Video games, a promising support for treating disorders such as anxiety or depression

Águeda Gómez Carbonero chose a difficult topic for her doctoral thesis in Video Game Design and Development at the Jaume I University. “I wanted to make a video game that had a purpose beyond entertainment,” explains the creator.

The result, after a long time of work, is

Horizon: Resilience

, a mobile game for people suffering from mild and moderate depression.

The beginning was the most complicated.

Video games have always had a complex relationship with psychology — their ability to create addicts who end up in clinical consultations is well known.

And its potential to help treat mental health problems such as stress or anxiety has barely been exploited.

“They are a very powerful tool, but they are undervalued,” says Gómez, who completed her thesis with the help of a doctor in psychology.

Horizon

: Resilience

begins with the story of a family that has to leave their home and move to a forest where everything remains to be done.

A green field and an interface similar to traditional mobile games appear on the mobile screen.

“The objective is to make the town progress,” explains Gómez, “improving the resilience of its inhabitants.”

In order to build buildings and attract more population, the player has to earn points (in the game they are called “energy”) by developing four components: motivation for change, cognitive flexibility, behavioral activation (moving and walking down the street ) and the promotion of positive emotions.

It is also possible to get energy by answering the daily questionnaire that evaluates the psychological state of the patient/player, going to the library to learn techniques to work on depression or talking to the town's residents.

Images of different moments from the Spanish video game 'Horizon: Resilience' provided by the creator.

There are more and more scientific studies that support this type of games.

“In general, video game-based interventions were useful and effective in the treatment of depressive disorders,” states in its conclusions a review of studies carried out in 2022 by experts from the Autonomous University of Madrid and Imperial College London.

“However,” he continues, “the limited number of studies identified highlights that this is a novel area of ​​research.”

It is the same conclusion reached by other research: certain video games, including the most commercial ones, can have a positive effect on depressed patients, although there is a lack of data to confirm this trend.

It was just two years ago when authorities in the United States approved EndeavorRx, a video game that doctors can prescribe to treat children with attention deficit disorder with or without hyperactivity (ADHD).

First steps

It is difficult to determine the components that make a video game suitable for patients with mental health problems.

“The research is still in its infancy, and there are no studies regarding which isolated elements are consistent with which symptoms,” laments Gómez.

The EndeavorRx can be a good guide: its creators say it uses sensory stimuli to stimulate specific areas of the brain that play a key role in attention.

It has an algorithm that measures performance and “personalizes treatment for each patient in real time” and its use is limited to 25 minutes and 5 days a week.

In the case of minors, it has a mode in which only parents can access certain features.

“The most important thing to determine the usefulness of this type of game is its subsequent analysis, to check if it is really achieving the changes we are looking for in the patient,” recommends Juan Antonio Román, psychologist at the Acierta clinic.

There are already several generations that spend hours a week with the Xbox or PlayStation controller in front of a screen with hyper-realistic graphics.

77% of people between 15 and 29 years old are fans of video games, according to data from the Foundation for Help Against Drug Addiction (Fad).

And it is precisely that age range that is the worst in terms of mental health: 60% claim to have suffered some related problem, according to a study carried out in 2023 by the Mutua Madrileña Foundation.

Furthermore, many patients must wait months to get their first appointment with a psychologist in the public system.

In this context, a game capable of helping and monitoring a patient with depression, chronic stress or anxiety can be crucial.

“Video game-based interventions do not replace pharmacological treatment and therapeutic monitoring, which are the basis for treating depression,” recommends the study cited above, which recognizes some advantages of these tools.

“They do not rely on face-to-face advice and are cheaper and easier to implement,” especially for “people living in remote areas, or in areas where the number of healthcare providers is limited.”

Games like Animal Crossing, which involves building a town from scratch and was a

boom

during the Covid-19 pandemic, can be beneficial for mental health, as various studies have shown.

Others are also included such as Minecraft, where you can create all kinds of structures with blocks, or Pokémon Go, which brought millions of kids to the streets.

But the world of video games is very broad, and addiction is a constant threat.

Most are designed to keep the player hooked for as long as possible, and use all kinds of techniques to achieve this.

Use and addiction have increased over the years: 85% of young people between 14 and 18 years old play video games and 7.1% had a possible addiction in 2021, according to the Survey on Drug Use in Secondary Education in Spain .

“When we are going through an emotionally tense situation and we are looking for a way to feel better, we can end up finding solutions that are dysfunctional, such as excessive use of video games or gambling.

“That makes you feel better in the short term, but it has harmful effects in the long term,” explains psychologist Román.

Román still does not recommend video games to his patients, but he does not see it as something far away.

“They have a brutal ability to push us to do things that we would not otherwise do,” he defends.

“And they propose a clear formula for achieving objectives that is very helpful, because on many occasions throughout our lives we try to achieve things, but the result is always uncertain.

No matter how hard we try, sometimes there are many factors and everything is very complicated.

But in games like that the result of our actions is always very predictable,” he explains by phone to EL PAÍS.

The calming effect of Animal Crossing

Using this type of video game does not imply that the user has a specific pathology.

“There may be a correlation.

That is to say, there will be people who manage to calm their anxiety thanks to a calmer game, but there are many others who surely play to entertain themselves and do not feel anxiety or depression," says the psychologist.

Animal

Crossing: New Horizons

, for example, has been analyzed for its ability to calm anxiety.

The game, one of Nintendo's latest hits, is at the center of the study carried out by two researchers from the University of Singapore during the pandemic.

“It helped satisfy psychological needs (autonomy, relationships and competence) such as those described by self-determination theory,” they say.

An image of the video game Animal Crossing: New Horizons, by Nintendo.

Nintendo

“The players stopped playing when they discovered that their psychological needs were better satisfied through other activities,” the researchers explain.

That is to say, during a period it may be that someone plays a lot due to a need that arose at that moment, and that this will pass over time.

“Our findings support that video games can offer psychological relief in stressful contexts by providing opportunities for people to satisfy key psychological needs,” they conclude.

At the moment, Gómez would like to have more funding to continue developing the video game, because with the money he has been offered from the doctorate he has only been able to develop an initial test.

“More funds are needed for research.

Because if we were given funding for this video game, it would be feasible to hire professional people, or collaborate with private companies to develop these tools so that psychologists can use them in their consultations.

“We can’t just stay at the demo.”