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Alayna Myers

Sarah Vause

English 2010

27 September 2014

The Reality of Virtual Gaming

“After one month of release of the game Call of Duty: Black Ops, it had been played for 68,

000 years worldwide” (Bavelier n. pag.). With the rising popularity of videogames it is no

wonder that they are quickly being developed to become one of the best options for the future

treatment of mental disorders, as well as many physical ones. As the years have progressed,

and technology with it, doctors have been able to adapt virtual realities to target specific

afflictions of the mind and body.

Since the 1990’s we have been developing video games to help people to cope with, and

eventually overcome, their disabilities (Halpern n. pag.). Treatment plans involving virtual

realities are the key to a faster and more efficient recovery for many, and may “[have] the

potential to transform the field of mental health” (“Video Games Play May Provide Learning,

Health, Social Benefits, Review Finds” n. pag.). In fact, even those who do not have a specific

ailment can reap the benefits of playing video games.

Playing a video game, whether originally designed for therapeutic use or not, causes

positive structural changes in the brain. It can actually increase the overall mass of gray matter

in the brain, targeting regions “responsible for spatial orientation, memory formation, strategic

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planning, and fine motor skills” (Brooks n. pag.). According to Daphne Bavelier, action

packed games are especially beneficial when it comes to the way the brain behaves in situations

requiring high levels of attention, multitasking, or tracking multiple objects (n. pag.). This sort

of research suggests that video games can actually be used to train, or retrain, specific areas of

the brain. This would be highly beneficial for those of the older population, as these are the

sorts of skills that deteriorate with age. Games that could help them to recover these skills would

allow them to again participate in activities that have fallen outside of their range of abilities,

such as operating a motor vehicle; a task that involves all the skills mentioned by both Brooks

and Bavelier.

Video games do not only aide those who are aging adults, however. They also seem to

benefit the growing minds of children, as Granic, Lobel, and Engels have found they promote a

wide range of cognitive skills needed to be successful in the field of science, engineering,

technology, and mathematics. However, first person shooter games (or action video games)

hold far more weight when it comes to affecting the brain than puzzle or role-playing games do.

In many studies where participants were assigned to either an action game versus another type of

video game, those who played the action game showed “faster and more accurate attention

allocation, higher spatial resolution in visual processing, and enhanced mental rotation abilities”

(Granic, Lobel, and Engels 68). Furthermore, it has become evident that:

... [S]patial skills improvements derived from playing commercially available

shooter video games are comparable to the effects of formal (high school and

university-level) courses aimed at enhancing these same skills. ... [S]patial skills

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can be trained with video games in a relatively brief period, that these training

benefits last over an extended period of time, and crucially, that these skills

transfer to other spatial tasks outside the video game context. (Granic, Lobel,

and Engels 68)

While it is easy to see how video games can be used to increase the cognitive ability of

teens, the social skills they teach are often over looked despite the fact that over seventy percent

of gamers play with a friend, either competitively or cooperatively (“Video Games Play May

Provide Learning, Health, Social Benefits, Review Finds” n. pag.). Video games, especially

online ones, are an ideal way for children and teens to make the social connections necessary

for their development, as it is through social interactions that they “begin to establish a sense of

‘self’ and to learn what others expect of them. … [and] have higher self-esteem” (Child and

Family Services n. pag.).

Yet even when players are not directly bonding with another player, games force players

to make decisions about whom to trust or reject, how to lead a group, how to support their

teammates and work together, and much more. For example, it has been found that

“adolescents who [play] games with civic experiences (e.g., Guild Wars 2, an MMORPG, or

massive multiplayer online role-playing game) were more likely to be engaged in social and

civic movements in their everyday lives” (Granic, Lobel, and Engels 73). This constitutes

activities such as volunteer work or raising money for charities. Teenage gamers are constantly

learning social skills and behaviors that can be transferred to their relationships outside of virtual

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reality. Learning how to use such skills competently is imperative as teens mature and

eventually enter the adult world.

When specifically used in treatment plans, video games help to increase a patient’s

motivation to adhere to their therapy programs. When a video game dubbed Re-Mission was

designed to “help teens and young adults with cancer stick to their treatment plan. … Adherence

to therapy was 16% better in patients who played Re-Mission [sic] video game as compared to

those who played a popular standard video game” (Kato, “Video Game Improves Adherence to

Therapy” n. pag.). Motivation for patients to actually follow through with their therapy

programs is key, as treatments required usually entail painful, mundane, or aversive behaviors.

When a patient’s attention is focused on an engaging distraction, such as a video game, it

allows them to better cope with any unpleasant symptoms they may encounter.

Video games can actually provide a patient the chance to experience “catharsis, or a

release of tension and fears in a safe context” (“Video Games in Health Care: Closing the Gap”

114). Video gaming allows both children and adults stress relief from their current life

situation, providing a way for them let out any emotions they have. They are also very effective

at promoting relaxation while also decreasing any anxiety a patient may feel about their current

predicament. These games often drastically improve the mood of the gamer as well, as they are

one of the “most effective means ... to generate positive feelings” (Granic, Lobel, and Engels

71).

It definitely helps that the motivation to play video games is already present in the youth

of America, as “91% of children between the ages of 2 and 17 play video games” (Granic,

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Lobel, and Engels 66). Given that information, it is easy to assume that video games would be

geared only toward treating those of the younger generation, but not so. The average age of a

gamer today is “33 years old” (Bavelier n. pag.).

This is most likely because video games can adjust themselves to the skills and

capabilities of the individual player, and so the difficulty level of the game can be changed

dynamically. The best motivational games also include a phenomenon most commonly referred

to as the “sweet spot” (Granic, Lobel, and Engels 71). This event occurs when the game is able

to balance “optimal levels of challenge and frustration with sufficient experiences of success and

accomplishment” (Granic, Lobel, and Engels 71). Basically, this means that if the game is too

difficult the player will lose interest and will feel that the game is unbeatable. However the

game cannot be made too easy or else the player will feel he or she is not being challenged

enough, and so will also lose their desire play. Game designers must make the game hard, but

not too hard, and offer some sort of rewards or achievements the player can earn throughout the

game. Oftentimes this motivational factor is employed by progressing through plotlines, point

systems, and unlocking new games or levels within the video game.

Because of the high motivational factors that many video games possess, they have

become a very logical alternative to the traditional at home treatments used today. Typically if a

patient requested to be treated from their home it would involve the use of expensive robotics or

installing complex technological systems in their home. But if a video game could be created

that could generate the same results at home, a patient would simply need the game and its

console.

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This makes treating all patients in the comfort of their own homes a realistic goal. Home

treatment with virtual games could potentially save both the practitioners and the patients an

incalculable amount of money and time, as there would be no excess travel time, no paying for

the use of large expensive machines, and the repair/maintenance of said machines, nurses could

use their time attending to those in immediate need instead of walking a patient through therapy,

etc.

The use of video games to treat patients can be spread across a staggering number of

physical ailments. Studies so far have shown that they help with pediatric cancer (and the

associated nausea that comes from its treatment), burn pain, asthma, diabetes, bladder or

bowel dysfunction, physical therapy, physical fitness, cerebral palsy; the list goes on and on.

Often times treatment involving the use of video games actually speeds up the whole therapeutic

process. For example, when used to treat amblyopia (an eye disorder more commonly referred

to as lazy eye) results were reached five times faster than when the traditional occlusion therapy

treatments were used (Roger et al 1).

As mentioned previously, these video games also provide a meaningful distraction to any

unpleasant symptoms of a patient’s treatment, or their ailment. This is particularly significant

when applied to the pain a patient can handle. It has been found that burn patients who were

immersed in the RPG (or role-playing game) SnowWorld, which featured falling snow and cool

breezes along with an icy landscape, while receiving treatments such as burn debridement

(which involves scraping off the neurotic skin from the burn sites and is incredibly painful),

were actually able to achieve an extra level of pain tolerance and described it as “fun” (Kato,

“Video Games in Health Care: Closing the Gap” 116). Video games that are capable of

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immersing the player into a virtualized world have the potential to help any patient, not just burn

victims, who struggle with pain management.

Just as video games apply to many physical impairments, they also apply to a vast array of

mental illnesses. Their uses range from treating things like eating disorders (ED’s) and OCD to

helping patients cope with more complex disorders like schizophrenia and PTSD. They have

proved to have the “potential capacity to change underlying attitudinal, behavioral and emotional

processes of patients with impulse-related disorders” (Fernández-Aranda et al 364).

Researchers have been able to develop virtual games that come incredibly close to the actual

reality of our physical world, recreating not only images and sounds but textures and scents as

well. This is important as exposure therapy is becoming a more and more popular method of

treating mental disorders, especially those involving high levels of anxiety (Joseph and Gray

71). Exposure therapy focuses on repeatedly exposing the patient to their phobia(s), or

whatever is causing them anxiety.

In more recent years, a lot of emphasis has been put on finding more effective treatments for

PTSD, as it has become a more prevalent disorder among American troops. However, while

over “twenty per sent [sic] of Iraq and Afghanistan war veterans are suffering from P.T.S.D. ...

Almost half won’t seek treatment” (Halpern n. pag.). Many veterans find the idea of chatting

with a therapist to be demeaning or a waste of time, and so refuse help. This is a big reason why

video games have been so much more effective in treating recent generations of veterans; they

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grew up on video games, and so it feels more natural and masculine than sharing their feelings

and personal experiences with a therapist.

Such virtual games utilizing exposure therapy have proved to be extremely effective, some

patients recovering in “five to six weeks” (Halpern n. pag.). This is not only because they are a

more attractive alternative to the traditional therapies, but also because they “augment the

therapeutic process ... [by] treat[ing] the core fear, the avoidance and anxiety that are a part of

P.T.S.D.” (Halpern n. pag.).

A more recent breakthrough in treating ADD, ADHD, ED’s, and other impulse-related

disorders uses bio-feedback to retrain how the patients’ minds processes various pieces of

information. It entails using biosensors to take into account various physical reactions of the

patient (such as heartbeat, skin temperature, facial expressions, etc.) to change the difficulty

and type of game presented to the player. The obstacles that a player encounters increases both

in number and in difficulty if they allow more negative emotions to take over (e.g. anxiety,

stress). The only way to overcome these obstacles, and decrease their frequency, is to bring

those emotions back under control. Therefore, the video game is able to “[help] patients to learn

relaxation skills, better self-control strategies and develop new emotional regulation strategies”

(Fernández-Aranda et al 364 ). While the extent to which these games are able to teach patients

emotional-regulation skills is still unknown, “these ideas seems [sic] like an exciting new area

for future programs of research” (Granic, Lobel, and Engels 72).

While the benefits of using video games in the health care industry appear to be obvious,

there is a question that must be answered before any solid progress can be made. That is, how

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permanent are the effects of such treatments? Long-lasting effects are imperative for any

rehabilitative treatments, and the permanency of video game therapies appears to vary

depending on what specific ailment is being treated. While the improved results with PTSD

patients was still present over a year later (Halpern n. pag.), those who used virtual games to

improve specific cognitive skills (like multitasking or tracking multiple objects) found that the

improvement lasted only five to six months (Bavelier n. pag.).

However, the overall trend does seem to suggest that even if video games prove not to

be a one-time permanent solution, the nature of such games allows them to become a simple and

easy way for patients to maintain the results they have gained from previous treatments. Thus

allowing video games to “enhance the long-term effectiveness of traditional therapies”

(Fernández-Aranda et al 371).

A lot of research is still required to see exactly how video games can be integrated with

today’s medical practices, as there are several methodological drawbacks to conducting such

studies:

There are few, if any, well-designed published studies that examine both

the positive and negative effects for the same games and the conditions

under which these effects are most likely manifested. ... [T]he majority of

studies on video games ... continue to depend on survey assessments. ...

[T]here is a lack of controlled designs and lack of sample power, making

it difficult to expand on [any] obtained results.” (Granic, Lobel, and

Engels 74)

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Relying on such partial results, as a majority of gaming research does, limits our

understanding and application of video games in the medical field. Although considering the

level of difficulty involved in procuring more substantial results, video games have shown a lot

of promise so far.

Unfortunately, designing video games for use in treatment plans faces a few other

obstacles other than just the methodological issues in research, or the permanency of their

effects. These include creating games that all patients will enjoy and find engaging (while still

applying to the overall goal of the therapy) and finding a way to address specific therapeutic

goals that video games are usually not equipped to handle (e.g. strength building for those

suffering from cerebral palsy) (Biddiss 516). The potential negative side effects of gaming are

also a present threat to the possibility of their future use in medicine, these negative results

including symptoms like “addiction, depression, and aggression” (Granic, Lobel, and Engels

74).

It is quite clear that video games are quickly becoming one of the best ways to treat both

mental and physical disorders. Fortunately, research pertaining to such application for these

games is being rapidly expanded upon as “more health professionals are becoming interested in

innovative and cost-effective treatment approaches” (Fernández-Aranda et al 365). The results

thus far have proven how valuable developing these therapeutic games could be, even for those

without disorders.

Granic, Lobel, and Engels have stated, “Given how enthralled most children and

adolescents are with video games … a multidisciplinary team of psychologists, clinicians, and

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game designers can work together to develop genuinely innovative approaches to mental health

interventions” (76). The motivation to play video games is already inherent in today’s youth,

and so researchers will continue to delve deeper into the realm of virtual gaming, discovering

more and more ways to utilize virtual reality games for clinical use. Video games could very

well be involved in future medical breakthroughs.

Works Cited

Bavelier, Daphne. “Your Brain on Video Games.” TED Talks. June 2010. Web. 6 Sept.

2014.

Biddiss, Elaine. “Should We Integrate Video Games Into Home-Based Rehabilitation Therapies

for Cerebral Palsy?” Future Neurology 7.5 (2012):516. Web. 12 Sept. 2014.

Brooks, Megan. “Video Games a Viable Treatment for Mental Illness.”  Medscape

Multispeciality 8 Nov. 2013. Web. 10 Sept. 2014.

Child and Family Services. Stanislaus County Office of Education, n.d. Web. 28 Sept. 2014.

Fernández-Aranda, Fernando, et al. “Video Games as a Complementary Therapy Tool in

Mental Disorders: Playmancer, a European Multicentre Study.” Journal of Mental

Health 21.4 (2012):364-371. Web. 12 Sept. 2014.

Granic, Isabela, Lobel, Adam, and Engles, Rutger. “The Benefits of Playing Video Games.”

American Psychologist 69.1 (2014):66-76. Web. 10 Sept. 2014.

Halpern, Sue. “Annals of Psychology: Virtual Iraq.” New Yorker 19 May 2008. Web. 6 Sept.

2014.

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Joseph, J.S., Gray, M.J. (2008). “Exposure Therapy for Posttraumatic Stress Disorder.”

Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention 1.4

(2008):71. Web. 12 Sept. 2014.

Kato, Pamela. “Video Games in Health Care: Closing the Gap.” Review of General

Psychology, 14.2 (2010):114-116. Web. 10 Sept. 2014.

Kato, Pamela, et al. “Video Game Improves Adherence to Therapy.” Drug News 2010. Web.

10 Sept. 2014.

Roger, L. W., et al. “Video-Game Play Induces Plasticity in the Visual System of Adults with

Amblyopia.” PLoS Biology 9.8 (2011):1. Academic Search Premier. Web. 7 Sept.

2014.

“Video Games Play May Provide Learning, Health, Social Benefits, Review Finds.” American

Psychological Association 25 Nov. 2013. Web. 7 Sept. 2014.