Should Video Games Be Used in Therapy? (VG Series Part 7/10)

Neo-Academic coverage of the Journal of General Psychology special issue on the psychology of video games:

• Is Video Game Research Influenced by the Media?
• Does Personality Predict Vulnerability to Violence in Games?
• Can Spatial Cognition Be Trained with Video Games?
• How Do We Design Effective Video Games for Learning?
• Can Video Games Be Used in Health Care?
• Should Children with Autism Play Video Games?
• Should Video Games Be Used in Therapy?
• Can Video Games Get People to Vote?
• How Do Video Games Motivate People?
• How Do Typical Gamers Play Games?

There are few topics so hotly debated on the Internet as the value of video games. Are they the next generation’s artistic advance, as film was for the last, or are they a blight that makes children overly aggressive and dangerous? In this 10-part series, I’m reviewing a recent special issue of the Journal of General Psychology on video games. For more background information, see the first post in the series.

In the seventh article in this series, Ceranoglu (2010)1 discusses the use of video games within the context of psychotherapy. Much like the discussion of video games in relation to autism, there is not much of an established research literature in this area, though there is much potential in many of the same areas – patient compliance and understanding of their condition, for example.  We also see the same flaws: a lack of randomized controlled trials and small sample sizes.

What did surprise me is that games (generally) have been used in therapy for some time.  One citation put the use of board games in psychotherapy as early as 1957.  This implies to me a more receptive scientific community associated with general therapy than is associated with autism research.  Some of the earliest video games examined in the context of therapy were conversions of board games to computer-based versions.  This is a common theme we see in all computerization research: conversion of an already generally accepted technique to a new technology and comparison of outcomes.

The evidence that video games can be used to increase patient outcomes, though sparse, is intriguing.  In one study, kids in juvenile detention were exposed to a commercial available video game (though they do not reveal which one) in order to decrease their impulsiveness and improve their self-esteem, which was successful.  In another study, patient compliance (i.e. actually attending sessions and engaging with the therapist) was improved in a group of teenagers after a text-based adventure game was introduced in the session.

There are caveats, of course.  Ceranoglu lists three major areas where problems might arise: 1) the content and interactivity of the game itself, 2) both patient and parent attitudes toward video games, and 3) the availability and cost associated with many games.  For example, it is known that games can be engaging and distracting.  This is generally a positive, but in therapy, might turn against the therapist.  For example, someone engaged in a video game during therapy might pay less attention to the therapist, which would ultimately slow the building of rapport between them.  Though this is certainly avoidable, it is up to the therapist to monitor for such withdrawal.

Probably the most amusing part of this article for me personally is the discussion of “cheating.”  Anyone who has played more than handful of video games is probably aware of the concept of “cheat codes.”  The purpose of cheat codes is to “cheat” the game in that trials and struggles early in the game can often be bypassed.  For example, an invincibility cheat code would likely prevent the player character from dying despite game conditions where that player should have died (IDDQD!).  Other cheat codes give unlimited resources or skip the player ahead in the game.  Ceranoglu devote a good quarter-page to explaining that cheating in a video game is not the same as cheating in a board game, where the patient might be trying to take advantage of the therapist in order to “win.”  Ceranoglu makes this point by saying, “evaluation of possible meanings of cheating for a child during video game play should include this normative view.”  In other words, just because a kid cheats in a video game doesn’t mean there’s something wrong with them.

In any case, this article is, like the piece on autism, an excellent exploration of the potential of video games for therapy with relatively little background research to work from.  Once again, the answer to our title question – should video games be used in therapy? – is, “There’s no reason to think they shouldn’t, so go for it.” Just make sure to collect useful data and let the rest of the world know how it went.

1. Ceranoglu, T. (2010). Video games in psychotherapy. Review of General Psychology, 14 (2), 141-146 DOI: 10.1037/a0019439 [↩]