Michelle Colder Carras1,2*
Antonius J. Van Rooij3
Donna Spruijt-Metz4
Joseph Kvedar5
Mark D. Griffiths6
Yorghos Carabas1,2Alain Labrique1,2
- 1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- 2Johns Hopkins University Global mHealth Initiative, Baltimore, MD, United States
- 3Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
- 4Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
- 5Harvard Medical School, Boston, MA, United States
- 6Nottingham Trent University, Nottingham, United Kingdom
Emerging research suggests that commercial, off-the-shelf video games have potential applications in preventive and therapeutic medicine. Despite these promising findings, systematic efforts to characterize and better understand this potential have not been undertaken. Serious academic study of the therapeutic potential of commercial video games faces several challenges, including a lack of standard terminology, rapidly changing technology, societal attitudes toward video games, and understanding and accounting for complex interactions between individual, social, and cultural health determinants. As a vehicle to launch a new interdisciplinary research agenda, the present paper provides background information on the use of commercial video games for the prevention, treatment, and rehabilitation of mental and other health conditions, and discusses ongoing grassroots efforts by online communities to use video games for healing and recovery.
Introduction
In 2017, over 130 million Americans (40% of the population) played commercial video games (also known as digital games) (1). Substantial research attention around this now-mainstream habit has examined problems related to video gaming ranging from sedentary screen time, exposure to violence, and excessive or problematic gaming (2, 3). However, there is emerging empirical research into the area of commercial video games as therapy (VGTx). In contrast to the custom-made, video game-based health interventions and applications (games for health) developed by a large community of innovators in mHealth and eHealth, the present paper focuses on commercial, off-the-shelf video games (COTS games) that are designed for entertainment, with no consideration of their therapeutic potential. In a sense, one might consider VGTx as a different take on games for health. Instead of making a game as a way to address a health problem, we suggest adapting or incorporating games that millions of people already play into interventions that promote health.
Key aspects of COTS games and their associated technologies—from the virtual gameplay-centered social support networks to the highly engaging, realistic interactive environments—may disrupt healthcare over the coming decade. The level of technological and gameplay sophistication and subsequent user experience made possible through massive corporate funding for COTS games are often orders of magnitude superior to the budgets available to develop bespoke games for health. [It may come as a surprise to many that for some years now, the video game industry’s annual sales (~US$24billion) have been more than double Hollywood movie box office sales (~US$11billion) (4, 5)]. We position this research and action agenda as a call for investigators, mental health professionals, the video game industry, and the gaming community to work together to better understand the opportunities and challenges that this emerging field of innovation presents.
The small body of research in this sphere to date has focused on the impact of unmodified commercial games as health interventions. Pilot studies of games and gaming communities have begun to provide early evidence of outcomes in a variety of health areas [Table 1; for a recent review, see Griffiths et al. (6)].
Table 1. Selected studies of video games and health outcomes.
For example, success in playing the computer solitaire game FreeCell may be useful to monitor cognitive status in adults with mild cognitive impairment (8), while new augmented reality games such as Pokémon GO could be useful to promote physical activity among those who are normally reluctant to engage (7). For children undergoing surgery, a hand-held game was more useful in relieving preoperative anxiety than a dose of midazolam (10). Puzzle games such as Tetris and Bejeweled have been shown to reduce depression, stress, and even prevent flashbacks after a traumatic event (12, 18, 23). The structural characteristics of games may provide unique affordances that traditional therapies do not offer.
Games may also be a useful tool in psychotherapy for assessment, building rapport, and providing social skills training (19, 22). Family members or loved ones may also play a useful role in VGTx. For example, playing non-competitive and non-violent video games together is a good way for parents to participate in a child-directed activity in Parent-Child Interaction Therapy [(24) p. 207]. Playing together as a family also fosters social connection between grandparents and grandchildren, which is highly supportive of the health of older adults (25).
As gamers are able to join forces to defeat common virtual enemies or accomplish virtual tasks, gaming communities also unite around real-world problems in a therapeutic and philanthropic way. Gamers and gaming-related organizations—directly and indirectly through charitable contributions—provide social and psychological support, including peer support, online clinician-delivered services, information about mental health conditions, and assistance finding in-person mental health treatment to community members and the gaming population at large. For example, non-profit organizations, such as Stack-Up and Anxiety Gaming, provide spaces where gamers can learn about mental health problems, seek support and assistance, and interact socially either in person or online. This image of connected, socially engaged gamers challenges the stereotypical notion of video game play as an isolating and individual pastime that reinforces societal disconnectedness (26). Growing evidence suggests that online communities are, for specific types of players, socially liberating and contribute to improvements in self-esteem and control of emotions in real-world settings (27). Although it may seem counterintuitive to suggest that individuals with social anxiety or other reasons for avoiding face-to-face social interactions may benefit from interventions that do not involve exposure to “in vivo” therapy, online interactions allow individuals with mental health challenges to receive much needed social support and a sense of connectedness or belonging (28, 29), which are ideal interventions for individuals with suicidal ideation and behavior (30).
Improving Methodological Practice
The serious academic study of VGTx faces several challenges. First, evidence synthesis around VGTx is difficult. There is no standard terminology for commercial video games or gameplay in the medical and psychological literature, and even studies about “serious video games” (i.e., games developed specifically for therapeutic purposes), do not always use that term, instead using terms, such as “interactive digital rehabilitation technology” or simply “virtual reality” (31, 32). Some of the difficulty in defining and naming terms may also be due to researchers’ extant biases and attitudes toward commercial games. Published studies concerning video games from public health, pediatrics, psychiatry, and psychology perspectives appear to have become less positive over time, and studies having a positive focus are more likely to be found in journals with a low impact factor (33). Reviews of the therapeutic effects of video games usually conflate commercial games and custom-designed games or gamified interventions, making it difficult to compare interventions and draw conclusions about the potential benefits of popular commercial video games.
Second, rapidly changing technology requires a prepared and adaptive health research ecosystem. The pace of growth in technology related to mHealth, eHealth, and games for health research over the past decade has greatly increased and similar changes in video games themselves challenge the ability of public health research to keep up. COTS games would be considered complex interventions, making them among the most challenging to develop and evaluate. In addition, the emergent nature of gameplay experiences adds additional complexity to understanding the interactions between the traditional individual, social, and cultural determinants of health. As described in Figure 1, the individual and social context of users may drive video game play, which offers specific benefits such as purposeful engagement and social interactions that could also form the basis of interventions.
Figure 1. Conceptual framework for video games as therapy.
Gameplay itself may provide a data source that could potentially be used to identify needs or opportunities for specific interventions that could then be delivered to users, such as suicide prevention information or in-game peer support. For example, passive data capture of time spent playing games or in-game social interactions and activities (e.g., cooperative play, sending in-game messages) might be an indication of symptom strength in disorders such as schizophrenia or depression (34). Machine learning algorithms that use the “big data” resulting from video game play (Figure 1) may one day be a way to screen players for mental health states and offer intervention the way Twitter feeds have been used to predict depression, bipolar disorder, and PTSD (35). Because of this complexity, creating a science of VGTx involves many of the same challenges as recent efforts to bolster the science of digital health. Technology outpaces research, requiring an interdisciplinary approach that combines methodological rigor with rapid evaluation and changes in research capacity and infrastructure (36).
Games and gaming communities arguably represent complex populations and systems, the study of which requires interdisciplinary collaboration. For example, clinical and public health research may focus on the mainstays of health determinants, such as dose, delivery, and sociocultural contexts, but structural characteristics unique to games also need to be considered—ranging from social and immersive features and reward structures to the controllability of game experiences that contribute to beneficial (and problematic) outcomes (37). For example, it may be the high visuospatial task demand of Tetris that serves to disrupt memory consolidation after trauma, and since adherence to traditional exposure-based therapies for PTSD is low (38), this form of cognitive “vaccine” may be a particularly useful intervention. These structural characteristics are usually the purview of games studies researchers in the fields of communications, ergonomics, media psychology, and health psychology. In these latter fields, a substantive literature on game studies may be found, a body of work that is seldom consulted in the course of public health or medical research. Taking a broader perspective that involves attention to the complex and dynamic nature of gaming and incorporates rigorous scientific methods from various fields to study gaming effects and in-game events is critical to better understanding the individual and population health outcomes from therapeutic uses of games and game communities.
As with any technology-based intervention, public health research must find ways to keep pace with rapidly changing games and game-related technologies. Gaming communities and experiences evolve rapidly, but health research is notoriously slow (39). In the last 40 years, the video game space has moved from static, disconnected games such as Pong and Pac-Man to Internet-based multiplayer games to entertainment portals like Twitch (Figure 2). Twitch, a website and video streaming service devoted to video game play, amassed a following of 45 million viewers in its first 2 years (40). Game “streamers” broadcast and narrate their gaming and interact with viewers verbally while viewers post messages to streamers and other viewers in chatrooms. These 45 million gamers comprise a new type of population that is inherently reachable due to their use of an online gaming-community-based platform. The fast pace of change in gaming communities, technologies, and game features, driven by the demands of game designers (and the players they design for), is not friendly to the years or decades it may take to fund, study, and implement medical and public health innovations (41, 42). While health researchers may take months to over a year to write a grant application and find funding, a new video game community may be formed and grow to millions of individuals or a groundbreaking technology may become commercially available, making an older one obsolete.
Figure 2. Important milestones in the evolution of video games and gaming communities.
Second, software and hardware developers often alter game mechanics or features that change fundamental aspects of a game to improve or adjust the user experience, thus influencing any game-specific research activity and subsequent conclusions. For example, years of game studies research have discussed the social benefits of belonging to a “guild,” “clan,” or other team of players in massively multiplayer online games such as World of Warcraft (43–46), but guild membership is no longer necessary to achieve high-level game accomplishments since gameplay changes were implemented in 2011 and 2013 (47). This is an important difference from the study of custom-made games for health because existing game features and changes to commercial games are market driven by industry developers. Researchers and developers of VGTx may, therefore, have to be able to rapidly adapt or concentrate on therapeutic interventions/assessments that are not dependent on specific game features (e.g., developing interventions based on a type of computer game such as Solitaire) (8, 48) rather than focusing interventions on more specific features such as guild membership. The aforementioned challenges may be addressed by developing constructive partnerships with VGTx stakeholders, because only interdisciplinary scientific, industry, and game community partnerships will strengthen our capacity to engage in VGTx research.
New research frontiers require careful thought to the ethical, legal, and social implications of research on VGTx and the communities that play them. Protecting the privacy of players as research participants is an unclear landscape, with data privacy standards differing between game industry and research communities (49). Transparent descriptions of what type of play data will be used, how it will be used for research purposes, and the limits of data sharing will be vital to ensure participants’ privacy. Close collaboration will help ensure appropriate attention is given to guaranteeing the highest standards of research ethics, and that health research is not exploited for (or driven by) commercial gain. In addition, the potential adverse effects of any public health intervention should be considered. Clinical trials of VGTx will need to monitor and report all adverse effects. Finally, ways to address the conflicts of interest that might arise from academics working with industry partners (as is standard in areas such as pharmaceutical research) will have to be developed, including financial and non-financial conflicts of interest such as involvement of researchers with the games or the gaming communities being studied. Registration of clinical trials and hypothesis-testing in non-clinical studies is one way to enhance transparency and ensure reporting of outcomes (50).
A more nuanced and deeper understanding of the positive health and public health consequences of gaming as a major global pastime is long overdue. An industry that has experienced an approximately 8% compound annual growth rate since 2015 is, if anything, going to continue to penetrate further into contemporary society with continued innovation and novel digital gameplay (51, 52). It is contingent on the interdisciplinary research community to ramp up efforts to better understand which social and contextual elements of games and game communities can be harnessed as genuine health interventions, and which physical and mental health outcomes can be evaluated longitudinally on a population scale in a valid way.
Conclusion: Make Way for Chocolate-Covered Strawberries
Our team has been exploring the clinical and curative applications of this oft-maligned space and recognizes the need for more evidence to support the widespread use of these innovations. To conclude, we present a call for strategic investment into a research agenda that includes:
• Developing standardized terminology and reporting to describe the complex aspects of commercial video games and gaming communities as exposures and interventions.
• Designing standardized protocols and best practice methodologies to evaluate the effects of therapeutic uses of games and gaming communities on clinical and public health outcomes.
• Investigating interdisciplinary approaches to capture and integrate rapidly changing technologies, game culture and communities, and games themselves.
• Establishing best practices and ethical protocols for rules of engagement with the game industry as partners, including standards for player privacy and management of conflicts of interest.
• Investigating best practices for identifying which games work for which health condition (and which population), including potential mechanisms for effects, economic analyses, and ongoing monitoring and evaluation of intervention effectiveness.
• Learning to model the complex, temporally dense data that games can provide.
Digital gaming today is a far cry from its 8-bit predecessors of the 1980s. Internet connectivity has fostered hyperconnected global communities of gamers and distributed social networks through play, the consequences and implications of which are poorly understood. This research agenda will require innovative public/private collaborations between academia, gaming communities, and private sector developers. Furthermore, research investments will need to be made to fill these important knowledge and research gaps.
As Carl Jung said, “The creation of something new is not accomplished by the intellect but by the play instinct” (53). We might be a decade or more away from important breakthroughs that leverage video gaming to heal people and populations. In comparison to games for health, which have been described as “chocolate-coated broccoli” (54), VGTx might be “chocolate-coated strawberries” designed to attract, thrill, and retain players, who reap inadvertent or intentional benefits of their gameplay. Learning how to harness these play possibilities for clinical and public health good will first require us in the public health and clinical research community to think outside the proverbial [X]box.
Author Contributions
All authors contributed equally to the conception, writing and revision of the paper, approved the final version, and agreed to be accountable for all aspects of the work.
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The reviewer SO and handling Editor declared their shared affiliation.
Funding
This research was supported by the National Institute of Mental Health Training Grant 5T32MH014592-39.
References
1. Brown A. Younger Men Play Video Games, But So Do a Diverse Group of Other Americans [Internet]. Pew Research Center (2017). Available from: http://www.pewresearch.org/fact-tank/2017/09/11/younger-men-play-video-games-but-so-do-a-diverse-group-of-other-americans/
2. Aarseth E, Bean AM, Boonen H, Colder Carras M, Coulson M, Das D, et al. Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal. J Behav Addict (2016) 6(3):267–70. doi:10.1556/2006.5.2016.088
3. Elson M, Ferguson CJ. Twenty-five years of research on violence in digital games and aggression: empirical evidence, perspectives, and a debate gone astray. Eur Psychol (2014) 19(1):33–46. doi:10.1027/1016-9040/a000147
4. Theatrical Market Statistics [Internet]. Motion Picture Association of America (2016). Available from: https://www.mpaa.org/wp-content/uploads/2017/03/MPAA-Theatrical-Market-Statistics-2016_Final.pdf
5. Entertainment Software Association. Essential Facts about the Computer and Video Game Industry [Internet]. (2016). Available from: http://essentialfacts.theesa.com/
6. Griffiths MD, Kuss DJ, Ortiz de Gortari AB. Videogames as therapy: an updated selective review of the medical and psychological literature. Int J Priv Health Inf Manag (2017) 5(2):71–96. doi:10.4018/IJPHIM.2017070105
7. Althoff T, White RW, Horvitz E. Influence of Pokémon Go on physical activity: study and implications. J Med Internet Res (2016) 18(12):e315. doi:10.2196/jmir.6759
8. Jimison H, Pavel M, McKanna J, Pavel J. Unobtrusive monitoring of computer interactions to detect cognitive status in elders. IEEE Trans Inf Technol Biomed (2004) 8(3):248–52. doi:10.1109/TITB.2004.835539
9. Redd WH, Jacobsen PB, Die-Trill M, Dermatis H, McEvoy M, Holland JC. Cognitive/attentional distraction in the control of conditioned nausea in pediatric cancer patients receiving chemotherapy. J Consult Clin Psychol (1987) 55(3):391–5. doi:10.1037/0022-006X.55.3.391
10. Patel A, Schieble T, Davidson M, Tran MCJ, Schoenberg C, Delphin E, et al. Distraction with a hand-held video game reduces pediatric preoperative anxiety. Paediatr Anaesth (2006) 16(10):1019–27. doi:10.1111/j.1460-9592.2006.01914.x
11. Mortensen J, Kristensen LQ, Brooks EP, Brooks AL. Women with fibromyalgia’s experience with three motion-controlled video game consoles and indicators of symptom severity and performance of activities of daily living. Disabil Rehabil Assist Technol (2015) 10(1):61–6. doi:10.3109/17483107.2013.836687
12. Russoniello CV, Fish M, O’Brien K. The efficacy of casual videogame play in reducing clinical depression: a randomized controlled study. Games Health J (2013) 2(6):341–6. doi:10.1089/g4h.2013.0010
13. Elliott L, Golub A, Price M, Bennett A. More than just a game? Combat-themed gaming among recent veterans with posttraumatic stress disorder. Games Health J (2015) 4(4):271–7. doi:10.1089/g4h.2014.0104
14. Han DH, Renshaw PF, Sim ME, Kim JI, Arenella LS, Lyoo IK. The effect of Internet video game play on clinical and extrapyramidal symptoms in patients with schizophrenia. Schizophr Res (2008) 103(1–3):338–40. doi:10.1016/j.schres.2008.01.026
15. Pope AT, Palsson OS. Helping Video Games Rewire “Our Minds” [Internet]. Arts & Humanities in Public Life Conference: “Playing by the Rules: The Cultural Policy Challenges of Video Games”. Chicago, IL (2001). Available from: http://archive.org/details/nasa_techdoc_20040086464
16. Larose S, Gagnon S, Ferland C, Pépin M. Psychology of computers: XIV. Cognitive rehabilitation through computer games. Percept Mot Skills (1990) 69(3 Pt 1):851–8. doi:10.2466/pms.1989.69.3.851
17. Yong Joo L, Soon Yin T, Xu D, Thia E, Pei Fen C, Kuah CWK, et al. A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. J Rehabil Med (2010) 42(5):437–41. doi:10.2340/16501977-0528
18. Iyadurai L, Blackwell SE, Meiser-Stedman R, Watson PC, Bonsall MB, Geddes JR, et al. Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial. Mol Psychiatry (2017). doi:10.1038/mp.2017.23
19. Ceranoglu TA. Star Wars in psychotherapy: video games in the office. Acad Psychiatry (2010) 34(3):233–6. doi:10.1176/appi.ap.34.3.233
20. Gardner JE. Can the Mario Bros. help? Nintendo games as an adjunct in psychotherapy with children. Psychother Theor Res Pract Train (1991) 28(4):667–70. doi:10.1037/0033-3204.28.4.667
21. Gaylord-Ross RJ, Haring TG, Breen C, Pitts-Conway V. The training and generalization of social interaction skills with autistic youth. J Appl Behav Anal (1984) 17(2):229–47. doi:10.1901/jaba.1984.17-229
22. Blum-Dimaya A, Reeve SA, Reeve KF, Hoch H. Teaching children with autism to play a video game using activity schedules and game-embedded simultaneous video modeling. Educ Treat Child (2010) 33(3):351–70. doi:10.1353/etc.0.0103
23. Russoniello CV. The effectiveness of casual video games in improving mood and decreasing stress. J Cyber Ther Rehabil (2009) 2(1):53–66.
24. McNeil CB, Hembree-Kigin TL. Parent-Child Interaction Therapy. New York: Springer Science & Business Media (2010). 477 p.
25. Zhang F, Kaufman D. A review of intergenerational play for facilitating interactions and learning. Gerontechnology (2016) 14(3):127–38. doi:10.4017/gt.2016.14.3.002.00
26. Kowert R, Festl R, Quandt T. Unpopular, overweight, and socially inept: reconsidering the stereotype of online gamers. Cyberpsychol Behav Soc Netw (2014) 17(3):141–6. doi:10.1089/cyber.2013.0118
27. Kowert R, Quandt T. The Video Game Debate: Unravelling the Physical, Social, and Psychological Effects of Video Games. New York: Routledge (2015). 184 p.
28. Highton-Williamson E, Priebe S, Giacco D. Online social networking in people with psychosis: a systematic review. Int J Soc Psychiatry (2015) 61(1):92–101. doi:10.1177/0020764014556392
29. Alvarez-Jimenez M, Alcazar-Corcoles MA, González-Blanch C, Bendall S, McGorry PD, Gleeson JF. Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res (2014) 156(1):96–106. doi:10.1016/j.schres.2014.03.021
30. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite S, Selby EA, Joiner TE. The interpersonal theory of suicide. Psychol Rev (2010) 117(2):575–600. doi:10.1037/a0018697
31. Bird ML, Cannell J, Callisaya ML, Moles E, Rathjen A, Lane K, et al. “FIND Technology”: investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial. Trials (2016) 17(1):203. doi:10.1186/s13063-016-1318-0
32. Teo W-P, Muthalib M, Yamin S, Hendy AM, Bramstedt K, Kotsopoulos E, et al. Does a combination of virtual reality, neuromodulation and neuroimaging provide a comprehensive platform for neurorehabilitation? A narrative review of the literature. Front Hum Neurosci (2016) 10:284. doi:10.3389/fnhum.2016.00284
33. Segev A, Rovner M, Appel DI, Abrams AW, Rotem M, Bloch Y. Possible biases of researchers’ attitudes toward video games: publication trends analysis of the medical literature (1980–2013). J Med Internet Res (2016) 18(7):109–18. doi:10.2196/jmir.5935
34. Suenderhauf C, Walter A, Lenz C, Lang UE, Borgwardt S. Counter striking psychosis: commercial video games as potential treatment in schizophrenia? A systematic review of neuroimaging studies. Neurosci Biobehav Rev (2016) 68:20–36. doi:10.1016/j.neubiorev.2016.03.018
35. Coppersmith G, Dredze M, Harman C. Quantifying mental health signals in Twitter. Associational for Computational Linguistics Workshop of Computational Linguistics and Clinical Psychology [Internet]. (2014). Available from: http://www.aclweb.org/anthology/W14-3207
36. Nilsen W, Kumar S, Shar A, Varoquiers C, Wiley T, Riley WT, et al. Advancing the science of mHealth. J Health Commun (2012) 17(Suppl 1):5–10. doi:10.1080/10810730.2012.677394
37. King D, Delfabbro P, Griffiths M. Video game structural characteristics: a new psychological taxonomy. Int J Ment Health Addict (2010) 8(1):90–106. doi:10.1007/s11469-009-9206-4
38. Kehle-Forbes SM, Meis LA, Spoont MR, Polusny MA. Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychol Trauma (2016) 8(1):107–14. doi:10.1037/tra0000065
39. Riley WT, Glasgow RE, Etheredge L, Abernethy AP. Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise. Clin Transl Med (2013) 2(1):10. doi:10.1186/2001-1326-2-10
40. Ewalt DM. How Big Is Twitch’s Audience? Huge. [Internet]. Forbes (2014). Available from: https://www.forbes.com/sites/davidewalt/2014/01/16/twitch-streaming-video-audience-growth/
41. USAID From the American People. CII 2017 Impact Brief [Internet]. USAID From the American People (2017). Available from: https://www.usaid.gov/cii/cii-2017-impact-brief
42. Tynan K. How Gaming Is Shaping the Future of Work [Internet]. Harvard Business Review (2016). Available from: https://hbr.org/2016/05/how-gaming-is-shaping-the-future-of-work
43. Shen C, Monge P, Williams D. The evolution of social ties online: a longitudinal study in a massively multiplayer online game. J Assoc Inf Sci Technol (2014) 65(10):2127–37. doi:10.1002/asi.23129
44. O’Connor EL, Longman H, White KM, Obst PL. Sense of community, social identity and social support among players of massively multiplayer online games (MMOGs): a qualitative analysis. J Community Appl Soc Psychol (2015) 25(6):459–73. doi:10.1002/casp.2224
45. Snodgrass JG, Lacy MG, Dengah HJF, Batchelder G, Eisenhower S, Thompson RS. Culture and the jitters: guild affiliation and online gaming eustress/distress. Ethos (2016) 44(1):50–78. doi:10.1111/etho.12108
46. Ducheneaut N, Moore RJ, Nickell E. Virtual “third places”: a case study of sociability in massively multiplayer games. Comput Support Coop Work CSCW (2007) 16(1–2):129–66. doi:10.1007/s10606-007-9041-8
47. Raid Finder Q&A – WoW [Internet]. World of Warcraft (2017). Available from: https://worldofwarcraft.com/en-us/news/4023602
48. Gielis K, Tournoy J, Brito F, Vanden Abeele V. Screening Mild Cognitive Impairment in Older Adults via Meaningful Play. Amsterdam, Netherlands (2017).
49. Newman J, Jerome J, Hazard C. Press Start to Track?: Privacy and the New Questions Posed by Modern Videogame Technology [Internet]. Rochester, NY: Social Science Research Network (2014). Report No.: ID 2483426. Available from: https://papers.ssrn.com/abstract=2483426
50. International Committee of Medical Journal Editors. Recommendations | Clinical Trial Registration [Internet]. International Committee of Medical Journal Editors (2016). Available from: http://www.icmje.org/recommendations/browse/publishing-and-editorial-issues/clinical-trial-registration.html
51. The Global Games Market. Per Region & Segment [Internet]. Newzoo (2017). Available from: https://newzoo.com/insights/articles/the-global-games-market-will-reach-108-9-billion-in-2017-with-mobile-taking-42/
52. The Global Games Market. Per Region & Segment [Internet]. Newzoo (2016). Available from: https://newzoo.com/insights/articles/global-games-market-reaches-99-6-billion-2016-mobile-generating-37/
53. Jung CG. Collected Works of C.G. Jung: The First Complete English Edition of the Works of C.G. Jung. New York: Routledge (2015). 9887 p.
Keywords: video games, mental health, prevention, technology, social media, eHealth, Internet, social support
Citation: Colder Carras M, Van Rooij AJ, Spruijt-Metz D, Kvedar J, Griffiths MD, Carabas Y and Labrique A (2018) Commercial Video Games As Therapy: A New Research Agenda to Unlock the Potential of a Global Pastime. Front. Psychiatry 8:300. doi: 10.3389/fpsyt.2017.00300
Received: 28 July 2017; Accepted: 15 December 2017;
Published: 22 January 2018
Edited by:
Matthias Jaeger, Psychiatrische Universitätsklinik Zürich, SwitzerlandReviewed by:
Lucia Romo, Université Paris Nanterre, FranceSebastian Olbrich, University of Zurich, Switzerland
Copyright: © 2018 Colder Carras, Van Rooij, Spruijt-Metz, Kvedar, Griffiths, Carabas and Labrique. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Michelle Colder Carras, michelle.carras@gmail.com