Games are an important cultural touchstone. Family and friends gather to play board and card games. Nations tune in to watch sports. Videogames have exploded in the entertainment industry, with sales outpacing the revenue of Hollywood movies. In addition to their entertainment value, games are emerging as tools for bolstering mental well-being. For example, a survey during the COVID-19 pandemic found that playing the multiplayer function of the video game Animal Crossing: New Horizons predicted decreased scores in loneliness and anxiety . Additionally, a systematic review of studies investigating the effects of playing Pokemon Go found that playing the game was associated with increased physical activity, reduced anxiety, and increased social bonding . Therapists have also noticed the benefits of games, incorporating them into therapeutic interventions.
The Use of Games in Therapy
Games were initially utilized in psychotherapy as a component of play therapy for children in the early 20th century . Therapist researchers like Joseph Solomon started using toys and activities to encourage children to process complex emotions and problems. Play therapists use games to build rapport, as well as build prosocial and coping skills. The principles of play therapy are then scaled to more mature games for an adolescent or adult audience. With the proliferation of video games and virtual reality (VR), the role of games in therapy sessions has expanded.
Researchers Horne-Moyer et al. (2014) explain two methods of incorporating electronic games into therapy . The first method is to use pre-existing entertainment games and mold them toward a therapeutic goal. For example, a therapist could encourage a client struggling with agoraphobia to play Pokémon Go to encourage exploration outside of the home. The second method is to design a game around a therapeutic intervention, which is called serious games. Horne-Moyer et al’s systematic review found that both serious and entertainment are effective therapeutic interventions, though more research has been focused on serious games . Therapeutic games don’t have to be electronic to be effective. A review of 27 studies investigating the efficacy of incorporating classic entertainment board games (e.g. chess and shogi) into ADHD treatment found that the use of board games was associated with a significant decrease in reported symptom scores and a significant increase in cognition scores .
Examples of Games in Therapy
Using games in therapy can have substantial benefits. A review of electronic games in therapy found that the use of electronic games can increase client engagement and enjoyment of therapeutic interventions, granted that the game matches the client’s age and diagnoses . Therapeutic games are easily adaptable to a specific diagnosis, especially serious games. Below are three examples of how games have been effectively applied across a variety of diagnoses.
For clients who struggle with social skills or social anxietyphobias, VR games provide safe exposures. One might assume that being in a VR space is isolative and inhibits social interaction. However, a survey of 273 users of a social VR platform found that the most common motivation for joining the game was to engage in social activities and satisfy social needs . Additionally, VR games effectively provide exposures for social anxiety. A meta-analysis by Freitas et al. (2021) found that VR therapeutic games had an estimated 94% success rate in lowering phobia symptoms and were effective in both children and adults . If the client does not enjoy VR, or if the system is too expensive, there are several activities for free on Adhere.ly centered around building social skills.
Mindfulness is the ability to remain in the present moment while being aware of thoughts and feelings. Practicing mindfulness has been widely acknowledged as a protective factor for mental well-being . A review by Sliwinski et al. (2015) found that entertainment video games can bolster key mindfulness attributes, such as environmental awareness and environmental understanding . The researchers also identified that serious games were effective in enhancing other mindfulness principles like openness to experience, acceptance, and decentering.
Games have also been shown to be effective therapy tools for helping clients develop emotional intelligence. A systematic review of 40 studies examining the use of serious electronic games in autism treatment found that the use of games consistently resulted in increased emotional intelligence if the game is engaging to the client . The researchers then used qualitative analysis to find the key components of serious games for emotional understanding and concluded that the games should incorporate reward systems and customization. Clinicians can also use entertainment games to enhance emotional intelligence therapies. In a randomized clinical trial with 121 adolescents, the game-based emotional intelligence intervention group had significantly higher scores for emotional recognition and use of cognitive re-evaluation compared to the control group . Adhere.ly is a great resource for incorporating simple affect games during sessions or even in-between sessions, like emoji emotion matching.
Therapy can be a draining experience due to rigorous cognitive and emotional processing. Games can help make interventions engaging and enjoyable for clients, especially children and adolescents. The role of games in therapy is still being researched as more entertainment games are studied and serious games are developed. With the exponential improvement of VR and electronic games, the incorporation of games into therapy is one of the emerging frontiers combining technology and psychotherapy.
 Lewis JE, Trojovsky M, Jameson MM. New social horizons: anxiety, isolation, and animal crossing during the COVID-19 pandemic. Frontiers in Virtual Reality. 2021 Mar 30;2:627350.
 Wang AI. Systematic literature review on health effects of playing Pokémon Go. Entertainment Computing. 2021 May 1;38:100411.
. Johnson JL. The history of play therapy. Handbook of play therapy. 2015 Nov 16:17-34.
. Horne-Moyer HL, Moyer BH, Messer DC, Messer ES. The use of electronic games in therapy: a review with clinical implications. Current psychiatry reports. 2014 Dec;16(12):1-9.
. Noda S, Shirotsuki K, Nakao M. The effectiveness of intervention with board games: a systematic review. BioPsychoSocial medicine. 2019 Dec;13(1):1-21.
. Sykownik P, Graf L, Zils C, Masuch M. The Most Social Platform Ever? A Survey about Activities & Motives of Social VR Users. In2021 IEEE Virtual Reality and 3D User Interfaces (VR) 2021 Mar 27 (pp. 546-554). IEEE.
. Freitas JR, Velosa VH, Abreu LT, Jardim RL, Santos JA, Peres B, Campos PF. Virtual reality exposure treatment in phobias: a systematic review. Psychiatric Quarterly. 2021 Dec;92(4):1685-710.
. Doll A, Hölzel BK, Bratec SM, Boucard CC, Xie X, Wohlschläger AM, Sorg C. Mindful attention to breath regulates emotions via increased amygdala–prefrontal cortex connectivity. Neuroimage. 2016 Jul 1;134:305-13.
. Sliwinski J, Katsikitis M, Jones CM. Mindful gaming: How digital games can improve mindfulness. InIFIP Conference on Human-Computer Interaction 2015 Sep 14 (pp. 167-184). Springer, Cham.
. Hassan A, Pinkwart N, Shafi M. Serious games to improve social and emotional intelligence in children with autism. Entertainment computing. 2021 May 1;38:100417.
. Carissoli C, Villani D. Can videogames be used to promote emotional intelligence in teenagers? Results from EmotivaMente, a school program. Games for health journal. 2019 Dec 1;8(6):407-13.