Connection, meaning, and distraction: A qualitative study of video game play and mental health recovery in veterans treated for mental and/or behavioral health problems

"Instead, You're Going to a Friend": Evaluation of a Community-Developed, Peer-Delivered Online Crisis Prevention Intervention

OBJECTIVE

Online communities promote social connection and can be used for formal peer support and crisis intervention. Although some communities have programs to support their members' mental health, few programs have been formally evaluated. The authors present findings from a mixed-methods evaluation of the Stack Up Overwatch Program (StOP), a digital peer support intervention delivered in an online gaming community.

METHODS

Data were collected from members of the Stack Up Discord server between June and October 2020 and included chat messages, survey responses, encounter forms (documenting information from private interactions between users and peer supporters), and interviews with peer support team members. The authors analyzed data on demographic characteristics, mental health and crises, use of and experiences with StOP, and chat posts. Thematic analysis and descriptive statistics were combined in a joint display table, with mixed-methods findings explained in narrative form.

RESULTS

The findings show that StOP provides users in crisis with a source of mental health support when other options have been exhausted and that military and veteran users valued the connections and friendships they formed while using it. Participants reported that StOP met needs for support and connection when formal services were inaccessible or did not meet their needs, and volunteer peer supporters detailed how StOP's design facilitates use of the intervention. Volunteering offered members of the peer support team a "family feeling" facilitated by the unique chat room structure.

CONCLUSIONS

Community-based crisis prevention programs administered through chat rooms may provide valuable support to both users and peer support providers.

An Escape Game on University Students' Mental Health During the COVID-19 Pandemic: Cocreation Study

BACKGROUND

The COVID-19 pandemic has had a severe impact on students' mental health. Interventions are needed to promote their psychological well-being and prevent mental illnesses in the aftermath of this unprecedented situation. Digital escape games can be an effective tool to support students' mental health. A cocreation approach can improve the acceptability of these interventions by involving different stakeholders (eg, end users, game designers, and health professionals) to obtain audience-specific games.

OBJECTIVE

This study aims to describe the process of testing and optimizing the game "EscapeCovid" on students' mental health, to serve as a model for the cocreation of future similar interventions.

METHODS

The PRODUCES (Problem, Objective, Design, End Users, Cocreators, Evaluation, Scalability) framework was used. Cocreation steps (test and optimization) were detailed for replicability. A total of 45 students tested a pilot version of the game, with 10 undergoing a semistructured interview. Meetings with a group of stakeholders and brainwriting were organized to optimize the game.

RESULTS

We produced a new version of the game incorporating the suggestions provided by student testers and following the stakeholders' guidelines. Improvements were made to both the content and the form of the new version of the pilot game. The storyline, including the protagonist and the scenes, was adapted to the student population.

CONCLUSIONS

Our results suggested that cocreation can contribute to the design of more widely accepted interventions aimed at promoting mental health and preventing psychological disorders. Results also suggest that an end user-centered approach can facilitate intervention tailoring. When conceiving a health-related escape game for students, we recommend using the cocreation approach to enhance players' experience, thus positively influencing their learning process and overall well-being.

No evidence that Chinese playtime mandates reduced heavy gaming in one segment of the video games industry

Governments around the world are considering regulatory measures to reduce young people's time spent on digital devices, particularly video games. This raises the question of whether proposed regulatory measures would be effective. Since the early 2000s, the Chinese government has been enacting regulations to directly restrict young people's playtime. In November 2019, it limited players aged under 18 to 1.5 hours of daily playtime and 3 hours on public holidays. Using telemetry data on over seven billion hours of playtime provided by a stakeholder from the video games industry, we found no credible evidence for overall reduction in the prevalence of heavy playtime following the implementation of regulations: individual accounts became 1.14 times more likely to play heavily in any given week (95% confidence interval 1.139-1.141). This falls below our preregistered smallest effect size of interest (2.0) and thus is not interpreted as a practically meaningful increase. Results remain robust across a variety of sensitivity analyses, including an analysis of more recent (2021) adjustments to playtime regulation. This casts doubt on the effectiveness of such state-controlled playtime mandates.

Putting the Gaming Experience at the Center of the Therapy-The Video Game Therapy® Approach

Video games have been increasingly used as a form of therapy for various mental health conditions. Research has shown that video games can be used to treat conditions such as depression, anxiety, PTSD, and addiction. One of the main benefits of video games in therapy is that they can provide a sense of engagement and immersion that traditional therapy methods may lack. Additionally, video games can teach valuable skills such as problem solving, decision making, and coping strategies. Video games can also simulate real-life scenarios, allowing individuals to practice and improve social skills in a safe and controlled environment. Furthermore, video games can provide feedback and track progress objectively and quantifiably. This paper proposes an approach, the Video Game Therapy^® (VGT^®) approach, where game experience is put at the center of the therapy in a tailored way, connecting the individual patient's personality, the therapy's goals, and the suggested type of video game through the Myers Briggs Type Indicator (MBTI).VGT^®'s core assumption is that playing video games could facilitate patients in reaching conditions where traditional methodologies and therapeutic approaches could work best. VGT^® was elaborated according to the Adlerian therapy vision and, consequently, the different phases of Adlerian therapy and VGT^® match. Despite the use of video games in psychotherapy might have some adverse effects in specific cases, VGT^® is currently used in three associations with positive results in promoting emotional experimentation and literacy, social feeling, sense of identity, and activating cognitive processes. Future developments include expanding the use of VGT^® further to validate such results from a statistical point of view.

The role of online game usage in the relationship between initial daily negative moods and subsequent positive moods: The moderating role of hedonistic motivation

This study explores the relationship between initial daily negative mood, online game usage and subsequent positive mood; and examine the moderating roles of hedonistic motivation on the perspective of mood regulation theory. To gather data over five consecutive workdays, this study used the experience sampling method. We then obtained 800 valid daily data from 160 participants. The results of multilevel path analysis show that: (i) initial daily negative mood increases the usage of online games and further enhances subsequent positive mood; (ii) students with higher hedonic motivation will show a stronger positive correlation between initial daily negative mood and online game usage; (iii) students with higher hedonic motivation will show a stronger positive correlation between online game usage and subsequent positive mood. Theoretical and practical implications are also investigated in this study.

Relationship between Internet Use and Negative Affect

While positive emotions like happiness and life satisfaction have received great attention, how to eliminate negative affect is largely neglected. This study contributes to the literature by examining the relationship between Internet use and people's negative affect. Unlike previous studies that consider only one indicator, we capture negative affect from different dimensions by considering loneliness, sadness, and life hardship. We employ an endogenous ordered probit model to address the selection bias of Internet use and analyze the 20,107 individual-level samples sourced from the 2020 China Family Panel Studies survey. The results show that Internet use significantly reduces people's loneliness, sadness, and life hardship. We also find that studying online and watching short videos would increase people's loneliness feeling and shopping online deepens people's life hardship. In contrast, using WeChat significantly reduces sadness and life hardship. Our findings confirm that guiding people to use the Internet appropriately is necessary to reduce negative affect and improve the quality of their life.

The Impact of Social Media Use and Gaming on Initiation of Smokeless Tobacco Use Among Rural Male Youth

PURPOSE

Smokeless tobacco (SLT) use is more common among White male youth in rural locations than among other youth. Previous literature documents risk factors for SLT use (e.g., perceived harm). However, no research has examined whether SLT initiation is associated with the use of social media and video games, despite the high prevalence of those behaviors among adolescent males.

METHODS

As part of the evaluation of "The Real Cost" smokeless prevention campaign, we conducted a baseline survey of a cohort of US males aged 11-16 in 2016 and four follow-up surveys conducted approximately every 8 months. We used discrete-time survival analysis to examine factors associated with SLT initiation. Logistic regression estimated the odds of initiation as a function of lagged values of key predictors (social media use in tertiles and frequency of gaming) and other baseline and lagged correlates. The model controlled for campaign exposure.

RESULTS

Relative to the lowest tertile of social media use, moderate (odds ratio [OR] = 1.80) or high use (OR = 2.77) was associated with increased risk of SLT initiation at the subsequent survey wave. Relative to playing every few weeks or less, playing video games once a day (OR = 0.50) or several times a day (OR = 0.33) was associated with decreased risk of SLT initiation.

DISCUSSION

SLT initiation was positively associated with social media use and negatively associated with gaming. Future research should explore reasons for the protective nature of gaming (e.g., social support, improved mood) and whether parental supervision of social media use could mitigate its negative impact.

Seeking virtual support: Digital technology use in adolescent and young adults with advanced cancer

BACKGROUND

A cancer diagnosis, especially advanced cancer, interferes with adolescent/young adult (AYA) peer relationships. AYAs increasingly use digital technologies (i.e., social media, video games) as a social instrument; little is known about the role of digital technologies in the AYA cancer experience. The objective of this analysis was to describe the use and impact of digital technologies among AYAs with advanced cancer.

PROCEDURE

As part of the "Exploring the Concept of a 'Good Death'" study, semi-structured interviews were conducted with 32 English-speaking AYAs (14-25 years) with advanced cancer (relapsed/refractory disease, estimated survival <50%). Interviews were audio recorded, deidentified, and transcribed verbatim. Questions focused on communication and sources of psychosocial support. Directed content analysis was used for codebook creation. Three reviewers completed transcript coding and reconciled discrepancies. Thematic analysis identified hierarchical themes. The present analysis focused on the specific theme of "digital technologies as a support mechanism."

RESULTS

When asked about sources of support, social media and multiplayer online games were most often recognized by AYAs. Three themes emerged regarding the role of digital technologies: distraction, maintaining existing peer support, and connecting with peers with cancer. Two AYAs acknowledged negative consequences of social media.

CONCLUSIONS

AYAs with advanced cancer cite digital technologies as a mechanism for maintaining and seeking peer support. Digital technologies may be leveraged to provide psychosocial support for AYAs with advanced cancer.

Social connection and gene regulation during the COVID-19 pandemic: Divergent patterns for online and in-person interaction

BACKGROUND

Social connection has been linked to reduced disease risk and enhanced antiviral immunity, but it is unclear whether online social connections have similar effects to those previously documented for in-person/offline social relationships, or whether online connections can substitute for in-person social relations when the latter are restricted. We examined this question in the context of the COVID-19 pandemic, focusing specifically on an immune system gene regulation profile known as the conserved transcriptional response to adversity (CTRA), which is characterized by up-regulation of proinflammatory genes and down-regulation of genes linked to innate antiviral responses and antibody production.

METHODS

We analyzed CTRA RNA profiles in blood samples from 142 healthy young adults (69% female, 87% white) during the "social distancing" period of the COVID-19 pandemic. Mixed effect linear models quantified the relation of CTRA gene expression to measures of in-person social connection (number of friends, social eudaimonia, loneliness) and online psychosocial connection (online loneliness, perceived social value in online leisure and educational contexts, and internet use) while controlling for demographic and health factors.

RESULTS

Multiple indicators of in-person and generalized social connection were associated with lower CTRA gene expression, whereas no measure of online social connection showed any significant association with CTRA gene expression.

CONCLUSION

Experiences of in-person social connection are associated with reduced CTRA gene expression during a period of restricted social interaction. In contrast, online social relationships show no such association. Digitally mediated social relations do not appear to substantially offset the absence of in-person/offline social connection in the context of immune cell gene regulation.

Prevalence of virtual reality (VR) games found through mental health categories on STEAM: a first look at VR on commercial platforms as tools for therapy

BACKGROUND

Immersive virtual reality (VR) games are increasingly becoming part of everyday life. Several studies support immersive VR technology as a treatment method for mental health problems. There is however little insight into the prevalence of commercially available VR games for treatment of mental health problems on commercial platforms such as STEAM, and to what extent they can be used as tools for treatment or add-on treatment of mental health problems.

OBJECTIVE

The aim of this study was to take a first look at the prevalence and overview of content of commercially available games. The games were found using search words related to psychiatric diagnosis or care.

METHODS

We performed a search for keywords related to symptoms, diagnosis, and treatment strategies of mental health problems. The search was performed November 2020 on STEAM. A scheme was created for elimination and inclusion of games, eliminating those games which were irrelevant to mental health or had triggering elements such as violence, excessive movement which could trigger nausea, horror and pornographic imagery.

RESULTS

In total, 735 hits were found, 565 unique games. After the games were reviewed for content via trailers, descriptions and screenshots, 32%, i.e. 182 games passed the inclusion criteria. Majority of the games which were excluded were either not connected to mental health, contained violence, adult content or were in other ways irrelevant or inappropriate.

CONCLUSIONS

Commercial platforms are only at the beginning of the development towards therapeutic content. Currently the quality and usability for therapeutic use is scarce but holds great potential.

Playing Pokemon Go: Increased Life Satisfaction Through More (Positive) Social Interactions

Pokemon Go (PoGo) is a social mobile game requiring both physical activity and social interaction, and previous research has reported positive effects of PoGo on physical health. However, little research has been conducted on the effects of PoGo on social functioning and life satisfaction, which are important factors for good mental health. The current study investigated the effects of PoGo on life satisfaction and social functioning in participants with and without self-reported diagnoses of mental disorders. Participants were 434 current PoGo players aged 18–69 of diverse genders and nationalities, with a subsample (N = 138) self-reporting diagnoses of various mental disorders with impairments in social functioning. Participants provided retrospective and current self-report measures about their PoGo use, life satisfaction, social functioning (sociality and social ability) and clinical symptom severity. Results showed higher self-reported social functioning and life satisfaction since playing PoGo compared to the time period before playing, which involved a shift from negative to positive ratings. The increases in self-reported life satisfaction and sociality (but not social ability) were more pronounced for the clinical compared to the non-clinical subsample. Results also showed the effect of the social ability change on the life satisfaction change was mediated by the sociality change and moderated by the number of daily in-person player interactions (including strangers). The findings here, using subjective judgements, show that PoGo motivates social interactions and increases life satisfaction, demonstrating that social mobile gaming provides an easy to implement tool to subjectively improve social functioning. This has important implications for populations with social difficulties and reduced social motivation.

The role of internet gaming in the association between anxiety and depression: A preliminary cross-sectional study

BACKGROUND

Disordered Internet gaming is thought to be perpetuated by one's need to escape their real-life distress or mental health symptoms, which may in turn generate depressive feelings. Nevertheless, moderate engagement with Internet games has also been suggested to provide relief, thus improving one's mood. This study aspires to clarify the contribution of Internet gaming and gender in the association between anxiety and depression.

METHODS

A large sample of Internet gamers (N = 964) were recruited online. Disordered Internet gaming was assessed with the Internet Gaming Disorder Scale, 9 Items Short Form (IGD9S-SF). Anxiety and depression symptoms were assessed using the Depression, Anxiety and Stress Scale, 21 items (DASS-21).

RESULTS

Regression, moderation and moderated moderation analyses accounting for the effects of gender on the relationship between disordered gaming, anxiety, and depression found a significant effect for anxiety symptoms on depression symptoms and a significant interaction between anxiety and Internet gaming disorder on depression symptoms. Findings support the theory that although anxious gamers bear a higher depression risk, this is buffered with lower and exacerbated with higher disordered gaming symptoms.

CONCLUSION

Findings suggest a dual role of Internet gaming in the association between anxiety and depression, depending on the intensity of one's disordered gaming symptoms. Depression prevention and intervention protocols should be optimized by considering the effects of Internet gaming among anxious gamers by focusing on the intensity of a gamer's involvement and any gaming disorder symptoms. Further research should include clinical samples to better understand this interaction.

Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation

BACKGROUND

Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals.

OBJECTIVE

This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations.

METHODS

The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP.

RESULTS

In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features.

CONCLUSIONS

The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process.

Play the Pain: A Digital Strategy for Play-Oriented Research and Action

The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.

Draconian policy measures are unlikely to prevent disordered gaming

In August of 2021, China imposed severe restrictions on children's online gaming time. We argue that such a policy may seem useful on the surface but does not reflect the current evidence concerning prevention of disordered gaming. Videogame play is normal for children worldwide, and like other leisure activities can lead to benefits for the majority and problems for a minority. Problematic or disordered play results from the interaction of multiple risk factors that are not addressed by draconian policy measures. Identifying these factors through stakeholder-engaged research and current evidence will be much more likely to succeed in preventing disordered gaming and promoting youth wellbeing.

Internet Use and Adolescents' Physical and Mental Health: the Mediating Role of Self-consciousness and Peer Relationships

In recent years, online gaming and cyber pornography have become problematic activities among Internet users. When individuals immerse themselves in these activities, the experience of flow can negatively influence users’ physical and mental health and interpersonal relationships. Thus, this study analyzed the mediating roles of self-consciousness and peer relationships in the relationships between online gaming, cyber pornography, and physical and mental health. We obtained data from fifteen senior high schools in Taiwan (N = 1838 students; first year, 996 students, and second year, 842 students) by conducting a 2-year longitudinal survey. Statistical analyses were performed using structural equation modeling. The results indicated that adolescents’ online gaming was positively associated with their physical and mental health; however, it was negatively associated with their self-consciousness. In addition, when they became absorbed in cyber pornography, they lost track of time and lost self-consciousness, and it influenced their peer relationships. Self-consciousness and peer relationships mediated the relationships between cyber pornography and participants’ physical and mental health. We identified relationships between online gaming, cyber pornography, elements of flow, and physical and mental health. The findings of this research can offer guidelines for policy makers and educators who evaluate adolescents’ Internet use and behavior to provide proper access to Internet use and promote by building a healthy Internet environment in educational activities.

Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games

Globally, depression and anxiety are the two most prevalent mental health disorders. They occur both acutely and chronically, with various symptoms commonly expressed subclinically. The treatment gap and stigma associated with such mental health disorders are common issues encountered worldwide. Given the economic and health care service burden of mental illnesses, there is a heightened demand for accessible and cost-effective methods that prevent occurrence of mental health illnesses and facilitate coping with mental health illnesses. This demand has been exacerbated post the advent of the COVID-19 pandemic and the subsequent increase in incidence of mental health disorders. To address these demands, a growing body of research is exploring alternative solutions to traditional mental health treatment methods. Commercial video games have been shown to impart cognitive benefits to those playing regularly (ie, attention control, cognitive flexibility, and information processing). In this paper, we specifically focus on the mental health benefits associated with playing commercial video games to address symptoms of depression and anxiety. In light of the current research, we conclude that commercial video games show great promise as inexpensive, readily accessible, internationally available, effective, and stigma-free resources for the mitigation of some mental health issues in the absence of, or in addition to, traditional therapeutic treatments.

An Exploration of Mental Health Discussions in Live Streaming Gaming Communities

Live streaming is a unique form of media that creates a direct line of interaction between streamers and viewers. While previous research has explored the social motivations of those who stream and watch streams in the gaming community, there is a lack of research that investigates intimate self-disclosure in this context, such as discussing sensitive topics like mental health on platforms such as Twitch.tv. This study aims to explore discussions about mental health in gaming live streams to better understand how people perceive discussions of mental health in this new media context. The context of live streaming is particularly interesting as it facilitates social interactions that are masspersonal in nature: the streamer broadcasts to a larger, mostly unknown audience, but can also interact in a personal way with viewers. In this study, we interviewed Twitch viewers about the streamers they view, how and to what extent they discuss mental health on their channels in relation to gaming, how other viewers reacted to these discussions, and what they think about live streams, gaming-focused or otherwise, as a medium for mental health discussions. Through these interviews, our team was able to establish a baseline of user perception of mental health in gaming communities on Twitch that extends our understanding of how social media and live streaming can be used for mental health conversations. Our first research question unraveled that mental health discussions happen in a variety of ways on Twitch, including during gaming streams, Just Chatting talks, and through the stream chat. Our second research question showed that streamers handle mental health conversations on their channels in a variety of ways. These depend on how they have built their channel, which subsequently impacts how viewers perceive mental health. Lastly, we learned that viewers' reactions to mental health discussions depend on their motivations for watching the stream such as learning about the game, being entertained, and more. We found that more discussions about mental health on Twitch led to some viewers being more cautious when talking about mental health to show understanding.

Community Case Study: Stack Up's Overwatch Program, an Online Suicide Prevention and Peer Support Program for Video Gamers

Traditional mental health services are often not enough to meet the needs of people at risk for suicide, especially in populations where help-seeking is stigmatized. Stack Up, a non-profit veteran organization whose goal is to use video games to bring veterans together, recognized a need in its gaming-focused online community and created the Overwatch Program. This suicide prevention and crisis intervention program is delivered entirely through the Internet by trained community members through Discord text and voice chat. By combining aspects of virtual gaming communities, veteran mental health, and community-based peer support, this program provides an innovative format for implementing crisis intervention and mental health support programs. We describe here the context and features of the program, an ongoing evaluation project, and lessons learned.

Substitute Addictions in Persons with Substance Use Disorders: A Scoping Review

Substitute addictions, addictive behaviors that sequentially replace each other's functions, have implications for recovery trajectories but remain poorly understood. We sought to scope the extent, range, and characteristics of research on substitute addictions in persons with substance use disorders. Method: Using Arksey and O'Malley's framework for scoping reviews, a systematic search was conducted to identify publications that referenced substitute addictions up to April 2018. Study characteristics were extracted and summarized to provide an overview of the extant literature. Results: The 63 included studies show that substitute addictions are terminologically and conceptually ambiguous. Much of the available literature is concentrated in developed contexts - and in particular the United States of America. While presentations varied, at least two sub-types of substitute addictions appeared: long-term replacement and temporary replacement. Existing theories suggest a multifactorial etiology. Conclusions: The findings suggest a strong need for: increased awareness of substitute addictions and its potential consequences for recovery; interventions that structure prevention and pre-, during-, and post-treatment interactions as well as future research to explore its nature and dynamics drawing on multiple methods.

The Paradox of Interactive Media: The Potential for Video Games and Virtual Reality as Tools for Violence Prevention

Interactive media such as video games and virtual reality (VR) provide users with lived experiences that may be dangerous or even impossible in daily life. By providing interactive experiences in highly authentic, detail-rich contexts, these technologies have demonstrated measurable success in impacting how people think, feel, and behave in the physical world. At the same time, violent interactive media content has been historically connected with a range of antisocial effects in both popular press and academic research. Extant literature has established a small-but-statistically significant effect of interactive media violence on aggressive thoughts and behaviors, which could serve as a risk factor for interpersonal violence. However, left unexplored is the seemingly paradoxical claim that under some conditions, interactive media experiences might protect against interpersonal violence. Drawing on advances in media theory and research and the evolution of interactive media content and production practices, the current manuscript suggests ways in which interactive media violence may be leveraged to lower the likelihood of real-world violence experiences. For example, research on both violent and non-violent games has found that players can (a) express guilt after committing violent acts, (b) report reflective and introspective emotional reactions during gameplay, and (c) debate the morality of their actions with others. Regarding VR, studies have demonstrated that (a) witnessing physical violence in immersive spaces led participants to take the perspective of victims and better understand their emotional state and (b) controlled exposure to traumatic or violent events can be used for treatment. Broadly, studies into video games and VR demonstrate that the impact of actions in virtual worlds transfer into the physical worlds to influence (later) attitudes and behaviors. Thus, how these experiences may be potentially harnessed for social change is a compelling and open consideration, as are side-effects of such interventions on vulnerable groups. The current manuscript summarizes emerging research perspectives (as well as their limitations) to offer insight into the potential for interactive media violence to protect against real-world violence victimization and perpetration.

Evaluating the quality of evidence for gaming disorder: A summary of systematic reviews of associations between gaming disorder and depression or anxiety

Gaming disorder has been described as an urgent public health problem and has garnered many systematic reviews of its associations with other health conditions. However, review methodology can contribute to bias in the conclusions, leading to research, policy, and patient care that are not truly evidence-based. This study followed a pre-registered protocol (PROSPERO 2018 CRD42018090651) with the objective of identifying reliable and methodologically-rigorous systematic reviews that examine the associations between gaming disorder and depression or anxiety in any population. We searched PubMed and PsycInfo for published systematic reviews and the gray literature for unpublished systematic reviews as of June 24, 2020. Reviews were classified as reliable according to several quality criteria, such as whether they conducted a risk of bias assessment of studies and whether they clearly described how outcomes from each study were selected. We assessed possible selective outcome reporting among the reviews. Seven reviews that included a total of 196 studies met inclusion criteria. The overall number of participants was not calculable because not all reviews reported these data. All reviews specified eligibility criteria for studies, but not for outcomes within studies. Only one review assessed risk of bias. Evidence of selective outcome reporting was found in all reviews-only one review incorporated any of the null findings from studies it included. Thus, none were classified as reliable according to prespecified quality criteria. Systematic reviews related to gaming disorder do not meet methodological standards. As clinical and policy decisions are heavily reliant on reliable, accurate, and unbiased evidence synthesis; researchers, clinicians, and policymakers should consider the implications of selective outcome reporting. Limitations of the current summary include using counts of associations and restricting to systematic reviews published in English. Systematic reviewers should follow established guidelines for review conduct and transparent reporting to ensure evidence about technology use disorders is reliable.

What role can videogames play in the COVID-19 pandemic?

Video games are often thought of as trite activities for younger generations. However, research in game studies over the last few decades have revealed that games can be valuable tools for growth and connection, particularly among older generations. Exploring the ways digital games can be used as tools for connection has gained increased attention in recent months with global quarantines as a result of COVID-19. This article reviews the research that has examined the utility of digital games for older adults, focusing specifically on the ways in which games can be tools for social connectedness and psychological healing for older adults and intergenerationally. Special focus will be placed on the role games can play for post-traumatic stress among first responders.

Habits and Attitudes of Video Gaming and Information Technology Use in People with Schizophrenia: Cross-Sectional Survey

Background

Information technology and video gaming have potential advantages in the treatment of schizophrenia. However, information regarding the habits and attitudes related to internet use and video gaming in people with schizophrenia is limited.

Objective

The aim of this study was to explore the habits and attitudes regarding video gaming and information technology usage and their associated factors in people with schizophrenia in Hong Kong.

Methods

In this cross-sectional survey, service users with schizophrenia were recruited from 6 halfway hostels and 7 integrated centers for mental wellness in Hong Kong. A 79-item self-report questionnaire was utilized to explore the habits of internet use and video gaming in these people with schizophrenia. The attitude toward video gaming was assessed using the Gaming Attitudes, Motivations, and Experiences Scales. Of the 148 individuals in a convenience sample who were invited to participate in this study, 110 willingly participated (a response rate of 74.3%). The data were analyzed using descriptive statistics, a two-tailed independent t test, Pearson correlation, and principal analysis with 3 methods of rotation (varimax, equimax, and promax).

Results

Most participants (100/110, 90.9%) had access to the internet and half of them (54/110, 49.1%) used the internet daily mostly to watch videos (66/110, 60.0%) or read news or books, etc (42/110, 38.2%). One-third of the participants (36/110, 32.7%) used the internet to play web-based games, and most of them (88/110, 80.0%) had played a video game in the past year. The most favorable gaming platforms were cellular phones (43/88, 49%) followed by computers (19/88, 22%) and arcade cabinets (6/88, 7%). The most favorable game genre was action games (34/145, 23.4%). Those who had a bachelor’s degree or higher scored lower in social interaction than those with a lower education level (P=.03). Those who played video games daily scored higher in the category of story than those who did not play daily (t₈₆=2.03, P=.05). The most popular gaming category was autonomy and the least popular categories were violent catharsis and violent reward. Two motives, “social playing” and “evasive playing,” were formed to describe the characteristics of playing video games.

Conclusions

Our data showed a high internet utilization rate among people with schizophrenia in Hong Kong. Only a few of them used the internet to search for health-related information. Our study also exemplified the unique habits of gaming among the participants. Health care professionals could utilize video games to engage people with schizophrenia and promote coping with stress and provide social skills training to such people with schizophrenia. Identification of the gaming attitudes can contribute to the development of serious games for the schizophrenic population. Further investigation is vital for the promotion of mental health through web-based platforms.

Mind over Matter: Testing the Efficacy of an Online Randomized Controlled Trial to Reduce Distraction from Smartphone Use

Evidence suggests a growing call for the prevention of excessive smartphone and social media use and the ensuing distraction that arises affecting academic achievement and productivity. A ten-day online randomized controlled trial with the use of smartphone apps, engaging participants in mindfulness exercises, self-monitoring and mood tracking, was implemented amongst UK university students (n = 143). Participants were asked to complete online pre- and post-intervention assessments. Results indicated high effect sizes in reduction of smartphone distraction and improvement scores on a number of self-reported secondary psychological outcomes. The intervention was not effective in reducing habitual behaviours, nomophobia, or time spent on social media. Mediation analyses demonstrated that: (i) emotional self-awareness but not mindful attention mediated the relationship between intervention effects and smartphone distraction, and (ii) online vigilance mediated the relationship between smartphone distraction and problematic social media use. The present study provides preliminary evidence of the efficacy of an intervention for decreased smartphone distraction and highlights psychological processes involved in this emergent phenomenon in the smartphone literature. Online interventions may serve as complementary strategies to reduce distraction levels and promote insight into online engagement. More research is required to elucidate the mechanisms of digital distraction and assess its implications in problematic use.

What role can videogames play in the COVID-19 pandemic?

Video games are often thought of as trite activities for younger generations. However, research in game studies over the last few decades have revealed that games can be valuable tools for growth and connection, particularly among older generations. Exploring the ways digital games can be used as tools for connection has gained increased attention in recent months with global quarantines as a result of COVID-19. This article reviews the research that has examined the utility of digital games for older adults, focusing specifically on the ways in which games can be tools for social connectedness and psychological healing for older adults and intergenerationally. Special focus will be placed on the role games can play for post-traumatic stress among first responders.

Avatar Creation in Videogaming: Between Compensation and Constraint

Objective: We examine the extent that videogame avatars provide players with opportunities for identity exploration, aiming to test the findings of self-discrepancy theory research on the user/avatar relationship with novel cognitive anthropological methods. Specifically, we examine if avatar traits are idealized (more representative of players' ideal rather than actual self) or actualized (more representative of players' actual self) as a function of players' self-esteem. Materials and Methods: Utilizing cognitive anthropological methods, we examine the relationship between actual, avatar, and ideal selves. We first asked 21 respondents to list traits they associated with their various selves. We then asked 57 new respondents to perform four pile sorts of the salient items from these lists (1 unconstrained sort of like-traits, and 3 sorts of terms indicative of respondents' ideal/actual/avatar self). Analysis of this "free list" and "pile sort" data allowed us to clarify (in a manner sensitive to gamer culture) relationships between respondents' various conceptions of self, including how those relationships were modified by self-esteem. Illustrative quotes from the interviews further clarified these relationships. Results: Paired t-test analysis shows that informants as a whole describe their avatar compared with actual selves with fewer negative terms (idealization). Low-esteem players actualize what they deem as positive traits onto their avatars, while simultaneously idealizing avatars' negative traits by minimizing them. Compared with low-esteem gamers, high-esteem players associate significantly more positive attributes with all their various selves-actual, avatar, and ideal-while describing avatar compared with actual selves with fewer positive terms and comparable numbers of negative terms (the latter a process of actualization). Conclusion: Results point to the necessity of theoretical accounts that recognize that avatars may reflect a complex relationship with the user's actual and ideal self, without assuming that avatar play frees gamers from offline social, psychological, or bodily constraints.

Positive mental well-being and immune transcriptional profiles in highly involved videogame players

Previous research has identified a link between experiencing life as meaningful and purposeful-what is referred to as "eudaimonia"-and reduced expression of a stress-induced gene profile known as the "conserved transcriptional response to adversity" (CTRA). In the current study, we examine whether similar links between eudaimonic well-being and CTRA reduction occur in a sample of 56 individuals with a particularly strong engagement with virtual worlds: avid online videogame players. Results consistently linked higher eudaimonic well-being, and more specifically the social well-being subdomain of eudaimonia, to lower levels of CTRA gene expression. That favorable psychobiological relationship between eudaimonia and CTRA appeared most strongly among individuals reporting high levels of positive psychosocial involvement with gaming. Findings are consistent with the hypothesis that committed social/recreational activity may help damp CTRA expression especially among persons who are already experiencing some kind of threshold of positive eudaimonic experience.

Pathologic Use of Video Games and Motivation: Can the Gaming Motivation Scale (GAMS) Predict Depression and Trait Anxiety?

Videogaming is an increasingly prevalent activity among adolescents worldwide. The present study aimed at adapting the Gaming Motivation Scale (GAMS) to the Italian context, assessing its psychometric properties and verifying its sensitivity to predict depression and anxiety levels. From a sample of 1899 participants, a group of 388 adolescents who participated in the survey was divided into two subgroups of Heavy (HG, N = 188) and Light Gamers (LG, N = 200). A sub-sample of N = 172 adolescents also filled-in CESD and STAI to assess, respectively, depression and trait anxiety. Internal consistency and factorial structure of the Italian version of GAMS (GAMS-it) have been evaluated. Moreover, a latent regression structural equation model by predicting the CES-D and STAI scores with the GAMS-it factors has been carried out. GAMS-it has adequate validity and reliability levels, showing a very similar factorial structure to the original version. Therefore, this scale can be used to evaluate gaming motivation, which is useful for gaming motivation screening. Finally, it has been found that lower gaming motivation can be related to high level of depression and anxiety. The present findings provide a coherent picture, supporting the reliability and validity of the GAMS-it, that appears potentially useful in predicting anxiety and depression levels in a population of adolescents.