hour sessions per week. We’ve shown that we can get the same benefits as CBT for these young people, which is huge. No other game has been able to show this kind of thing.
We’ve also done randomized controlled trials of MindLight in children with autism, 75% of whom have comorbid anxiety. Most of the quality of life and functioning in childhood autism has a lot to do with whether the children are anxious or not, and how anxious they are and in what context. We showed that MindLight was actually better than treatment as usual according to parents, and about equal according to children, in decreasing their anxiety.
Getting these to the commercial market would mean that more people have access to these very rigorously tested games. Because there are about 2000-plus apps for depression, and less than 1% are ever tested in any kind of scientifically rigorous way. There are a lot of claims flying around, and very few real data points to show that they are effective.
You’ve been in this field for two decades. How have attitudes and around video games and technology changed?
When I first started doing this, the fun thing was showing clinicians who were generally antigames and had no clue how far we had come from Pac-Man and Space Invaders. And I put myself in that category; I started gaming at 42 years old. There used to be a lot more resistance, and worry about being replaced. But more and more as I talk with clinicians, they’re recognizing that there are both benefits and harms that might come from these digital experiences.
We’ve been saying for hundreds of years that any new technology is part of the anxiety problem in our young people. We said it with rock and roll, we said it with radio, we even said newspapers were making people antisocial!
Follow Medscape on Facebook, Twitter, Instagram, and YouTube
