Press Start to Heal: Video Games and Mental Health Awareness

Content Warning: This article, part of Mental Health Week, deals with various aspects of mental health. It sometimes includes examples of negative emotions and unhealthy behaviours that may trigger adverse reactions in some people. Please be cautious with texts that may contain potentially triggering themes for you.

Important Note: If you are experiencing depression or self-destructive thoughts, you are not alone. Please seek help, for example, from the Samaritans. They offer emotional support 24 hours a day in complete confidence. Call 116 123—it’s FREE. You can also email jo@samaritans.org.uk or visit free counselling centres. Also, see any support groups near your area. This is for the UK only.

Besides representing “Mental Health” themes, video games can directly influence our well-being even when not explicitly addressing them. This article is unique, and we are writing about to highlight the impact of video games and mental health as part of Mental Health Awareness Week. We hope it reveals the connection between our psychological needs and how some video games can help.

More and more games are addressing mental health or mental illnesses in one way or another. While indie games like Hellblade: Senua’s Sacrifice and Celeste were known for addressing “Mental Health” in the past, mental illnesses now find a place in larger productions such as Returnal. However, video games are not only used as a projection surface for Mental Health content but can also contribute to improving mental health (e.g., well-being and emotional stability).

At the same time, mainstream media, especially, warn about gaming addiction, which is now named “Gaming Disorder” in the latest edition of the International Classification System for Diseases (ICD-11). This article attempts to shed light on the myths surrounding gaming and mental health: Can games help us feel better about mental illnesses? How can games help us endure difficult times? And when does it become unhealthy?

Video Games And Mental Health: a Therapeutic Relationship

 When individuals seek therapists, they often expect someone to solve their problems, as if the psyche were simply a leaky pipe that the soul plumber needs to fiddle with. While a joint search for solutions can be an essential and meaningful part of therapy, according to a famous study in professional circles, something else is crucial for treatment: the relationship between therapist and client. Therefore, at the beginning of therapy, relationship building is significant.

What we expect from video games can vary greatly. Do we want to be creative (like in Minecraft) or immersed in a story(like in any Mass Effect game)?

Like we build a relationship with people, slowly getting to know them, the first steps in a new video game also unfold similarly: Do I find the game interesting? Does it give me what I want – fun, challenge, and space to express myself? And do I feel engaged by the game, or should I try another one? But what needs to happen to feel involved in video games?

Validation – When it’s okay not to be “okay.”

Validation refers to a therapeutic technique that accepts and values current thoughts, feelings, and actions as they are. To convey “I see that you’re not feeling well” and “You are not wrong or defective as a person because of it.” Video games that depict mentally ill protagonists and characters can convey this feeling to affected individuals and show that, for example, anxiety disorders or depressive moods are not something we alone experience. Taking it a step further, the game Life is Strange: True Colours not only represents therapeutically meaningful strategies for emotion regulation (e.g., mood diary) but also exemplifies how validation in everyday life can look and how it can even make us better friends.

Life is Strange, and so are feelings…

In Life is Strange: True Colours, perceiving and validating feelings takes on special significance. The protagonist, Alex Chen, has the power to recognise the emotional states of other people and fully empathise with them. By seeing the world through the emotional lens of those affected and fully accepting their experience, she can help them empathetically overcome complex emotional states.

Thus, the basic principles of therapeutic approaches are illustrated. However, both in True Colours and in therapy, and sometimes even in friendship, the focus is precisely that:

• Perceiving what feelings and thoughts occupy a person.

• Accepting them.

• Offering what the person needs.

• These are not always solutions; sometimes, it’s just the feeling of being seen and accepted in one’s suffering.

Life is Strange, a Lesson in Video Games And Mental Health

Alex validates Mac by naming and acknowledging the prevailing thoughts and feelings, showing him that he is not alone. Alex validates Mac by naming and acknowledging the prevailing thoughts and feelings, showing him that he is not alone.

Life is Strange: True Colours extensively addresses thoughts and feelings and, indirectly, mental health. Games that specifically address mental illnesses and topics such as depression, addiction, and trauma are still somewhat niche despite their increasing popularity. And as much as we love challenging topics and psychology, we find it nice to escape into another world and not deal with complex issues. And that’s okay because the intuitive incentive of video games is to have fun. But how can games, even if they don’t explicitly address “Mental Health,” make us feel better?

Is Being Fun the Answer?

Or is there more to it? It’s worth examining how video games can satisfy our psychological needs. According to Grawe’s four basic psychological needs, these include pleasure gain/avoidance of displeasure, control/orientation, closeness/bonding, and enhancement/stabilisation of self-esteem. It is clear and intuitive that video games satisfy our need for “pleasure” or fun. It’s just enjoyable, and we like doing pleasant things. So far, so good, but what about the other needs?

According to Grawe, the four basic psychological needs are a model commonly used in therapy to understand why we do things.

Besides fun, video games can give us the feeling of achievement. Video games repeatedly challenge us, whether in single-player or multiplayer. Overcoming these challenges and triumphing over the annoying Dark Souls boss or another team at the end gives us the feeling of having achieved something, positively affecting our need for self-worth and, ultimately, our self-concept. Intertwined with this are also so-called power fantasies and feelings of superiority, which in video games are predominantly functional or healthy. Dysfunctional would be indulging in behaviour that harms oneself or others (e.g., psychologically). Hostility and exclusion of any kind, especially the sexist remarks and comments that female players still frequently encounter in voice chats.

We also extensively wrote about online cyberbullying in one of our previous articles.

Co-op Video Games And Mental Health

What many players have long known, but which was also highlighted by the COVID-19 pandemic: Through contact in video games, we can both build and maintain our social relationships. MMORPGs, in particular, are designed through their internal social structures to make connections. The numerous, sometimes intercontinental, romantic relationships that have arisen through playing together are evidence that video games can satisfy the needs for closeness and bonding, at least to some extent, through their opportunities for social interaction.

Video games have created exceptional bonding experiences for decades, whether on the couch or in online co-op.

We need to look closer at the need for control and orientation. It can be a good feeling for some people to complete quests as a daily routine, while it can be stressful for others. However, the success of games like Stardew Valley shows that many players are also interested in having a self-determined, clear framework with small “to-dos.” Completing tasks and implementing structures fulfil our need to control our (virtual) lives and is also one of the main reasons for playing games of this kind.

Satisfying needs is thus one of the most critical functions that video games can fulfil in maintaining and building mental health. When we feel competent, autonomous, and socially integrated, we can be more resilient against demands and events that challenge our well-being and health.

When Does Gaming Become Unhealthy?

With a somewhat simplified view, video games could solve all our (Mental Health) problems if they can satisfy all needs to some extent. However, it’s more complicated. It does make a difference in how and with what we satisfy our needs. If we try to meet all our needs through one source, we not only become dependent on it but also run into serious trouble if that source dries up (e.g. due to outages, shutdown servers, or losing streaks).

Gaming Disorder, colloquially known as gaming addiction, is characterised not primarily by the extent of gaming consumption itself but by a loss of control over gaming behaviour. Those affected have difficulty reducing their gaming time and need more and more game time to avoid feeling bad. As a result, things like school, work, or friends are often neglected against better judgment of the long-term consequences.

 If these three criteria persist for more than 12 months and lead to impairment in various areas of life (e.g. school, work, family, friends), the diagnosis of “Gaming Disorder” can be given in the future. This is why you should consider limiting screen time, whether your child is a gamer or not.

In Conclusion

The connection with needs becomes apparent when looking at current studies on the comorbidities of Gaming Disorder. Often, it is associated with other mental illnesses, such as depression or social anxiety. This suggests that excessive video game gaming is sometimes a substitute for the needs of individuals who have not learned or have no other functional means available. In these cases, treatment is advisable and often necessary.

However, for most video game enthusiasts, this is not the case, and diving into virtual worlds can be an easily accessible and interactive way to meet their needs.

Important Note Again: If you are experiencing depression or self-destructive thoughts, you are not alone. Please seek help, for example, from the Samaritans. They offer emotional support 24 hours a day in complete confidence. Call 116 123—it’s FREE. You can also email jo@samaritans.org.uk or visit free counselling centres. Also, see any support groups near your area. This is for the UK only.