The Effects of Casual Videogames on Anxiety, Depression, Stress, and Low Mood: A Systematic Review

Detecting and tracking depression through temporal topic modeling of tweets: insights from a 180-day study

Depression affects over 280 million people globally, yet many cases remain undiagnosed or untreated due to stigma and lack of awareness. Social media platforms like X (formerly Twitter) offer a way to monitor and analyze depression markers. This study analyzes Twitter data 90 days before and 90 days after a self-disclosed clinical diagnosis. We gathered 246,637 tweets from 229 diagnosed users. CorEx topic modeling identified seven themes: causes, physical symptoms, mental symptoms, swear words, treatment, coping/support mechanisms, and lifestyle, and conditional logistic regression assessed the odds of these themes occurring post-diagnosis. A control group of healthy users (284,772 tweets) was used to develop and evaluate machine learning classifiers-support vector machines, naive Bayes, and logistic regression-to distinguish between depressed and non-depressed users. Logistic regression and SVM performed best. These findings show the potential of Twitter data for tracking depression and changes in symptoms, coping mechanisms, and treatment use.

Video gaming and sleep in adults: A systematic review

Video games (VGs) are one of the most common forms of entertainment and their diffusion is constantly increasing. Although largely studied in the framework of their relationship with mental and physical health, the relationship of VGs with sleep are not yet fully understood. This review provides a systematic assessment of the studies that investigated the relationships between video gaming and sleep in adults. The review search included both online databases (PubMed, Scopus, and PsycInfo) and citation tracking. Twenty-six studies were included in the final qualitative analysis. Findings are described separately for subjective and objective sleep measures and then discussed considering exposure levels and VG typology. Observational studies showed an association between excessive video gaming, poor sleep quality, and delayed sleep timing, whereas habitual and/or casual use was not associated with poor sleep and some studies even showed a beneficial effect on daytime functioning. Experimental evidence shows that playing an arousing VG before sleep delays sleep onset with possible alteration of sleep structure, whereas non-arousing cognitively challenging video gaming resulted in improved sleep continuity, stability, and organization. Overall, these findings show that the effect of VGs on sleep depends on the level of arousal associated with gaming, gaming sessions' duration, and frequency of gaming.

Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial

BACKGROUND

The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health-based intervention designed to systematically facilitate thought progression would substantially alleviate depression.

OBJECTIVE

The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns.

METHODS

A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life.

RESULTS

The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was -7.01 points (95% CI -10.72 to -3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app.

CONCLUSIONS

The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758.

Effects of game-based digital interventions for mental disorders: A meta-analysis

With increasing research attention on game-based digital interventions for mental disorders, a number of studies have been conducted to explore the effectiveness of digital game-based interventions on mental disorders. However, findings from previous research were inconsistent. Thus, we conducted a comprehensive meta-analytic review of the effectiveness of game-based digital interventions for mental disorders. By searching the articles in databases, we identified 53 studies in which 2433 participants were involved, and 282 effect sizes were extracted. Among the 53 studies, 14 employed within-group (pre/post) designs, and the remaining 39 utilized controlled trial designs. Using a three-level random-effects meta-analytic model, a medium effect size of game-based digital interventions (g = 0.47, 95 % CI: 0.33, 0.61) was revealed in the controlled trial designs and a close-to-medium effect size (g = 0.45, 95 % CI: 0.32, 0.58) was found in the within-group (pre/post) designs, indicating close-to-medium-sized efficacy of game-based digital interventions for mental disorders. Moderator analyses showed that age in the controlled trial designs had contributed to the heterogeneity in previous studies, suggesting that interventions might be more effective for the elderly. However, given that only a limited number of studies were focused on the elderly, more studies with older participants should be conducted in the future to provide more robust evidence and explore the mechanisms of how digital gaming interventions can be more effective in improving mental disorders symptoms.

Temporal Changes in Depressive Symptoms Among Goodville Farm Game Players: A 6-Week Observational Study

Aim of the Study: The primary objective was to evaluate the potential impact of the Goodville farm game on depressive symptoms. Methods: The Goodville game, characterized by its unique farming features, incorporates elements of emotional well-being and various mental health assessment tools, enabling players to monitor and improve their emotional state. Using self-reported Patient Health Questionnaire-8 (PHQ-8) data from 1717 US and UK players, changes were monitored weekly over a 6-week period. The study focused on the game's ability to integrate emotional well-being elements and various mental health assessments to facilitate self-monitoring and improvement of players' emotional states. Results: There was a significant overall time effect (F = 154.498, df = 1711, P < 0.001), indicating a moderate-to-large effect size, with progressive decreases in PHQ-8 scores throughout the period. About 60% of players reported reduced depressive symptom severity, with around 35% experiencing complete symptom relief. More significant improvements were observed in players with higher initial severity. No correlations were found between symptom changes and demographic data or the number of active playing days. Conclusion: Goodville demonstrates potential as a digital mental health intervention in reducing depressive symptoms through its specific characteristics designed to improve emotional well-being. The study emphasizes the need to consider baseline severity and highlights the therapeutic promise of authentic farming game features. Despite the absence of a control group, the findings contribute meaningful insights into digital interventions for mental health care and set a direction for future studies to validate and expand upon these results.

Longitudinal Relationships Between School Climate, Academic Achievement, and Gaming Disorder Symptoms Among Chinese Adolescents

Despite growing concerns regarding the development of gaming disorder symptoms among adolescents, the longitudinal relationship between school factors and gaming disorder symptoms remains far from being fully understood. This two-year longitudinal study examined the relationship between school climate perceptions, academic achievement, and gaming disorder symptoms among three distinct demographic cohorts: preadolescents (n = 1513; 46.9% girls, Mage = 10.64 years, SD = 0.56), early adolescents (n = 1771; 48.3% girls, Mage = 13.54 years, SD = 0.70), and late adolescents (n = 2385; 50.1% girls, Mage = 16.41 years, SD = 0.59). A four-wave study was conducted (six months apart) using random intercept cross-lagged panel models (RI-CLPMs) to separate the within-person (state level) from the between-person (trait level) effects. The results obtained from the RI-CLPMs indicated that fluctuations in school climate perceptions negatively predicted subsequent changes in gaming disorder symptoms among preadolescents at the within-person level, but not among early and late adolescents. Fluctuations relating to gaming disorder symptoms also negatively predicted subsequent changes regarding academic achievement in late adolescents, but not in preadolescents and early adolescents. The effect of school-related factors on gaming disorder symptoms varies across different developmental stages. While preadolescents may represent a particularly susceptible subgroup for gaming disorder in terms of being predicted by their school environment, late adolescents appear to be more vulnerable to predictors of gaming disorder symptoms. The current study also discusses the implications of school-wide programs aimed at improving school climate and preventing the development of gaming disorder symptoms during key developmental periods.

Smartphone-based serious games for mental health: a scoping review

The use of smartphone-based Serious Games in mental health care is an emerging and promising research field. Combining the intrinsic characteristics of games (e.g., interactiveness, immersiveness, playfulness, user-tailoring and engaging nature) with the capabilities of smartphones (e.g., versatility, ubiquitous connectivity, built-in sensors and anywhere-anytime nature) yields great potential to deliver innovative psychological treatments, which are engaging, effective, fun and always available. This article presents a scoping review, based on the PRISMA (scoping review extension) guidelines, of the field of smartphone-based serious games for mental health care. The review combines an analysis of the technical characteristics, including game design, smartphone and game-specific features, with psychological dimensions, including type and purpose of use, underlying psychological frameworks and strategies. It also explores the integration of psychological features into Serious Games and summarizes the findings of evaluations performed. A systematic search identified 40 smartphone-based Serious Games for mental health care. The majority consist of standalone and self-administrable interventions, applying a myriad of psychological strategies to address a wide range of psychological symptoms and disorders. The findings explore the potential of Serious Games as treatments and for enhancing patient engagement; we conclude by proposing several avenues for future research in order to identify best practices and success factors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11042-024-18971-w.

Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences

Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.

A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study

BACKGROUND

Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored.

OBJECTIVE

This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents.

METHODS

We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] Māori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children's Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4.

RESULTS

Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI -0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI -2.71 to 4.31; P=.64) for GHSQ; -1.09 (95% CI -2.83 to 0.66; P=.21) for FS; and -3.42 (95% CI -6.84 to -0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful.

CONCLUSIONS

The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31588.

Games, hormones, and "dark" personalities: Dark tetrad and the effects of violent gaming on aggression, cortisol, and testosterone

We investigated how playing a violent versus non-violent video game affects cortisol and testosterone levels, whether these hormonal changes increase implicit aggressive cognition, and whether so-called Dark Tetrad personality traits (i.e., Machiavellianism, psychopathy, narcissism, everyday sadism) moderate these effects. Fifty-four men played either a violent or a non-violent video game for 25 min. Participants provided salivary samples at the beginning of the experiment (T1), after 25 min of gameplay (T2), and 20 min after gameplay ended (T3). In the violent condition, participants showed a significant decrease in cortisol levels (T1 to T2) and a significant negative trend in cortisol levels from T1 to T3. Moreover, higher Machiavellianism scores were related to a significantly stronger decrease in cortisol (T1 to T2) in this condition. In the non-violent condition, however, participants with higher scores in Machiavellianism had a higher increase in cortisol (T1 to T2). In contrast to changes in hormonal levels, there were no significant effects on implicit aggressive cognition. The present findings illustrate the complex interplay between personality, hormones, and game content, thus further specifying current notions on the effects of violent video games. Playing a violent video game can have a stress-reducing calming effect depending on personality traits such as Machiavellianism and the psychological need satisfaction associated with it. Also, the fact that VVG exposure was not automatically accompanied by an aggression-increasing effect proves that simple cause-effect models are not sufficiently specified without taking the underlying mechanisms into account.

Play in video games

Video game play is remarkably ubiquitous in today's society given its recent emergence only in the late 1950s. While this fast evolution could exemplify the power of play, video games exploit but also extend other types of play. Here, we review a classification of the ecosystem of video games useful in the emerging field of the cognitive neuroscience of video games. We then discuss how video games may leverage different play types, considering first locomotor-rotational, object, and social play before highlighting the importance of role, rule, and pretend play in video games. With an eye toward comparative studies of the neural bases of play across species, we discuss whether video games may fulfil the five criteria from Burghardt (2005) to identify play. Finally, in line with play's possible preparatory role for adulthood, we review the positive impact on cognition and future learning of action-like video games. Highlighting that not all video games have this impact, we note more granular hypotheses about the biological functions of play are to be encouraged.

Effects of Cooperative, Competitive, and Solitary Exergames on Cognition and Anxiety Levels in Children with Developmental Disabilities

Objective: Exergames are playing an important role in person-centered therapy, health care services, and in the rehabilitation field. This study aimed to compare the effects of cooperative, competitive, and solitary exergames on cognition and anxiety levels in children with developmental disabilities (DD). Materials and Methods: This study was a randomized controlled trial pretest-posttest including 36 children with DD who were allocated to the cooperative exergame group (CGG), competitive exergame group (CmGG), and solitary exergame group (SGG). The exergame program was performed two times a week for 8 weeks and the outcome measurements were conducted before and after the program. A paired sample t-test and one-way analysis of variance (ANOVA) were used to analyze the changes within and between the groups. Results: The result indicated a significant improvement in memory, attention, and visual perception in all groups; the CGG and CmGG showed a high increase in attention compared with the SGG. However, only the CGG presented a significant improvement in the language subscale. In terms of anxiety, only the CGG presented substantial improvements in all anxiety subscales. The CmGG showed improvement in social phobia and the SGG in physical injury fears, social phobia, and general anxiety fears. Conclusion: The findings suggest that cooperative and competitive exergames may be used to effectively improve cognitive functions; cooperative exergames can be applied as the most effective method to reduce anxiety compared with the other game types for children with DD.

No evidence that Chinese playtime mandates reduced heavy gaming in one segment of the video games industry

Governments around the world are considering regulatory measures to reduce young people's time spent on digital devices, particularly video games. This raises the question of whether proposed regulatory measures would be effective. Since the early 2000s, the Chinese government has been enacting regulations to directly restrict young people's playtime. In November 2019, it limited players aged under 18 to 1.5 hours of daily playtime and 3 hours on public holidays. Using telemetry data on over seven billion hours of playtime provided by a stakeholder from the video games industry, we found no credible evidence for overall reduction in the prevalence of heavy playtime following the implementation of regulations: individual accounts became 1.14 times more likely to play heavily in any given week (95% confidence interval 1.139-1.141). This falls below our preregistered smallest effect size of interest (2.0) and thus is not interpreted as a practically meaningful increase. Results remain robust across a variety of sensitivity analyses, including an analysis of more recent (2021) adjustments to playtime regulation. This casts doubt on the effectiveness of such state-controlled playtime mandates.

Generalised anxiety disorder, depressive symptoms and their subjective change after the first wave of COVID-19 among gamers in Poland

Previous studies have indicated that levels of emotional distress were considerably elevated during the COVID-19 pandemic; however, some longitudinal studies did not confirm these findings. There is a very limited number of studies on specific subpopulations, such as video gamers in this particular period. Playing video games may have either a beneficial influence on mental health by diminishing stress or a detrimental impact in terms of increasing depression and anxiety. It is, therefore, important to establish whether regular gamers differ from the general population in terms of symptoms of depression and anxiety during COVID-19. A total of 1023 participants (aged 18-50) participated in the study. The sample was composed of gamers and was representative of the Polish population. Participants completed a modified version of GAD-7, PHQ-9 online, addressing subjective change in anxiety and depressive symptoms. 25% of the sample reported clinically significant anxiety levels, and 35% mentioned depression. There were no differences in anxiety and depression levels between the investigated sample of gamers and the general population. However, up to 30% of individuals reported an increase in subjective change in anxiety or depressive symptoms during COVID-19. A further 30% reported a downward subjective change in anxiety or depressive symptoms during COVID-19. The remaining 40% declared a lack of change in the subjective change in anxiety or depressive symptoms during COVID-19. Those who reported an increase scored substantially higher in anxiety and depression than other groups. This indicates that the COVID-19 pandemic may have impacted people's mental health along a syndemic-syndaimonic continuum. COVID-19 might have been harmful to those with already poorer mental health and beneficial to those with good mental health. It is also important to plan interventions targeting vulnerable individuals who report clinically significant levels of anxiety and depression - women and younger adults and those who subjectively perceive their emotional condition to deteriorate during the COVID-19 lockdown.

A smartphone-based serious game for depressive symptoms: Protocol for a pilot randomized controlled trial

Background

Depression is the most prevalent mental disorder, with detrimental effects on the patient's well-being, high disability, and a huge associated societal and economic cost. There are evidence-based treatments, but it is difficult to reach all people in need. Internet-based interventions, and more recently smartphone-based interventions, were explored to overcome barriers to access. Evidence shows them to be effective alternatives to traditional treatments. This paper presents the protocol of a pilot study whose primary aim is to investigate the efficacy of a smartphone-based serious game intervention for patients with mild to moderate depressive symptoms.

Methods

This randomized controlled pilot trial protocol foresees two arms design: 1/ smartphone- based serious game intervention (based on Cognitive Behavior Therapy with particular emphasis on Behavioral Activation and Physical Activity), 2/ waiting list control group. The study is expected to recruit 40 participants (18+), which will be randomly assigned to one of the experimental conditions. The duration of the intervention is two months. The primary outcome measure will be depressive symptomatology. Secondary outcomes will include other variables such as physical activity, resilience, anxiety, depression impairment, and positive and negative affect. Treatment expectation, satisfaction, usability, and game playability will also be measured. The data will be analyzed based on the intention-to-treat and per protocol analyses.

Discussion

The study aims to establish initial evidence for the efficacy of a smartphone-based serious game intervention, to serve as input for a larger-scale randomized control trial. The intervention exploits advanced smartphone capabilities, such as the use of a serious game as delivery mode, with the potential benefit of engagement and treatment adherence, and motion sensors to monitor and stimulate physical activity. As a secondary objective, the study aims to gather initial evidence on the user's expectations, satisfaction, usability and playability of the serious game as a treatment.

Habitual Videogame Playing Does Not Compromise Subjective Sleep Quality and Is Associated with Improved Daytime Functioning

Research on the effects of videogames (VGs) on health has produced mixed results. Here, we assess the relationships of VG playing with sleep; chronotype; sleepiness; and levels of depression, anxiety, and stress; and how they are modulated by the level of exposure to VGs. Four hundred-and two adult participants (age = 26.2 ± 7.84; 227 F) completed an online survey including questions on VG use and a set of standardized questionnaires. The sample was divided into three groups: habitual gamers (HGs, 42.2%), nonhabitual gamers (NHGs, 36.5%), and non-gamers (NGs, 21.3%). No between-group differences emerged in sleepiness (Epworth Sleepiness Scale) or Pittsburgh Sleep Quality Index measures except the sleep disturbances subscore, which was higher in NHGs. HGs showed delayed bed- and risetimes and higher eveningness (reduced Morningness-Eveningness Questionnaire). HGs and NHGs showed higher depression subscores (Depression Anxiety Stress Scale) but remained in the subclinical range. Moreover, hours/week of VG playing predicted delayed sleep timing, lower daytime dysfunction, and lower sleepiness. Our data suggest that VG playing does not necessarily compromise sleep quality and may even benefit daytime functioning, underlining the need to reconsider the relationships between VG use and health by taking into account possible modulating factors such as habitual VG exposure.

Positive effects of online games on the growth of college students: A qualitative study from China

Objectives

This study aimed to explore the positive effects of online games on college students' psychological demands and individual growth.

Methods

A qualitative study design was carried out in September 2021. Semi-structured, in-depth, and individual interviews were conducted with a purposive sample of 20 undergraduates who played the online game "Glory of Kings" from six universities. Thematic analysis was employed to explore the positive features caused by "Glory of Kings".

Results

College students reported three positive effects of online games, namely, satisfying the need for personal growth, meeting the requirement of social life and promoting academic performance.

Conclusion

College educators and families should take advantage of the positive effect of online games to guide college students to use online games reasonably.

The Association between Video Game Time and Adolescent Mental Health: Evidence from Rural China

As digital devices like computers become more widely available in developing countries, there is a growing need to understand how the time that adolescents spend using these devices for recreational purposes such as playing video games is linked with their mental health outcomes. We measured the amount of time that adolescents in rural China spent playing video games and the association of video game time with their mental health. We collected data from primary and junior high schools in a poor, rural province in northwest China (n = 1603 students) and used the Depression, Anxiety, and Stress Scales (DASS-21) to measure mental health symptoms. The results indicated that the average video game time was about 0.69 h per week. There was a significant association between adolescent video game time and poorer mental health. Each additional hour of playing video games also increased the chance of having moderate or above symptoms. Moreover, boys and non-left-behind children had worse mental health if they played more video games. Our study contributes to literature on the links between recreational screen time and mental health, and it sheds light on an issue addressed by recent government legislation to limit the video game time of minors in China.

Animation Narrative on Stress Relief and Psychological Cognitive Development in Adolescents

As the atmosphere of domestic animation is getting stronger and stronger in recent years, its proportion in the process of public aesthetics, entertainment, and consumption is increasing; thus, the relationship between the audience and works has become an important academic focus. The theatrical animation in the animation industry has become the category that needs to be focused on and changed in the development process of domestic animation because of its characteristics of receiving attention from all-age audiences. Because of the diversified audience levels faced by theatrical animation, it is particularly difficult to coordinate the needs of each audience level, coupled with the long-term influence of Japanese and American animation; the trend of pop culture led by network culture; the inheritance, excavation, and reconstruction of national culture; and other cultural environment and creative thinking intertwined, making the construction of the independence of domestic animation appear more and more difficult. The purpose of this paper is to analyze the theoretical study of the healing elements of Natsume Yojimbo and to analyze the creation of Chinese traditional ink and wash in the creation of our own works. It is concluded that the thematic choices are based on two categories: emotions and dreams, which focus on personal life experience and universal concern for human life. The character construction is divided into three aspects: self-resistance and self-reflection, self-vision and self-actualization, and traumatic experience and self-rescue to explain the complexity and diversity of the characters' growth connotation. The narrative perspective constitutes the perspective from which the issues are viewed. The omniscient perspective allows for the coexistence of complex character relationships and a clear storyline, while the limited perspective reveals certain emotional tendencies. The narrative mode presents the moral of the text with cause-and-effect narrative, embellished group narrative, and dreamlike polyphony narrative. Finally, the article discusses the realistic dilemma of the growth narrative of domestic online animation and tries to put forward feasible development suggestions in response to the problems at this stage.

Moving towards the End of Gender Differences in the Habits of Use and Consumption of Mobile Video Games

The world of video games has become one of the most important entertainment niches for society. In the last decade it has surpassed in turnover audio-visual markets such as cinema and music, driving the development of a new form of communication. The increase in the number of female gamers has highlighted the need to discover differences and similarities between players, both in habits and motivations. We present a study based on a survey procedure for the completion of a questionnaire that aimed to cover the age range of 18 to 30 years of Spanish youngsters and that reached a total of 711 valid responses. The results showed that there were no significant differences in terms of hours spent playing video games between the two genders, although there were motivational differences in the reasons for playing, specifically in terms of competition and challenge. The discussion of the results was carried out by means of a comparative statistical analysis of means to confirm the hypotheses and meet the objectives. Despite the existence of significant differences between genders, these were not as notable as might be expected. When it comes to gaming, as we have detected in our study, there were some consumption habits with differentiated gender patterns; however, in relevant indicators such as hours of consumption, increase in lockdown consumption, and spending, there were no significant differences. The gender gap that existed a few years ago between video gamers is becoming progressively narrower.

Music-based casual video game training alleviates symptoms of subthreshold depression

Objectives

In this preregistered study, we investigated the beneficial effects of music-based casual video game training on the depression, anxiety and stress symptoms in a cohort of young individuals with subthreshold depression and the underlying mechanisms.

Methods

The study included 56 young individuals (18–26 years of age) with subthreshold or mild depression based on the Beck Depression Inventory-II (BDI-II) scores between 14 and 19. They were randomly assigned into the experimental group (n = 28) or the control group (n = 28). The experimental group underwent music-based casual video game training for 4 weeks. During the same time, the control group participants conducted daily life activities without any intervention. The study participants in the two groups were analyzed using the Depression Anxiety and Stress Scale (DASS-21) during the baseline before the intervention, as well as DASS-21, Positive and negative Affect Scale (PANAS), General Self-efficacy Scale (GSES), and the Emotional Regulation Questionnaire (ERQ) twice a week during the 4 weeks of intervention.

Results

The depression, anxiety, and stress symptoms were significantly reduced in the experimental group participants after 4 weeks of music-based video game training compared with the control group. The DAS scores in the experimental group were alleviated in the third and fourth weeks of training compared with the control group. Moreover, analysis using the general linear model demonstrated that the number of training weeks and self-efficacy were associated with significant reduction in depression, anxiety and stress. Furthermore, our results demonstrated that self-efficacy was correlated with positive emotion and emotional regulation.

Conclusion

Our study showed that music-based casual video game training significantly decreased depression, anxiety, and stress in the young individuals with subthreshold depression by enhancing self-efficacy.

Developing Serious Video Games to Treat Attention Deficit Hyperactivity Disorder: Tutorial Guide

Video game–based therapeutic interventions have demonstrated some effectiveness in decreasing the symptoms of attention deficit hyperactivity disorder (ADHD). Compared with more traditional strategies within the multimodal treatment of ADHD, video games have certain advantages such as being comfortable, flexible, and cost-efficient. However, establishing the most appropriate type(s) of video games that should be used for this treatment remains a matter of debate, including the commercial existing video games or serious video games that are specifically constructed to target specific disorders. This guide represents a starting point for developing serious video games aimed at treating ADHD. We summarize the key points that need to be addressed to generate an effective and motivating game-based treatment. Following recommendations from the literature to create game-based treatments, we describe the development stages of a serious video game for treating ADHD. Game design should consider the interests of future users; game mechanics should be based on cognitive exercises; and therapeutic mechanisms must include the control of difficulty, engagement, motivation, time constraints, and reinforcement. To elaborate upon this guide, we performed a narrative review focused on the use of video games for the treatment of ADHD, and were inspired by our own experience during the development of the game “The Secret Trail of Moon.”

Mastering uncertainty: A predictive processing account of enjoying uncertain success in video game play

Why do we seek out and enjoy uncertain success in playing games? Game designers and researchers suggest that games whose challenges match player skills afford engaging experiences of achievement, competence, or effectance—of doing well. Yet, current models struggle to explain why such balanced challenges best afford these experiences and do not straightforwardly account for the appeal of high- and low-challenge game genres like Idle and Soulslike games. In this article, we show that Predictive Processing (PP) provides a coherent formal cognitive framework which can explain the fun in tackling game challenges with uncertain success as the dynamic process of reducing uncertainty surprisingly efficiently. In gameplay as elsewhere, people enjoy doing better than expected, which can track learning progress. In different forms, balanced, Idle, and Soulslike games alike afford regular accelerations of uncertainty reduction. We argue that this model also aligns with a popular practitioner model, Raph Koster’s Theory of Fun for Game Design, and can unify currently differentially modelled gameplay motives around competence and curiosity.

The Effects of Playing Video Games on Stress, Anxiety, Depression, Loneliness, and Gaming Disorder During the Early Stages of the COVID-19 Pandemic: PRISMA Systematic Review

During the initial phases of the COVID-19 pandemic, playing video games has been much more than just a pastime. Studies suggested that video games for many individuals have helped to cope with such difficult life experience. However, other research indicates that gaming may have had harmful effects. Within this context, this systematic review aimed to describe the literature on the effects of video games during the early stages of the COVID-19 crisis on stress, anxiety, depression, loneliness, and gaming disorder (GD), examining the study characteristics and outcomes. A systematic search of the literature was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. It was preregistered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY)-INPLASY202180053. The search databases were PsycINFO, Web of Science, and Medline. The search string was: [("video game*") OR ("computer game*") OR ("gaming")] AND [("COVID-19")]. Twenty-four studies met the inclusion criteria. Four research explored the effects of playing video games during the COVID-19 pandemic on stress, anxiety, and depression. Four studies investigated loneliness, while 18 research investigated game disorder. Video games, especially augmented reality and online multiplayer ones, mitigated stress, anxiety, depression, and loneliness among adolescents and young adults during stay-at-home restrictions. However, in the case of at-risk individuals (i.e., particularly male youths), playing video games had detrimental effects.

Effects of Gaming on Pain-Related Fear, Pain Catastrophizing, Anxiety, and Depression in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis

The aim was to systematically review the effects of gaming on pain-related fear, pain catastrophizing, anxiety, and depression in patients with chronic musculoskeletal pain. Databases (Medline, EMBASE, PsycInfo, CINAHL, Cochrane Central Register for Controlled Trials [CENTRAL], Web of Science, and SCOPUS) were searched from inception up to October 2021. Two reviewers independently selected randomized controlled trials that compared the effects of any gaming modality with other interventions or no treatment on pain-related fear, pain catastrophizing, anxiety, and depression. For data synthesis, Standardized Mean Differences (SMDs) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model for meta-analysis according to the outcome of interest, comparison group, and follow-up period. The level of evidence was synthesized using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Thirteen studies were included with a total sample of 680 patients. Gaming was superior to other treatments and no treatment on reducing pain-related fear (SMD: -1.23; 95% CI: -2.02 to -0.44) and anxiety (SMD: -0.55; 95% CI: -1.01 to -0.09), respectively. Gaming was not superior to other treatments on reducing pain catastrophizing, anxiety, and depression, and it was not superior to no treatment on reducing pain-related fear, pain catastrophizing, and depression. Those findings were based on very low or low-quality evidence. In a conclusion, gaming modalities may have positive effects on some mental health outcomes. However, there were conflicting results with low-quality evidence, which indicates that more high-quality randomized controlled trials are needed.

The development and usability of a video game to attenuate pandemic-related stress using an equity lens

Background

The emergence of the novel coronavirus (COVID-19) has introduced additional pressures on an already fragile mental health care system due to a significant rise in depression, anxiety, and stress among Canadians. Although cognitive behavioral therapy (CBT) is known to be an efficacious treatment to reduce such mental health issues, few people have access to CBT in an engaging and sustainable manner. To address this gap, a collaboration between the Centre for Addiction and Mental Health (CAMH) and the National Research Council of Canada (NRC) developed CBT-based self-led, online, clinician-tested modules in the form of a video game, named Legend of Evelys, and evaluated its usability in the attenuation of a COVID-19–related increase in stress.

Objective

We here present the conceptualization and design of new self-care modules in the form of a video game, its implementation in a technological infrastructure, and inclusivity and privacy considerations that informed the development. A usability study of the modules was performed to assess the video game’s usability, user engagement, and user perceptions.

Methods

The development of the video game involved establishment of a technology infrastructure for secure implementation of the software for the modules and a clinician-led assessment of the clinical utility of these modules through two “whiteboard” sessions. The usability study was informed by a mixed methods sequential explanatory design to evaluate the intervention of the mobile app through two distinct phases: quantitative data collection using in-app analytics data and two surveys, followed by qualitative data collection by semistructured interviews.

Results

A total of 32 participants trialed the app for 2 weeks. They used the video game an average of six times and rated the game as “good” based on the Systems Usability Scale score. In terms of stress reduction, the study demonstrated a significant difference in the participants’ Perceived Stress Scale score at baseline (mean 22.14, SD 6.187) compared with that at the 2-week follow-up (mean 18.04, SD 6.083; t₂₇=3.628, P=.001). Qualitative interviews helped participants identify numerous functionality issues and provided specific recommendations, most of which were successfully integrated into the video game for future release.

Conclusions

Through this collaboration, we have established that it is possible to incorporate CBT exercises into a video game and have these exercises adopted to address stress. While video games are a promising strategy to help people with their stress and anxiety, there is a further need to examine the real-world effectiveness of the Legend of Evelys in reducing anxiety.

Video Games as a Complementary Therapy for Schizophrenia: A Systematic Review

BACKGROUND

Schizophrenia is a prevalent and serious disorder. Video games have shown potential as an aid in health care for people who suffer from schizophrenia. Although video games may contribute benefit in the treatment of schizophrenia, reviews on this topic are scarce. In this article, we systematically review the evidence concerning video game-based therapeutic interventions for people diagnosed with schizophrenia.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in the PROSPERO database. We searched 4 databases-PubMed, Web of Science, EMBASE, and clinicaltrials.gov-to identify original studies exploring video game-based therapeutic interventions for people with schizophrenia.

RESULTS

After initial screening, full-text review, and study selection, 11 articles were included in the review. Most studies used video consoles as the platform, with a minority using a personal computer. Video game-based therapeutic interventions were well accepted and generally effective in improving cognitive areas.

CONCLUSIONS

Cognitive training could be one of the main mechanisms underlying the usefulness and effectiveness of video game-based therapeutic interventions. Software optimization and greater collaboration between developers and health care professionals are some of the priorities for future research in this area.

Does Playing Apart Really Bring Us Together? Investigating the Link Between Perceived Loneliness and the Use of Video Games During a Period of Social Distancing

During the COVID-19 pandemic, several countries implemented social distancing measures to contain virus transmission. However, these vital safety measures have the potential to impair mental health or wellbeing, for instance, from increased perceived loneliness. Playing social video games may offer a way to continue to socialize while adhering to social distancing measures. To examine this issue further, the present online survey investigated social gaming during the pandemic and its association to perceived loneliness within a German-speaking sample. Results indicated a small positive correlation between general gaming frequency and perceived loneliness. Detailed analysis revealed a negative association between perceived loneliness and increased social forms of video gaming. Specifically, gamers with a higher social motive for gaming perceived less loneliness, but gamers with a dominant escape motive demonstrated a positive link to perceived loneliness. The use of social gaming in times of social distancing seems to play a small but significant factor in perceived loneliness compared to other demographical data. The findings are discussed with respect to methodological limitations, effect sizes, and sample characteristics. The results enrich the current knowledge on video gaming and its link to social wellbeing and provide a more nuanced picture than simplistic investigations of screen time.

Liquiritin Alleviates Depression-Like Behavior in CUMS Mice by Inhibiting Oxidative Stress and NLRP3 Inflammasome in Hippocampus

Objective

Central inflammation is generally accepted to be involved in the pathology of depression. We investigated whether liquiritin exerts antidepressant effects by inhibiting central NLRP3 inflammasomes.

Results

The behavioral despair model and chronic unpredictable mild stress (CUMS) model in mice were established to evaluate the antidepressant action of liquiritin. In the despair model study, liquiritin (40 mg/kg) administration reduced immobility time in tail suspension test (TST) and forced swimming test (FST) without affecting locomotion activity. In CUMS model study, liquiritin (40 mg/kg, once daily for 4 weeks) significantly increased sucrose consumption and body weight of CUMS mice. The behavioral experiment results showed that liquiritin reduced the immobile time of CUMS mice in TST and FST, respectively, and increased the time spent and open arm entries in the elevated plus-maze (EPM) test. Further, the hippocampal superoxide dismutase (SOD) activity was increased in liquiritin-treated group, while malonaldehyde (MDA) decreased. Additionally, the hippocampal cytokines interleukin-18 (IL-18) and interleukin-1 beta (IL-1β) contents were reduced in the liquiritin-treated group. Further, liquiritin downregulated the expression of NLRP3 in the hippocampus of CUMS mice rather than TLR4. Besides, NLRP3 inflammasome-associated proteins caspase-1 and ASC were also downregulated. However, liquiritin did not alter the thermal stability of NLRP3 in the cellular thermal shift assay (CETSA), suggesting that its inhibition of NLPR3 was not by direct targeting of NLRP3 protein.

Conclusions

Liquiritin attenuates depression-like behavior of CUMS mice and inhibited cytokines levels triggered by NLRP3 inflammasome, suggesting the antidepressant action is, at least partially, associated with antioxidant stress and inhibition of NLRP3 inflammasome activation.

Winning The Game Against Depression: A Systematic Review of Video Games for the Treatment of Depressive Disorders

PURPOSE OF REVIEW

To review the evidence about video game-based therapeutic intervention for people diagnosed with depressive disorders.

RECENT FINDINGS

Psychotherapy has been proved to reduce depressive symptoms and is a key element in the treatment of depressive disorders. However, geographical, economical and stigmatized concerns are barriers to access to psychotherapy. New technologies and videos games can overcome some of these barriers by providing teleconferencing evidence-based therapy as time as they may offer an interactive entertainment. Overall, video game-based interventions were useful and effective in reducing symptoms of depressive disorders. Seven of the studies were published in the last 5 years, which reflects the increased research interest in video game-based interventions for depression. Overall, when adherence was reported, rates of acceptability and feasibility were high.

A data-driven approach for examining the demand for relaxation games on Steam during the COVID-19 pandemic

The COVID-19 pandemic has been a major source of stress for a majority of people that might have negative long-term effects on mental health and well-being. In recent years, video games and their potential positive effects on stress relief have been researched and "relaxation" has been an important keyword in marketing a certain kind of video game. In a quasi-experimental design, this study investigated the increase of average daily player peak (ADPPs) for the COVID period compared to the pre-COVID period and if this increase was significantly larger for relaxing games in contrast to non-relaxing games. Results showed a medium-sized increase of ADPPs over all types of games but no difference between relaxing games and non-relaxing games. These results are discussed in regards to their potential of presenting gaps between the current theoretical models of the influence of video games on mental health and actual observed player behaviour.

A narrative literature review: the application of video games as therapeutic tools for psychological therapy

OBJECTIVES

Video games (games played by electronically manipulating images produced by a computer programme on a screen) are being developed with a specific focus on treating mental health. This narrative review briefly discusses the history of video games and mental health. It then provides a critical discussion on the application of video games as therapeutic tools, then discusses the notion of 'serious games' (games designed for a primary purpose other than entertainment) and their applicability.

CONCLUSIONS

Serious games have preliminary evidence to support their use practically in the clinical treatment of mental illness. Future randomised control trials are necessary to further explore their efficacy and potential areas of application.

Quality evaluation of stress, anxiety and depression apps for COVID-19

Background

COVID-19 has caused increased stress, anxiety and depression with increased barriers to treatment. Mobile apps offer a potential solution, but there is no information on the quality of such apps recommended for COVID-19. This study aims to evaluate the quality of stress, anxiety and depression apps recommended for COVID-19.

Methods

A search was conducted to identify relevant apps on the iOS and Android platforms. 44 apps were evaluated using the Mobile App Rating Scale (MARS), and the American Psychiatric Association's app evaluation model for data privacy and security.

Results

Overall quality scores of iOS and Android apps were 3.69 ± 0.43 and 3.66 ± 0.47. Thirty percent had good/excellent overall scores. In general, the iOS and Android versions of the apps scored best for functionality (4.21 ± 0.48, 4.12 ± 0.53), followed by aesthetics (3.84 ± 0.50, 3.78 ± 0.56), information (3.39 ± 0.54, 3.40 ± 0.60), and engagement (3.31 ± 0.81, 3.34 ± 0.84). Over half (59%) shared personal information with third parties and 14% were compliant with data protection standards.

Limitations

Only free apps available in Singapore were evaluated. Our results are time sensitive due to addition, removal, and update of apps in the app stores, thus our results should be extrapolated with caution to apps from other countries and paid apps.

Conclusion

Apps that addressed all three conditions had the highest overall quality scores. The top ranked apps (Sanvello, Woebot, Happify, Youper, Bloom) were of good quality, but majority were of acceptable quality and had room for improvement. App developers are encouraged to use our findings to improve and develop better quality apps.

Development of a casual video game (Match Emoji) with psychological well-being concepts for young adolescents

Digital interventions for mental health and well-being have been shown to be effective in trials, yet uptake and retention in real-world settings are often disappointing. A more significant impact may be achieved by building interventions that are closer to how target groups use technology to support their own psychological well-being. Casual video games may be poised to offer an opportunity in this area as they are a highly popular activity among young people. We propose that mental health content can be integrated into the explicit content and the implicit processes used in casual video games. In this paper, we describe the design and core processes of Match Emoji, a casual video game designed to support the development of psychological well-being via gameplay and micro-messages. The iterative development of Match Emoji involved various phases, including a systematic review of the literature, consultation with target users, clinicians, game developers, and close reading of the literature. Expert collaboration was sought throughout the process to ensure gameplay and messages matched behaviour change and learning theories. An acceptability and feasibility study of Match Emoji will inform a randomised controlled trial in the future.

Analysis of Heart Rate Variability in Response to Serious Games in Elderly People

As the proportion of elderly people continues to grow, so does the concern about age-related cognitive decline. Serious games have been developed for cognitive training or treatment, but measuring the activity of the autonomic nervous system (ANS) has not been taken to account. However, cognitive functioning has been known to be heavily influenced by the autonomic nervous system (ANS), and ANS activity can be quantified using heart rate variability (HRV). This paper aims to analyze the physiological response in normal elderly people as they play two types of serious games using HRV features from electrocardiography (ECG). A wearable device designed in-house was used to measure ECG, and the data from this device was pre-processed using digital signal processing techniques. Ten HRV features were extracted, including time-domain, nonlinear, and frequency-domain features. The experiment proceeds as follows: rest for three minutes, play a cognitive aptitude game, rest for another three minutes, followed by two reaction time games. Data from thirty older adults (age: 65.9 ± 7.34; male: 15, female: 15) were analyzed. The statistical results show that there was a significant difference in the HRV between the two types of games. From this, it can be concluded that the type of game has a significant effect on the ANS response. This can be further used in designing games for the elderly, either for training or mood management.

Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review

BACKGROUND

Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games.

OBJECTIVE

The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play).

METHODS

A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [("video game*") OR ("computer game*")] AND [("stress") OR ("anxiety") OR ("relaxation")] AND [("study") OR ("trial") OR ("training")].

RESULTS

A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety.

CONCLUSIONS

Efficacy in reducing stress and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081.

A Casual Video Game With Psychological Well-being Concepts for Young Adolescents: Protocol for an Acceptability and Feasibility Study

Background

Many face-to-face and digital therapeutic supports are designed for adolescents experiencing high levels of psychological distress. However, promoting psychological well-being among adolescents is often neglected despite significant short-term and long-term benefits.

Objective

This research has 3 main objectives: (1) to assess the acceptability of Match Emoji, a casual video game with psychological well-being concepts among 13-15-year-old students in a New Zealand secondary school; (2) to identify the feasibility of the research process; and (3) to explore the preliminary well-being and therapeutic potential of Match Emoji.

Methods

Approximately 40 participants aged 13-15 years from a local secondary college in Wellington, New Zealand, will be invited to download and play Match Emoji 3-4 times a week for 5-15 minutes over a 2-week period. Participants will complete 4 assessments at baseline, postintervention, and 3 weeks later to assess psychological well-being and therapeutic changes. Statistical analysis will be used to synthesize data from interviews and triangulated with assessment changes and game analytics. This synthesis will help to assess the acceptability and feasibility of the Match Emoji.

Results

The key outputs from the project will include the acceptability, feasibility, and therapeutic potential of Match Emoji. It is anticipated that participants will have finished playing the recommended game play regimen by August 2021 with analysis of results completed by October 2021.

Conclusions

Data from the study are expected to inform future research on Match Emoji including a randomized controlled trial and further adjustments to the design and development of the game.

International Registered Report Identifier (IRRID)

PRR1-10.2196/31588

Short-Term Effects of Video-Games on Cognitive Enhancement: the Role of Positive Emotions

According to established background knowledge, playing is essential in human development and a power remediation tool in clinical populations. In clinical interventions, the beneficial roles of playing have often been sought and investigated in the specific features of the game, rather than in the positive emotions generated by playing. However, regardless of game specifications, cognitive enhancement could be driven by the emotions linked to play. Establishing the causal connections between play and cognitive enhancement should allow us to determine how to involve play in therapy, prevention and educational programmes. Today, video-gaming is one of the most diffused forms of play. In the first crossover randomized controlled trial, we compared the short-term effects induced by shooting and puzzle video-games in visual perception, sensorimotor and reading skills in children with developmental coordination disorder and dyslexia. The funnier and more activating game enhanced breadth of visual perception and reduced sensorimotor and reading disorders. Visual perception, sensorimotor and reading improvements correlated with fun. In the second crossover randomized controlled trial, comparing the effects of the same shooting with a fighting video-game in healthy young adults, we show that regardless of game characteristics, changes in positive emotions correlated with contextual reading enhancement, while play-driven biochemical activation boosted single word and pseudoword reading. The short-term effects induced by play could be a useful clinical tool for the prevention and treatment of multiple cognitive disorders.

Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games

Globally, depression and anxiety are the two most prevalent mental health disorders. They occur both acutely and chronically, with various symptoms commonly expressed subclinically. The treatment gap and stigma associated with such mental health disorders are common issues encountered worldwide. Given the economic and health care service burden of mental illnesses, there is a heightened demand for accessible and cost-effective methods that prevent occurrence of mental health illnesses and facilitate coping with mental health illnesses. This demand has been exacerbated post the advent of the COVID-19 pandemic and the subsequent increase in incidence of mental health disorders. To address these demands, a growing body of research is exploring alternative solutions to traditional mental health treatment methods. Commercial video games have been shown to impart cognitive benefits to those playing regularly (ie, attention control, cognitive flexibility, and information processing). In this paper, we specifically focus on the mental health benefits associated with playing commercial video games to address symptoms of depression and anxiety. In light of the current research, we conclude that commercial video games show great promise as inexpensive, readily accessible, internationally available, effective, and stigma-free resources for the mitigation of some mental health issues in the absence of, or in addition to, traditional therapeutic treatments.

From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies

To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.

Stress-Reducing Effects of Playing a Casual Video Game among Undergraduate Students

To assess the potential effectiveness of playing a simple, casual video game (Flower) in reducing stress relative to participating in a mindfulness-meditation session (body scan) among undergraduate students. Eighty undergraduate student participants (mean age = 19.46 years, SD = 1.43; gender: 48 females, 29 males, 3 preferred not to answer) were assigned to one of two groups in alternating order: one who played Flower and the comparison group who participated in a body scan, each lasting 20 min. Psychological and physiological stress measurements were made before and after each intervention. Self-perceived psychological stress was measured using a modified version of the nine-item Psychological Stress Measure (PSM-9), and physiological stress (heart rate, systolic and diastolic blood pressure) was measured using an electronic blood-pressure cuff. The results were analyzed with a 2 (measurement: pre, post) × 2 (intervention: video game, mindfulness-meditation) mixed model analysis of variance (ANOVA) for each of the four outcome measures. There was a statistically significant reduction (pre- to post-intervention) across all outcome measures. Notably, there was a significant measurement × intervention interaction (p < .001) for the psychological stress measure; participants in the mindfulness-meditation group reported greater stress reduction after the intervention than participants in the video game group. Although these results suggest mindfulness-meditation provides a slight advantage for stress reduction than casual video games, the similarity in reduction across all physiological measures between the two interventions nevertheless suggests casual video games may also be an effective medium. This finding is especially promising given casual video games’ accessibility, ease of use, and popularity among students. These results may inform initiatives by colleges and universities to better support students during peak times of stress and especially during the current COVID-19 pandemic.

Video game play is positively correlated with well-being

People have never played more video games, and many stakeholders are worried that this activity might be bad for players. So far, research has not had adequate data to test whether these worries are justified and if policymakers should act to regulate video game play time. We attempt to provide much-needed evidence with adequate data. Whereas previous research had to rely on self-reported play behaviour, we collaborated with two games companies, Electronic Arts and Nintendo of America, to obtain players' actual play behaviour. We surveyed players of Plants vs. Zombies: Battle for Neighborville and Animal Crossing: New Horizons for their well-being, motivations and need satisfaction during play, and merged their responses with telemetry data (i.e. logged game play). Contrary to many fears that excessive play time will lead to addiction and poor mental health, we found a small positive relation between game play and affective well-being. Need satisfaction and motivations during play did not interact with play time but were instead independently related to well-being. Our results advance the field in two important ways. First, we show that collaborations with industry partners can be done to high academic standards in an ethical and transparent fashion. Second, we deliver much-needed evidence to policymakers on the link between play and mental health.