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Electronic Games

The prevalence and popularity of video games in recent years has created a wealth of psychological studies centered around them. While the bulk of those studies have covered video game violence and addiction, some mental health practitioners are becoming interested in including such games as therapeutic tools. Since the introduction of electronic media into popular culture, the nature of games has become "increasingly complex, diverse, realistic, and social in nature." The commonalities between electronic and traditional play (such as providing a safe space to work through strong emotions) infer similar benefits. Video games have been broken into two categories: "serious" games, or games developed specifically for health or learning reasons, and "off-the-shelf" games, or games without a clinical focus that may be re-purposed for a clinical setting. Use of electronic games by clinicians is a new practice, and unknown risks as well as benefits may arise as the practice becomes more mainstream.

Most of the current research relating to electronic games in therapeutic settings are focused on alleviating the symptoms of depression, primarily in teens and adolescents. However, some games have been developed specifically for children with anxiety and Attention Deficit Hyperactivity Disorder (ADHD), The same company behind the latter intends to create electronic treatments for children on the autism spectrum, and those living with Major Depressive Disorder, among other disorders. The favored approach for mental health treatment at this time is through cognitive behavioral therapy (CBT). While this method is effective, it is not without its limits: for example, boredom with the material, patients forgetting or not practicing techniques outside of a session, or the accessibility of care. It is these areas that therapists hope to address through the use of electronic games. Preliminary research has been done with small groups, and the conclusions drawn warrant studying the issue in greater depth.

Role-playing games (RPGs) are the most common type of electronic game used as part of therapeutic interventions. These are games where players assume roles, and outcomes depend on the actions taken by the player in a virtual world. Psychologists are able to gain insights into the elements of the capability of the patient to create or experiment with an alternate identity. There are also those who underscore the ease in the treatment process since playing an RPG as a treatment situation is often experienced as an invitation to play, which makes the process safe and without risk of exposure or embarrassment. The most well-known and well-documented RPG-style game used in treatment is SPARX. Taking place in a fantasy world, SPARX users play through seven levels, each lasting about half an hour, and each level teaching a technique to overcome depressive thoughts and behaviors. Reviews of the study have found the game treatment comparable to CBT-only therapy though one review noted that SPARX alone is not more effective than typical treatment. There are also studies that found role-playing games, when combined with the Adlerian Play Therapy (AdPT) techniques, lead to increased psychosocial development. ReachOutCentral is geared toward youth and teens, providing gamified information on the intersection of thoughts, feelings, and behavior. An edition developed specifically to aid clinicians, ReachOutPro, offers more tools to increase patients' engagement.

Biofeedback (sometimes known as applied psychophysiological feedback) media is more suited to treating a range of anxiety disorders. Biofeedback tools are able to measure heart rate, skin moisture, blood flow, and brain activity to ascertain stress levels, with a goal of teaching stress management and relaxation techniques. The development of electronic games utilizing this equipment is still in its infancy, and thus few games are on the market. As point of fact, The Journey to Wild Divine's developers have asserted that their products are a tool, not a game, though the three installments contain many game elements. Conversely, Freeze Framer's design is reminiscent of an Atari system. Three simplistic games are included in Freeze Framer's 2.0 model, using psychophysiological feedback as a controller. The effectiveness of both pieces of software saw significant changes in participants' depression. A biofeedback game initially designed to assist with anxiety symptoms, Relax to Win, was similarly found to have broader treatment applications. Extended Attention Span Training (EAST), developed by NASA to gauge the attention of pilots, was remodeled as an ADHD aid. Brain waves of participants were monitored during play of commercial video games available on Playstation, and the difficulty of the games increased as participants' attention waned. The efficacy of this treatment is comparable to traditional ADHD intervention.

Several online-only or mobile games (Re-Mission, Personal Investigator, Treasure Hunt, and Play Attention) have been specifically noted for use in alleviating disorders other than those for anxiety and mood. Re-Mission 2 especially targets children, the game having been designed with the knowledge that today's youth are immersed in digital media. Mobile applications for anxiety, depression, relaxation, and other areas of mental health are readily available in the Android Play Store and the Apple App Store. The proliferation of laptops, mobile phones, and tablets means one can access these apps at any time, in any place. Many of them are low-cost or even free, and the games do not need to be complex to be of benefit. Playing a three-minute game of Tetris has the potential to curb a number of cravings, a longer play time could reduce flashback symptoms from Post-Traumatic Stress Disorder (PTSD), and an initial study found that a visual-spatial game such as Tetris or Candy Crush, when played closely following a traumatic event, could be used as a "'therapeutic vaccine" to prevent future flashbacks.

While the field of allowing electronic media a place in a therapist's office is new, the equipment isn't necessarily so. Most children are familiar with modern PCs, consoles, and handheld devices even if the practitioner is not. An even more recent addition to interacting with a game environment is virtual reality equipment, which both adolescent and clinician might need to learn to use properly. The umbrella term for the preliminary studies done with VR is Virtual Reality Exposure Therapy (VRET). This research is based on traditional exposure therapy and has been found to be more effective for participants than for those placed in a wait list control group, though not as effective as in-person treatments. One study tracked two groups - one group receiving a typical, lengthier treatment while the other was treated via shorter VRET sessions - and found that the effectiveness for VRET patients was significantly less at the six-month mark.

In the future, clinicians may look forward to using electronic media as a way to assess patients, as a motivational tool, and facilitate social in-person and virtual interactions. Current data, though limited, points toward combining traditional therapy methods with electronic media for the most effective treatment.