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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 1990s 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
can be trained with video games in a relatively brief period, that these training

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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
reality. Learning how to use such skills competently is imperative as teens mature and
eventually enter the adult world.

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When specifically used in treatment plans, video games help to increase a patients
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 patients 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,
Lobel, and Engels 66). Given that information, it is easy to assume that video games would be

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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 patients 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 (EDs) 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 (Fernndez-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 wont 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
grew up on video games, and so it feels more natural and masculine than sharing their feelings
and personal experiences with a therapist.

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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, EDs, 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

(Fernndez-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
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

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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

(Fernndez-Aranda et al 371).
A lot of research is still required to see exactly how video games can be integrated with
todays 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)
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

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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 (Fernndez-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
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 todays youth,
and so researchers will continue to delve deeper into the realm of virtual gaming, discovering

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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.
Fernndez-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.