Digital games and healthJaana WessmanPrakticum, 8th & 29th Nov 2016

Who am I?

● PhD Computer Science● Medical doctor specializing in child psychiatry (in my final year of training)● Researcher of children & youth mental health (esp problem behaviors)● Computer gamer (not a competing one)● eSport spectator

What will I talk about today?

● benefits of digital gaming● health risks of digital gaming

○ (“computer game addiction”)

● performance optimization for serious/professional gamers● advice for game educators

(This lecture covers computer games played for recreation and/or competitively. By digital games I mean computer games, console games, games on handheld devices and all other digital platforms. Games specifically designed to improve a particular skill are excluded. I concentrate on mental health and

cognitive performance.)

Benefits of digital games

Visuomotor and attention skills

Clear, causal evidence from multiple intervention studies that playing action video games improves

● ability to maintain visual attention● multiple object tracking● visual search performance, visual & spatial working memory● task-switching speed, reaction speed● mental 3D processing● probabilistic inference?

Skill transfer to physical world, e.g. driving, has been proven.Green & Bavalier, 2012, Learning, attentional control, and action video games. Curr Biol.Chisholm et al, 2015, Action video game players' visual search advantage extends to biologically relevant stimuli.

Social benefits

Over 70 % of gamers regularly play with other people.

Players who play games that require teamwork are more likely to exhibit helpful behaviors online and offline at least for a short time after the experience.

People who play MMOGs in organized groups (e.g. guilds) are more likely to be engaged in social and civic movements in their everyday lives. (Causality?)

Experienced gamers are more persistent when facing increasingly difficult math problems than non-gamers.

Granic et al. 2014, The benefits of playing video games. Am Psychol 2014.

Last but not least

Playing games is immensely enjoyable.

For most people who play, games give experiences of enjoyment, relaxation, achievement and positive excitement.

Such experiences have a clear link to increased mental health.

Health risks of digital games

Are video games bad for you?

Playing computer games has been associated to:

● poor grades and worse work performance● depression and anxiety● aggressiveness, getting into fights● conduct problems in children● impulsiveness● attention problems● sleep problems● worse physical health

● back, neck and shoulder painsAndreassen et al, 2016, The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychol Addict Behav.

Causality?

Despite several attempts, researchers have failed to show a causal link of frequent computer gaming to

● conduct problems● depression and anxiety● attention/concentration difficulties● drug/alcohol use● work or school performance

Parkes et al, 2013, Do television and electronic games predict children's psychosocial adjustment? Longitudinal research using the UK Millennium Cohort StudyBrunborg et al, 2014, Is video gaming, or video game addiction, associated with depression, academic achievement, heavy episodic drinking, or conduct problems?

Sleep!

Link between less sleep and poorer sleep quality and playing digital games, especially late at night, has been shown.

● light wave-length?● social synchronization?● excitement?

Lack of sleep causes attention difficulties, impulsiveness, irritability, worse cognitive performance, changes in mood, lack of motivation, weight gain, and can even activate type II diabetes.

Exelmans et al, 2015, Sleep quality is negatively related to video gaming volume in adults.

Back, neck, and shoulders

● working or playing on a computer for prolonged periods causes more neck, shoulder and back pains (self-reported)

● long-term effects of this are unclear● physical exercise is probably protective

Silva et al. 2016. Prevalence of musculoskeletal pain in adolescents and association with computer and videogame use. J Pediatr

But what about “video/internet game addiction”?

Does it even exist?

Yes! But you do not get it from simply playing a lot. (About 1-5 % of gamers.)

“Gaming disorder” is a state where a person’s ability to function (e.g. in school or work, with friends) is severely disrupted, and they spend their time obsessively playing games. Play is obsessive and joyless, but the player is often unable to stop.

Usually results from avoiding an existing problem (depression/anxiety, family problems, problems at school/work) by escaping into games.

Turel et al, 2016, Health Outcomes of Information System Use Lifestyles among Adolescents: Videogame Addiction, Sleep Curtailment and Cardio-Metabolic Deficiencies. PLOS One.

The vicious circle

Excessive gaming /

internet use

Lack of sleep

“Real-life” problems

Anxiety / depression

You have a serious problem if

● you play, even though it’s not even fun anymore● you frequently skip school, work, or social obligations because of games● you cannot stop playing even though you have already decided to cut back● you are unable to think about anything else when you are not playing

(Whether your actual problem are the games themselves is a matter for a professional evaluation. It is very likely something else is the triggering cause.)

You risk your health with games if

● you do not sleep regularly and enough● you do not get physical exercise● you use games to run away from your problems instead of solving them

(That’s it.)

Performance optimization for serious gamers (or serious anything)

Remember this list?

Computer gamers develop (and therefore gaming requires) the following skills:

● ability to maintain visual attention● multiple object tracking● visual search performance, visual & spatial working memory● task-switching speed, reaction speed● mental 3D processing● probabilistic inference?● persistence in the face of difficult tasks

“In a fight, somebody always has an edge.”

These days, it is no longer enough just to know the game.

Everyone who plays competitively/seriously knows the game.

You have find out what gives you a performance edge over the other guys (or the game environment).

(“If you think the fight is fair, the other guys have it.”)

Physical exercise

Conclusive evidence that physical exercise improves (short-term and long-term)

● spatial memory● attention control● reaction time● visual and verbal problem solving● learning new skills● tolerance of stress and ability to function under stress● mood● sleep quality

Smith et al, 2010. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med. Schuch et al, 2016. Are lower levels of cardiorespiratory fitness associated with incident depression? A systematic review of prospective cohort studies. Prev Med.

Mechanisms?During the evolution of humans, exploration, defense, foraging as well as cognitive skills were tightly integrated to motor operations for survival.

Hippocampus?

● “GPS of the brain”● involved in short-term and long-term

memory● growth and neurogenesis after exercise

NOTE: complex exercise and moving outside are most beneficial for brain functions.Baek. 2016. Role of exercise on the brain. J Exerc Rehabil.

Stress

Temporary stress related to the situation is not harmful, but might actually boost problem solving and reaction times.

Chronic stress or stress unrelated to task at hand, however, will

● disturb your sleep● increase feelings of fatigue● increase your reaction time● make you slower in visual and verbal recognition tasks● cripple your ability to keep your attention at the task

Lupien et al, 2009. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci.

Sleep

Lack of sleep or bad quality of sleep causes

● attention difficulties● impulsiveness ● inability to take into account all details when making decisions● irritability ● worse performance in visual tracking tasks● changes in mood● lack of motivation

1 hour sleep deprivation = 0.5 ‰ blood alcohol contentDe Bruin et al, 2016. Effects of sleep manipulation on cognitive functioning of adolescents: A systematic review. Sleep Med Rev.

The lift to success

Sleep

Exercise

Stress Reduction

Success

Top three things to do outside of the game

1. Sleep○ regularly○ enough

2. Exercise○ preferably daily

○ preferably something requiring spatial navigation (walking/running outside) and/or complex co-ordination (dance, martial arts), or both (trail running, team sports)

3. Minimize unrelated stress○ take care of your family obligations○ take care of your school/work○ have a Plan B

Serious competitive gaming requires leading a disciplined life. (Sorry about that.)

Advice for game educators

Do not artificially limit screen time

There is no evidence whatsoever that strict limits of screen time are necessary or beneficial.

Instead, promote healthy lifestyle: sleep, diet, schoolwork, social interaction, physical exercise. Encourage “media-free zones”, especially bedrooms at the night-time to increase sleep time and quality.

What time remains, people should use for whatever they find enjoyable, interesting, and relaxing. The requirement to spend all your free-time in an educational manner is inordinate, also for children.

Brunborg et al, 2014, Is video gaming, or video game addiction, associated with depression, academic achievement, heavy episodic drinking, or conduct problems?

Encourage social play

Small children should play with adults and talk about games with adults. (Learning to talk, learning words for emotions, learning moral reasoning.)

Older children should play with friends and family. (Enjoying time together, sharing interests, learning co-operation and prosocial behavior.)

Youth and adults should play with friends, family, and online communities. (Teamwork increases prosocial behavior, reduces violent thoughts that result from violent play. Social communication reduces stress.)

Content matters

Children should only play age-appropriate games. (Exceptions to be made only by a guardian who knows both the game and the child.)

Adults should monitor themselves for their reactions to various games and self-regulate as necessary.

Online communities should self-police for bullying and hate-speech and reward prosocial behavior.

Carson et al. 2015. Systematic review of sedentary behavior and cognitive development in early childhood. Prev Med.

Do not separate games/internet from “real life”

● games are part of life● games are played by real people● those real people live in the real world● they play with other real people● all those real people have real feelings● games cost real money

The experiences of learning and enjoyment are as real as those gained from books, movies, other art, physical play, boardgames, travelling, and so forth.

Gaming friends are real friends.

If you are worried about someone’s gaming

● think through why you are worried about it○ are they skipping school? or have they dropped out completely?○ do they seem sad or distressed?○ do they sleep or exercise too little?○ are they lonely?○ are they neglecting their family or friends?○ are they unable to stop despite wanting to?

● then fix that problem● if it ain’t broken, don’t fix it

Final wordsThank you. Remember to sleep.