In a previous blog post, I wrote that research has shown that video games may be linked to mental illness.  It turns out that this was only part of the story.  Therapeutic video games exist, and you are already playing some of them.  A large body of research is identifying therapeutic video games and demonstrating ways in which they can help treat ailments such as anxiety, PTSD, depression, cerebral palsy, and other emotional and physical illnesses.  And this research is not confined to games created in a university laboratory; it includes many popular off-the-shelf video games that were produced primarily for entertainment value.

Therapeutic Video Games exist.

As I explained in my prior post, the American Psychiatric Association (APA) identified “Internet Gaming Disorder” as a candidate for further research and inclusion in future versions of the Diagnostic and Statistical Manual.

A competing body of research exists, however–also recognized by the APA–regarding therapeutic video games.  The APA issued the following statement in 2014:

“Playing video games, including violent shooter games, may boost children’s learning, health and social skills, according to a review of research on the positive effects of video game play to be published by the American Psychological Association.”

The APA published the review, entitled The Benefits of Playing Video Games in 2014 in its flagship journal American Psychologist.  You can read the entire review by clicking here.  The review made a number of statements regarding therapeutic video games:

“The vast majority of research by psychologists on the effects of “gaming” has been on its negative impact: the potential harm related to violence, addiction, and depression. We recognize the value of that research; however, we argue that a more balanced perspective is needed, one that considers not only the possible negative effects but also the benefits of playing these games.”

“For example, studies suggest that playing puzzle video games—games with minimal interfaces, short-term commitments, and a high degree of accessibility (e.g., Angry Birds, Bejewled II)— can improve players’ moods, promote relaxation, and ward off anxiety.”

My prior post summarizes the research describing the “negative impact.”  This post will summarize research regarding therapeutic video games.

Research summarizing positive benefits of “exergame” therapeutic video games.

Researchers from the University of Utah published a study in 2012 entitled Patient-Empowerment Interactive Technologies in the journal Science Translational Medicine.  Their study concluded:

“Such nonpharmacological interventions may enhance patients’ resilience toward various chronic disorders via neuronal mechanisms that activate positive emotions and the reward system.”

The researchers identified two categories of video games: sedentary games and “exergames”.  Researchers identified some “exergames” with which you are probably already familiar: Wii Virtual Reality games, Wii FitWii Sports (in particular boxing and bowling) and Dance Dance Revolution.  Regarding Dance Dance Revolution, the researchers had the following to say:

“[A]lthough the video game Dance Dance Revolution was not designed specifically to treat childhood obesity, it has been shown to be an effective aerobic workout that promotes weight loss in childhood obesity.”

The researchers also noted that “Wii Boxing and Bowling games have been effective in neurorehabilitation of adults with Parkinson’s disease and stroke.”

A separate perspective published in the journal Future Neurology, entitled Should We Integrate Video Games Into Home-Based Rehabilitation Therapies for Cerebral Palsy? noted:

“Video games certainly employ mechanisms to increase motivation and reward (e.g., through plotlines, point systems and unlocking new games or levels), and enjoyment of movement-based video games and [virtual reality technologies] is reportedly high in children with [cerebral palsy].”

Therapeutic video games also include off-the-shelf “sedentary” games.

A 2014 review entitled The Use of Electronic Games in Therapy: a Review with Clinical Implications published in the journal Current Psychiatry Reports concluded that “electronic games for entertainment (EGE) . . . have potential to be applied to a wide range of health and mental health issues and settings.”  The authors continued to state:

“EGE has been investigated as an adjunct to individual and group psychotherapy, primarily in behavioral or talk therapy with children or adults with developmental delays. A variety of commercially produced games are appropriate to use . . .”

The authors identified several examples of such games targeting different therapeutic outcomes, listed in this table:

Therapeutic video games include off-the-shelf games designed primarily for entertainment.
Therapeutic video games include off-the-shelf games designed primarily for entertainment.

The authors also acknowledged research that:

“describe[s] the use of imagery in a first-person shooter game to allow patients with brain tumors to experience an imagined immune response to the tumors. In a randomized clinical trial (RCT), significant reductions were noted by the authors in depression, anxiety, anger, and disruptive behavior and increases in self-concept, with significant advantages of the intervention over the control in all areas.”

The authors even expanded their review into virtual reality games, noting that:

“[i]n a systematic review of ten experimental studies using VRET [virtual reality entertainment technology] in combination with [cognitive-behavioral therapy] in the treatment of PTSD, VRET was found to be at least as useful as traditional exposure therapy.”

The authors concluded that “EGE, using off-the-shelf games, are easier and less expensive to acquire and update, provide a much larger set of options, and are generally more preferred by children and adolescents.”  They also provided clinical recommendations and described their own clinic:

“The authors have a variety of computer-based and console-based games . . . In using EGE for groups, we use games that allow as many clients to participate as possible; for a single console, the best option at this time is the Wii U with up to five players at a time; for multiple consoles, three Xbox 360 consoles can accommodate up to 12 players at a time.”

(Remember, the authors published this review in 2014, prior to wide adoption of current generation gaming consoles).

Controversy remains over whether so-called “brain games” are actually therapeutic video games (think Luminosity).

You have heard of the popular brain-training gaming suite Luminosity. Luminosity (the company) claims that it partners with the scientific community to provide a suite of games that improve cognitive performance.  According to Brenda Goodman, MA of WebMD, in a 2014 piece entitled The Promise and Perils of Brain Training, consumers are spending $1.3 billion on gaming products such as Luminosity, a number that increases each year.

The Federal Trade Commission, however, took exception to Luminosity’s claims.  In a Complaint filed in 2016, the FTC alleged that Luminosity:

“claimed training with Lumosity would 1) improve performance on everyday tasks, in school, at work, and in athletics; 2) delay age-related cognitive decline and protect against mild cognitive impairment, dementia, and Alzheimer’s disease; and 3) reduce cognitive impairment associated with health conditions, including stroke, traumatic brain injury, PTSD, ADHD, the side effects of chemotherapy, and Turner syndrome, and that scientific studies proved these benefits.”

You can read the entire Complaint by clicking here.  Luminosity eventually agreed to a $50 million consented judgment, all but $2 million of which was suspended after a review of Luminosity’s financial condition.  The judgment further required Luminosity “to have competent and reliable scientific evidence before making future claims about any benefits for real-world performance, age-related decline, or other health conditions.”  You can read the FTC’s press release here, and you can read the court-ordered consented judgment here.

The Stanford Statement and ensuing debate.

In an October 20, 2014 open letter by 69 scientists at the Stanford Center on Longevity, the authors complained:

“We object to the claim that brain games offer consumers a scientifically grounded avenue to reduce or reverse cognitive decline when there is no compelling scientific evidence to date that they do. The promise of a magic bullet detracts from the best evidence to date, which is that cognitive health in old age reflects the long-term effects of healthy, engaged lifestyles. In the judgment of the signatories, exaggerated and misleading claims exploit the anxiety of older adults about impending cognitive decline. We encourage continued careful research and validation in this field.”

The Stanford Statement prompted a response by 100 scientists affiliated with, among others, the California Institute of Technology, University of California at Berkeley, University of California at San Francisco [the “Harvard Med” of the West Coast, an honor attributable to Stanford as well], Yale University, New York University School of Medicine, and Columbia University.  They responded:

“There is, in fact, a large and growing body of such evidence [regarding brain games]. That evidence now includes dozens of randomized, controlled trials published in peer-reviewed journals that document specific benefits of defined types of cognitive training. Many of these studies show improvements that encompass a broad array of cognitive and everyday activities, show gains that persist for a reasonable amount of time, document positive changes in real-life indices of cognitive health, and employ control strategies designed to account for “placebo” effects.”

You can read the entire response here.

Concluding Thoughts: Many therapeutic video games exist, most of which are off-the-shelf games that gamers already play.

While controversy remains regarding the relative value of therapeutic video games, a wide body of research exists that identifies their value, going so far as to even identify specific mass-market video games.  Some bad actors, such as Luminosity, have stretched this research into unsupportable marketing claims, but the research exists and is real.  Therapeutic video games do exist, and you either have played or are already playing them.

Additional reading regarding research into therapeutic video games.

This post already runs long, so for the sake of (relative) brevity, I am listing some links to further reading without providing any commentary.

Therapeutic Video Games Aimed at Variety of Illnesses

Video Game or Treatment for PTSD?

Will Doctors Soon Be Prescribing Video Games For Mental Health?

The Neuroscape Project at the University of California San Francisco

Therapeutic Video Games Recommendations by Child’s Play Charity

Gaming the Emotions by Harvard Magazine

Health Care by Nintendo in Newsweek

Brain Training Doesn’t Make You Smarter in Scientific American

Scientific evidence does not support the brain game claims, Stanford scholars say in Stanford | News

Science-backed brain game eases distraction, anxiety

Therapeutic Video Games Exist, and You Are Already Playing Some

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