Gaming is ubiquitous in American culture, particularly with children and adolescents, where about 9 in 10 between the ages of 2 and 17 regularly play video games. My work as a therapist has provided me insight into the prevalence and influence of modern-day gaming. Parents typically show concern over the frequency and duration of play, expressing fear of addiction as their teenagers play from the moment they get home from school at 4:00pm until forced to shut it down well beyond midnight. When we look over their logged hours for the week, it reveals this young person has accrued enough screen time to be classified as a full-time employee and receive a W-2 at the end of the year. It’s a full-time commitment that our youth dedicate to game play and the concern is global. The Japanese Ministry of Health, Labour and Welfare described hikikomori as a psychiatric condition in which “a person without psychosis is withdrawn into his/her home for more than six months and does not participate in society such as attending school and/or work.” Over a half-million Japanese people aged 15-39 years old meet the criteria.

The potential for harm from extensive gaming is well-documented and researched. Gaming has the potential to lead to hours in a fixed, seated position, leading to the adverse health outcomes associated with a sedentary lifestyle. Boys aged 6 to 19 typically engage in 6-8 hours of daily sedentary behavior. Studies show that students who play more entertainment games perform worse in school and are at higher risk for obesity. Light-at-night has been shown to delay the onset of sleep by suppressing melatonin and decreasing total sleep time. The light emitted from the screen can shrink the blood vessels in our eyes, cause retinal damage, and desynchronize the internal clock. It heightens our stress state, placing high loads of processing on the brain, increasing cortisol and adrenaline in the blood stream, alters and desensitizes the dopaminergic system, which makes previously enjoyed activities outside of screens seem droll. Gaming shrinks white and grey matter in the brain, reducing cortical thickness. The frontal lobe decreases executive functioning. Viktoria Dunkely highlights how these concerns may be exacerbated for autistic people.

We need to keep these risks in mind and understand their purpose if we are going to include video games in our lives. We need to explore how to be responsible and construct days with screen time intentionally integrated.

Growing up with Gaming

It has been approximately twenty years since I’ve seriously engaged with video games, so my understanding of the current landscape is limited. However, I can distinctly remember the enjoyment and entertainment of playing games, either alone or socially, until the early hours of the morning. I understand the grip they hold and the obsession with getting on and playing. Video games were a part of my identity growing up. It was the same for the vast majority of my peers. We formed deep connections with each other on the platform of video games. We talked about them at lunch. We discussed strategies. We talked about our emotional reactions. We played them during sleepovers. I played for audiences. I watched friends as we’d take turns cheering along. We had our own community where we felt confident and safe. We could be courageous and practice striving, failing, pushing through, and finally mastering and completing an epic game. We could explore unlimited possibilities and go beyond the outer edges of reality. Gaming was our opportunity for play in the virtual world.

As a child and teenager, I hardly considered the risks and primarily focused on having fun and improving my gaming skills. Video games were highly motivating, meaning I could stay engaged on complex tasks for hours. I played role playing games like Final Fantasy VII, which showed me how to manage interpersonal relationships, understand and adapt to changing character perspectives, plan and organize tasks, and manage time. The Legend of Zelda: Ocarina of Time taught me resiliency as I attempted and failed to solve Gordian-knotted puzzles over and over yet persisting until I reached my goal and defeated Gannondorf. We experimented in these virtual worlds, took risks, and displayed courage as we put it all out on the line. Golden Eye 007 was a fast-paced game of chess. We learned how to quickly respond to our environment. We developed and tested strategies. We learned how to cooperative and persuade. We improved coordination and spacial reasoning as we navigated the screen with a remote control. We learned maps and strategized how to optimize our position in relation to others. We practiced perspective taking by simultaneously observing the screens of our opponents. We were able to control our selective attention as we moved through the maps, laser-focused on our mission. And we worked until every task in the game was complete. As a gamer, it was important to gain 100% completeness in every game started.

I transitioned to PC gaming in high school and turned to real time strategies games, including Command and Conquer: Red Alert 2 and Warcraft III. As the genre suggests, these games required real-time strategy, meaning we had to read and react to our opponents’ strategy. This required extensive trial and error testing to optimize our approach. We evolved with our opponents, adjusting and avoiding predictability, similar to strategies depicted in Sun Tzu’s The Art of War. We collected and managed resources and developed project management schedules for construction, which involved extensive multi-tasking and planning. I programmed shortcut keys and minimized wasted movement and effort. The skills learned in these games directly translated to success designing facilities as a professional engineer using AutoCad and Revit, computer-aided design software I learned and mastered within a week of my start date at Parsons Brinckerhoff. However, it wasn’t until recently, through my work as a professional counselor, that I deeply reflected on and researched how video games supported my social, emotional, and cognitive development.

The research appears to confirm much of my personal experience with gaming. Strategic video games, such as role playing games (RPG), may improve problem-solving skills and increase academic grades. Perspective taking and prosocial behavior is supported by cooperating with individuals and groups as players navigate alliances from the unique perspective of a character or team. Action video gamers may see improvements in selective attention, enhance functional connectivity and grey matter volume in the brain, improve dexterity, and augment spacial resolution of visual processing.

A meta-analysis found that spatial skills developed from playing first-person shooters are comparable to formal training at the university level. Longitudinal studies have shown that spatial reasoning skills are a strong predictor of fluency in science, technology engineering, and math (STEM). While some studies have shown that violent shooter games may increase aggressiveness, these claims have been shown to be exaggerated and do not accurately predict long-term aggressive behavior. In-game cooperation may be a mitigating factor, where violent game play in a social environment has been shown to increase helpful online and offline behavior and reduce feelings of hostility. Even controversial games such as Grand Theft Auto V that depict torture and sexual violence have not been shown to impact impulsivity, hostility, anxiety, or depression compared to non-violent gamers or non-gamers.

Present Day Gaming

Conversations with child, teenage, and adult gamers during professional counseling sessions has further piqued my interest into the benefits of gaming. Teenagers who typically communicate in single word sentences or respond to questions prompts with “I don’t know” lead deeply engaging and detailed discussions about video games. They share the educational benefits of simulators, such as PC Building, cooking, and house flipping. One student showed me how they simulated building a gaming PC, then purchased the parts and constructed it in real life. Survival gamers describe advancements in executive skills, managing time and resources in Last Day on Earth and Subnautica. They’ve developed a growth mindset through persistent attempts toward goals on challenges in Minecraft. Creative mode encourages them to test and explore limits. A child told me this world gives him a sense of freedom. They learn flexible thinking strategies by solving intricate puzzles in Portal 2. These games have the potential to improve reappraisal, inhibition, and working memory. Games use intermittent reinforcement schedules to teach players that persistence toward a goal and working through the failures will lead to valuable in-game rewards. The highly motivating structure may lead to generalizable educational benefits similar to behavioral therapies.

The gaming world is a virtual social community, where over 70% of gamers play with a friend. I’ve recently learned about Discord, a massive online chat and hangout community, where friendships and collaborations are built. Several shy, introverted, and reclusive teenagers have collaborated to form multidisciplinary teams to develop video games. They pour hours learning to code, model, and design. They cooperate with peers across continents, exploring and learning about other cultures, staying up until 3:00am to catch online friends who are just getting home from school. Games encourage individuals to stay connected with friends living thousands of miles away. These online relationships are viewed as a support system where peers feel welcomed.

An adult told me that one of his online friends talked him out of suicide because it was the only forum they felt safe enough to open up and share their emotional experience. A teenager told me how they saved up money to purchase a game on Steam for a friend, then showed them how to play on Twitch, a live-streaming platform where users can share their video screen and narrate as they play their game of choice. Twitch players can even connect with the experts and get into the mind and experience of a professional gamer. Another person shared that they met their significant other playing World of Warcraft, a common and heartwarming occurrence in this virtual world. People engaged in massive multiplayer online role playing games (MMORPG) are building social skills, learning who to trust or reject and how to lead a group. Adolescents who play MMORPGs have been shown to be more likely engaged in civic movements, meaning these games have the potential to build the foundation for prosocial behavior.

Advancements in Screen-Based learning, Training, and Problem-Solving

The purpose of gaming is typically viewed as passive recreational entertainment. However, researchers are seeking to tap into the inherent enjoyment of gaming and build platforms with the intent of skills training and rehabilitation. Cognitive training programs are being researched and have shown promising results with improvements in fluid intelligence and working memory. Pediatric physicians have explored video games to provide health-related education. For example, Packy and Marlon was designed to teach diabetic children about self-care and Remission was designed for cancer patients to improve adherence to treatment and cancer-related knowledge. Ron Gets Dressed was designed to help autistic children cope with changes in clothing and EmoGalaxy has been show to improve social skills in children with attention-deficits. Computerized behavioral therapies, such as SPARX, have been developed to help adolescents manage symptoms of depression and anxiety. Nintendo Wii games have been shown to be a safe alternative to facilitate stroke victim rehabilitation, while RehaCom has been specifically developed as a computerized cognitive training platform for patients with brain injuries. Nintendo Wii and Kinect are often cited as therapeutic “exergaming” platforms for stroke victims, improving balance and postural control for people with Parkinson’s disease, and other forms of motor rehabilitation of physical disability. Video game designers have found clever and fun ways of connecting with people and facilitating change.

Games for Change is a community that has developed nearly 200 digital and non-digital games that explore civic issues and seek to drive real-world change. A Closed World is a Japanese role-playing game (RPG) that explores the challenges of LGBTQ youth. In Activate, players campaign for civic issues. Games for Change also hosts Foldit, a multiplayer online game developed where players can predict the genetic makeup of protein structures. These games offer an active and engaging way to facilitate learning.

Advancements in technology have led to opportunities for augmented reality, which has been particularly helpful for individuals who struggle to stay focused during therapies. The Mobile Object Identification System (Mobis) allows teachers to superimpose digital content onto the physical world, integrating these realities into a virtual environment, which has been shown to increase interest and improve attention. Other augmented reality systems aim to improve hand-eye coordination and social interaction. Pokémon Go!, an augmented reality app that requires users to walk, run, and jump as they chase and catch Pokémon, saw substantial increases in users’ physical activity - much larger than standard mobile health apps in the marketplace.  The app also increased players’ social interaction and time spent outside exploring their neighborhoods and cities

Gaming with Intention

We are presented with an opportunity for individual and community growth as we continue to learn about the potential benefits of video games. We can build skills, connect and collaborate, learn, heal, explore, and create. However, we need to be intentional with our screen time use and balance the risks and benefits. Rather than immediately judge and scoff at video gamers, labeling them as hikikomori, let us engage in conversation about how people are engaging with video games:

1. What social opportunities are present?

2. How are reciprocal relationships being supported, how are players encouraged to cooperate, and what collaborations are taking place?

3. What connections and communities are being built?’ What advocacy opportunities are present?

4. What cognitive and emotional skills are being built?

5. What opportunities for creative problem solving are supported and what strategies are being employed?

6. What learning opportunities are supported?

7. What opportunities for healing are present?

8. How is mental and physical health supported?

It would be wise for us to work with video game developers to intentionally create games that benefit the public. Video games can take us places that only exist in our imaginations. We can augment our lives through the intentional use of video games. Further research is needed to further explore how we can effectively integrate gaming into our lives. However, we already understand how excessive screen time and sedentary lifestyle impacts physical and mental health outcomes, so it is important to develop a plan to mitigate the effects.

Developing a Plan to Mitigate the Harmful Effects of Screen Time and Gaming

As previously discussed, there is a well-established base of research about the harmful impact of screen time and gaming. Below are several recommendations to mitigate the risk of screens:

1. The American Optometrist Association recommends the 20/20/20 rule to prevent digital eye strain, which suggests to take 20 second break every 20 minutes and look at something 20 feet away.

2. Wear blue-light filtering glasses to protect the retina from potentially harmful short wavelength light.

3. Eliminate light-at-night by removing access to screens at least one hour prior to bedtime. Remove all screens and chargers from bedrooms.

4. Monitor and limit screen time for children and adolescents using an app on your iPhone or Android.

5. Aim to limit total screen time to one hour for children 2 to 12 years and two hours for teens and adults.

6. Create a family media plan using the American Academy of Pediatrics’ online tool.

7. Set screen blackout times, such as during meals or car rides, or on scheduled nights of the week.

8. Eliminate multitasking with screens and be fully present with your immediate experiences. For instance, avoid screens while eating, during conversation, on car rides, etc.

9. Schedule movement/exercise to interrupt continuous sedentary screen time. According to the U.S. Department of Health and Human Services, children under the age of 18 should engage in at least 1 hour of moderate-to-vigorous exercise per day, while adults should engage in at least 150 minutes per week.

10. Set-up your gaming space with ergonomics in mind. Ergonomic design minimizes risk to the musculoskeletal system by emphasizing proper posture and reducing the impact of repetitive movements.

If you have additional recommendations or believe helpful information has been overlooked, please comment or reach out directly. We are always looking to learn and expand our understanding of gaming culture.