In the first weeks of the pandemic, Monet Goldman tried different strategies for dealing with stress. “I was exercising, meditating, doing yoga,” says Goldman, a graduate in family and marriage therapy in Santa Clara, California. But he didn’t start to feel better until he turned to a familiar pastime: videogames. In the bright and immersive world of online gaming, Goldman found solace – and started having fun again. As he and his colleagues struggled to connect with customers virtually, he wondered if games could also help his patients.
Goldman began training other doctors to use online games in their work, starting with Roblox, a platform with millions of games that is especially popular with children ages 5-12 in the United States. In a Zoom session with two elementary school boys, Goldman kicked off by asking the kids to name their favorite Roblox game. At first, “it’s like radio silence. Everyone has their cameras turned off,” says Goldman. Eventually, a boy mentioned Brookhaven, an RPG set in a busy city. Soon the children were enthusiastically leading each other through the game space, forgetting their shyness.
Like conventional play therapy, which uses toys to help patients express thoughts and feelings, online games offer another form of communication. For some people who are anxious about their appearance or speech, gaming is an opportunity to discover “a voice in its different forms,” whether through avatars, artwork or other digital creations, says Goldman. He noticed that children struggling with personal therapy began to come alive and develop more confidence in a virtual environment. “That was the biggest benefit,” he says. Today, Goldman counsels children, teens and adults, incorporating a mix of games and psychotherapy.
While the reuse of video games for therapeutic use is not new, physician interest in this format grew significantly after the pandemic led to an abrupt shift to telehealth. “A lot of therapists were freaking out,” says Josué Cardona, founder of Geek Therapy, a non-profit organization that advocates the use of video games and other popular media. As of December 2019, the Geek Therapy Facebook group had just under 1,000 members, according to Cardona; now it has more than 5,400. Doctors use online games in different ways, from bringing together clients on platforms like Roblox or Minecraft to having patients play independently for a specific therapeutic purpose.
How games can help
“Video games have this way of getting attention and keeping it,” which could be the first step in helping patients control distressing thoughts, says Aimee Daramus, clinical psychologist and author of Understanding Bipolar Disorder. In her work with adults with chronic mental illnesses, including anxiety, depression and schizophrenia, Daramus uses video games as a bridge to other coping skills. If someone is overwhelmed by intrusive thoughts during a session, playing a video game for a while can help reduce anxiety. At that point, explains Daramus, a strategy like mindfulness becomes much more accessible to the patient.
Some research suggests that video games can be as effective – and potentially more effective – as other mental health interventions, especially for anxiety. A 2017 study published in Prevention Science found that the MindLight game was as effective as a cognitive-behavioral therapy program in reducing children’s anxiety. In another study, prescribing video games reduced patients’ anxiety more than adding a second drug to the treatment.
While some games are designed to highlight mental health struggles — for example, Sea of Solitude portrays a character experiencing depression and loneliness — casual games intended for entertainment can also be beneficial. In a 2009 study published in PLOS One, researchers found that playing the Tetris game after viewing a traumatic movie can reduce flashbacks in people, lowering the risk of post-traumatic stress disorder. The game, in effect, “hacks attention and memory to prevent someone from replaying, replaying, and replaying those memories while the brain is forming them,” says Daramus.
And sometimes it’s within the digital confines of the game world that patients can feel safer and freer to deal with intense emotions. Kim Wheeler Poitevien, a licensed clinical social worker in Pennsylvania who counsels children and teens, saw more young black patients gravitate toward games like Fortnite in response to racial violence during the summer of 2020. The kids were “afraid of the police,” then the idea was: “I want to protect myself,” she says. “They had these stories of what good people they are, but the police think they’re bad.”
Games can also help develop emotion regulation skills. Poitevien grew up in a family of gamers and played Atari as a child. Today she plays video games with her clients during sessions, but she doesn’t just let them win. “We are competitive, let’s go.” This can be an opportunity for kids to practice “frustration tolerance,” she says, if, for example, they’re losing to her in a Mario Kart game. And dealing with unavoidable glitches, such as when a game delays or expels the player, helps children develop patience.
Online gaming has been a critical add-on resource during the pandemic. “Every therapist I know is extremely busy right now,” Daramus told me. When clients can’t see her right away or want to practice coping skills between sessions, she often prescribes games with a mental health focus, such as Sea of Solitude, Night in the Woods, and Gris.
Problems With Online Gaming Addiction
Some experts have expressed concern about screen time and online gaming addiction, especially in children. China recently tightened its already strict regulations that limit online play time for children under 18 years old. Although the World Health Organization recognizes gambling disorders as a condition, estimates of its prevalence vary. A review of 53 studies in 2020 determined that the worldwide prevalence of the disorder is approximately 3% of gamblers.
Larry Rosen, professor emeritus and former chair of the Department of Psychology at California State University, Dominguez Hills and co-author of The Distracted Mind: Ancient Brains in a High-Tech World, says games can promote behavior modification that can turn into an addiction. The more we play, the more chemicals we feel good about – especially dopamine, serotonin and other chemicals, says Rosen.
On the other hand, gambling can help us get rid of unwanted feelings, especially anxiety. The daily login sequence – a concept popularized (but in no way originated by) Snapchat – is a perfect example. “You keep the sequel because you’re looking forward to it,” says Rosen. “You want to be responsible and fulfill your social obligations.” When we log in to keep the sequence alive, that unpleasant feeling starts to dissipate.
Ultimately, online games are incredibly immersive because their success depends on getting our attention. The more we play, the more likely we are to buy something and the more money game companies make. “The end result is that their goal is to keep you there,” says Rosen.
While remaining alert to the possible pitfalls of the game, therapists are careful to avoid stigmatizing the activity. Rather than telling a client to stop gambling, Poitevien finds that a more effective approach is to talk about balance. She might ask, “How do you feel when you play video games until 4 am? What are the natural consequences of this?”
Goldman agrees. He doesn’t like the word “addictive” to describe the game, but he recognizes the potential for turning to harmful habits. If we abuse the game as a coping strategy, once we leave “we’ll still have the same problems we were avoiding,” he says. And those challenges probably “became even bigger because we spend more time playing and less time maybe applying for this job, going to school.”
behind the pandemic
As online games continue to grow, doctors need stricter ethical guidelines about their use, says Daramus. The challenge is to ensure that “we don’t do therapy in a way that’s fun for us; we do therapy in the right way for the client”, she says. If a patient wants to spend the entire session playing Animal Crossing, how does the clinician link that activity to a specific treatment goal – for example, improving social skills or developing tolerance for suffering?
Even when the pandemic finally ends and personal counseling can be resumed, doctors see reasons to keep online games in their toolkits. If traditional talk therapy has failed, gambling can be a crucial last-minute opportunity to help patients. Goldman regularly gets calls from parents of high school and college students who hated therapy but still needed to talk to someone. Families find him because of his non-judgmental approach and enthusiasm for games.
“Therapy can be intimidating and difficult,” says Goldman. Connecting with patients in the gaming world, where they feel safe, can make a big difference, even if it means offering a meeting on a World of Warcraft server. “Whatever it takes to get you in.”
Matter translated from Wired.
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