Running head: VIDEO GAMES IN

THERAPY

Video Games in
Therapy:
Exploring the Possibilities of a New Medium for
Therapy
Gregorio V. Yrastorza IV
University of the Philippines
Manila

VIDEO GAMES IN
THERAPY

Since their first appearance in the 1940s, video games have been a popular
culture symbol for modernization and technological advancement. Video games
have been a source of entertainment for a very long time. Recently, however, much
interest has been taken into researching the possible use of video games as a
therapeutic tool (Ceranoglu, 2010). Based on an article by Prot, Anderson,
Gentile, Brown, and Swing (2014), many positive and negative efects caused by
video games have been identified. Miller (2015) expounds on this by explaining the
efects of the diferent facets of video games, such as playing video games and
designing video games. Because video
todays

culture

and

represent

games

are

now

deeply

rooted

in

the advancement of technology, they are also

opening to several diferent possibilities, some of which involve their use in

therapy. This research paper aims to identify the benefits and downsides to using
video games as a new form of therapeutic tool. It also aims to determine whether it
would be beneficial to continue studying the therapeutic use of video games based
on the weights of these benefits and downsides.
For almost seven decades, video games have constantly been changing,
improving as technology advanced, and have changed the lives of modern man
in the process (Ceranoglu, 2010). The advancement of video games has
opened up many possibilities, and one of these possibilities is the use of video
games as a tool for therapy. Despite being marketed primarily for entertainment,
many developers and companies have begun investing in video games as a means
of relieving and treating several psychological and physiological disabilities. An
article by Robbins (2016) talks about several companies pushing for the
development of games which aim to relieve the pains that may be caused by
certain disabilities such as autism, ADHD, and depression. The article goes on to
state that although many games have been labeled

as being able to generally improve cognitive abilities, none of those games are
actually therapeutic in the sense that they do not actually relieve pain caused by
any form of disability whatsoever. That is why more and more researches are being
made as to what aspects of video games can really contribute to them being viable
as therapeutic tools.
Majority of researches have focused on the positive efects of video games
that can help improve a persons general well-being. Separate researches done by
Wilkinson, Ang, and Goh (2008) and Prot et al. (2014) have shown that both
therapeutically-designed and entertainment-oriented video games can improve a
persons ability to cope with depression, anxiety, aggressive behavior, and overall
psychological wellness. Wilkinson et al.s (2008) research goes on to say that online
games also help improve a persons social behavior and ability to handle
interpersonal relationships. This is backed up by a 2010 review by Ceranoglu.
A review by Horne-Moyer, Moyer, Messer& Messer (2014) talks about the
benefits non-therapeutic videogames can provide. Their research showed that
many video games were able to help improve sensorimotor skills, memory, critical
thinking, and creativity. Horne-Moyer et al. also mentioned the emotional benefits
of playing relaxing video games, observing that people who played such games
showed improvement in mood stability and sense of fulfillment. The University of
Toronto (2014) also conducted a study which showed that gamers had an improved
ability to learn easily repeated motions when compared to non-gamers. There was
no diference when it came to more randomized actions, however an article written
by Sohn (2004b) states that video games help improve a persons ability to
adapt to changes rather quickly. These

inconsistencies can be attributed to the fact that these articles and reviews were
written at diferent times, with more information coming to light over time.
Research has also been made on the efects of video games which help
alleviate specific disorders and pain caused by some disabilities. Therapeutic video
games as well as some non-therapeutic online and casual games have been proven
to alleviate
traumatic

the

symptoms

of

stress

and

anxiety

that

stem

from

post-

stress disorder or PTSD (Complex, 2015; Miller, 2015; Ashley, 2015).

Complex (2015) writes that military doctors have taken to using video games in
order to simulate traumatizing conditions experienced by soldiers during active
duty and use these simulated situations to help soldiers sufering from PTSD to
cope with their trauma upon returning from service.
Video games have also been designed to help patients with autism
overcome the debilitating symptoms of the condition such as decreased ability
to learn social cues, dificulty in learning certain concepts, and impulsiveness
(Fernandez-Aranda et al.,
2012). One notable example of a therapeutic video game is PlayMancer, a
video game which became the basis of a study done by Fernandez-Aranda et al.
in 2012. Their study showed that the game induced notable improvements in
patients sufering from diferent degrees of anxiety, attention-deficit, and impulsive
disorders.
An article written by Sohn (2004b) states several diferent benefits of
video games. She writes about how the inherently engaging nature of video games
helps those with attention-deficit disorders learn to focus on performing specific
tasks required of them. Her article goes on to say that many video games can also
help improve cognitive and decision-making abilities by ofering several choices
and possibilities as

well as engaging problems and puzzles which the players are free to undertake in
any manner they so choose.
Apart from

alleviating

pain

caused

by psychological, psychosocial,

and

cognitive disabilities, video games have also been developed which aim to
alleviate problems encountered by people with physiological disabilities. Gauthier
(2013) writes about a video game designed and developed by the Ohio State
Wexner Medical Center which helped rehabilitate patients who had lost certain
gross and fine motor skills due to motor weakness experienced by majority of
stroke survivors. The centers tests showed notable improvements in the patients
motor abilities in as little as two weeks of treatment. Gauthier goes on to state that
the game was developed based on already existing theories and concepts on
rehabilitating motor skills, the only diference being that the game was designed to
be more engaging and immersive for the patients than traditional methods.
Kollect is another game which aims to improve the motor skills of those
suffering from some efects of cerebral palsy (Drexel University, 2016). Kollect is an
active video game developed by enAble Games which makes use of the Microsoft
Xbox 360 Kinect motion sensor device and is targeted towards children with
cerebral palsy. It ofers an engaging way for patients to improve motor skills and
fitness by making them perform several actions for specific amounts of time in a
day. According to Drexel Universitys (2016) article, the game is currently in a
beta phase and the developers are seeking input from respectable professionals in
the fields of rehabilitation and therapy.
This does not mean to say that there are no negative efects of video games.
At present, much efort is being put into researching the many diferent positive
efects video games have on patients. During the late 1980s to the early
2000s, however,

research was actually focused on the many possible negative efects of video
games (Ceranoglu, 2010; Wilkinson et al., 2008). The main negative efect that
most research focused on was violence and aggressive behavior caused by violent
video games (Ceranoglu, 2010).
An article by Sohn (2004a) likens video game violence to television and film
violence. She states that violent activities in television and film have a profound
efect on how children react to violence. She presents evidence showing that
children who spend a significant amount of time seeing violence on-screen
eventually grow desensitized to violent acts and even show an afinity for
resorting

to

aggressive behavior when dealing with moderate to dificult

challenges. Video games only make this worse by putting players in control of said
violent actions, leading to a more positive attitude towards violence, aggression,
and antisocial behavior (Prot et al., 2014).
Another negative efect of video game play that is gaining more attention is
video game addiction. Knoeller, Staub, Stubbs, and Bradley (n.d.) describe video
game addiction as a point where a suferers need to play video games begins to
interfere with his or her ability to perform functions important to normal living.
Based on research done by Prot et al. (2014), an average of about nine percent of
the populations of highly developed countries can be said to have pathological
video game addiction. Although this number may appear small, it is actually
rather large as shown by Young (as cited in Knoeller et al., n.d.), whose research
has shown that as many as 30 million adolescents in China and 5 million children in
the United States could possibly be addicted to video games.
According to Knoeller et al. (n.d.) and Prot et al. (2014), the primary
cause of video game addiction is boredom. Since majority of the players of video
games are

children and adolescents, constant boredom causes them to seek the engaging and
mentally stimulating properties of video games. As time goes on, they begin to seek
these properties more and more, eventually becoming pathologically addicted to
the games they play. Knoeller et al. add that video game addiction is also slowly
gaining prevalence among adults with the primary cause being the search for an
escape from the problems and hardships of real life. Their study shows that adults
become drawn to the escapist nature of many video games and eventually
become addicted. Despite all

the

evidence

that shows

that

video

game

addiction is a very dangerous and possibly debilitating condition, it is still not

considered as a formal disorder by the Diagnostic and Statistical Manual of Mental
Disorders (Knoeller et al., n.d.; Prot et al.,
2014;
2015).

Miller,

For the purposes of video game therapy, it would be easy to counteract the
negative efects that video games produce. As stated in articles by Gauthier
(2013) and the Drexel University (2016), video game therapy should follow a
predetermined schedule just like any other form of therapy. This promotes not only
consistency and sustainability when it comes to rehabilitation in video game
therapy but also self-control in order to avoid the possibility of addiction to video
games. Increase in aggressive behavior and violent tendencies can also be avoided
by the use of calming elements as well as non-inclusion of violence in therapeutic
games altogether.
Aside from the therapeutic efects of playing video games, some research
has also been put into the therapeutic efects of designing and creating video
games. Miller (2015) looked into the development process of three diferent video
games which were described by their respective developers as being key to
recovering from certain psychological problems. The first of these games was
designed as a means for the

developer to come to terms with past trauma which afected them. The game itself
has very little in the way of helping players in a therapeutic manner.
Papo & Yo was a game developed by Minority Media Inc., and designed
by Vander Caballero. It tells the story of a boy who tries his best to deal with a
creature that is sometimes his friend and sometimes a terrifying monster. The
game itself is not very therapeutic, with no target audience and with seemingly no
point. For Caballero, however, the game was made as a coping mechanism for the
hardships he endured as the child of an alcoholic father. Caballero incorporated
elements of his childhood into the game which were not very relatable to players
yet held some psychological meaning to himself as they symbolized diferent
struggles and experiences which took root deep within his psych (Leone, 2012).
The second game looked into in Millers thesis was a game called That
Dragon, Cancer. It was designed by a couple as a coping mechanism after the
death of their son due to a terminal disease. The game also doubles as a
therapeutic tool to aid parents who also find themselves in a similar situation as
the game has been described to be autobiographical in nature, narrating the
diferent problems encountered when dealing with children aflicted with terminal
diseases. It also serves as a tool for promoting awareness on what life is like to be
a parent whose child has a terminal disease (Tanz, 2016).
The last of the three games is the most diverse as a therapeutic tool.
SuperBetter is more of a community-based game which was originally developed
as a means for the developer to gain relief from their own problems. Now, it is
available to a wide audience as a motivational tool for overcoming depression and
achieving self-growth (SuperBetter,
receives feedback from an

2016).

The development team constantly

active community in order to improve the game, so essentially the development of

the game becomes a therapeutic experience for both the developers and the player
community.
There are still negative efects to game development, however. Besides the
fact that developing video games is a very time- and resource-intensive venture,
developer harassment is also becoming prevalent in the online community.

The

International Game Developers Association (2015) has made an extensive resource

for video game developers that ofers advice as well as contact information for
several organizations that can help developers who are experiencing harassment.
Video games have also been used as therapeutic aids for assessing and
diagnosing the possible presence of psychological and psychosocial disorders in
patients. Games such as PlayMancer are designed not only to address, correct,
and relieve problems patients may face but also to assess and diagnose the
presence of disorders (Fernandez-Aranda et al., 2012). Wilkinson et al. (2008) and
Ceranoglu (2010) have described the use of video games in assessing disorders
based on actions the players perform while playing the games as well as how
players deal with specific in- game situations. In particular, Clancy et al. (as cited
in Wilkinson et al., 2008) found that children who were liable to endanger
themselves and others also behaved more dangerously in video games, taking
several risky actions and triggering more accidents in games than control groups.
Video games also have another very important use that does not involve the
use of video games in actual therapy. Video games can be used as a tool to spread
awareness on disability. According to the National Disability Navigator Resource
Collaborative (2016), it is important to be able to understand disabilities as it
allows

people to know the needs of people with disabilities. This ultimately aids in the
therapy process as it removes the barrier of relatives and colleagues being unaware
of what the person with disability they are related to requires in terms of treatment.
Miller (2015) and Ashley (2015) both write about video games being used as
symbols of depression, where multiple elements in games represent aspects of
depression which are still relatable to those who are not sufering from it. This helps
in the process of making those living without the condition understand and
empathize with those who sufer from it.
As mentioned before, That Dragon, Cancer is an autobiographical video
game which narrates the life of a parent whose child is afflicted with terminal
illness. The game contains many situations which are understandable and
enlightening for people who do not know what life is like for the parent of a child
with a terminal disease. It also helps people understand what it is like to
experience and subsequently cope with the loss of a child, which is a very dificult
subject to explain using words (Tanz, 2016).
To The Moon (Gao, 2011) is a video game which tells the story of how a
man struggled to cope with the death of his brother at a young age as well as being
married to a woman with autism. The game dispels many stereotypes regarding
people with autism and sheds more light on what having autism really entails. It
also shows the dificulty of trying to cope with a loss as well as all the
psychological disorders caused by the coping process such as amnesia and taking
on the personality of the lost loved one.
Taking all of this into account it can be seen that the benefits of video
game therapy outweigh the possible problems that may arise from it. Therapeutic
video games can help improve psychological well-being by lowering a persons
afinity for

aggression and improving their cognitive and sensorimotor abilities. Therapeutic

games can also help alleviate many of the symptoms of targeted disabilities and
disorders, possibly even providing a long-term solution to such problems. Video
games have also proven to be viable tools in improving a persons physiological
aspects as well, being able to improve gross and fine motor skills as well as
sensorimotor

ability.

Developing video games also provides an outlet for

developers to cope with their own problems. Video games designed for the purpose
of increasing awareness on disability are also important tools in making therapy
easier. Despite the fact that there exist downsides to video games such as being
causes for addiction, violent tendencies, and harassment, the benefits still
outweigh them. Any problems that could arise from these downsides can also be
controlled, particularly if the goal of being used for therapy is kept in mind while
developing video games. In the end, it can be said that even though video games
can cause many negative efects, there are far more positive efects that can be
gained and it will indeed be worthwhile to continue putting efort into researching
the use of video games in therapy.

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