Researchers look to video games for therapeutic effects

Tuesday, July 15, 2008 | 9:19 p.m. CDT; updated 1:01 p.m. CDT, Tuesday, July 22, 2008

KANSAS CITY — This fall, East Carolina University researcher Carmen Russoniello will hand sickle cell anemia patients video game controllers and see whether playing the games helps them control stress and reduce pain caused by their disease.

Scientists, intrigued by video games’ intrinsic ability to distract and focus the mind, have for decades looked for ways to use them to improve health and patient outcomes. Much of the work, however, has dwelt in obscurity as researchers struggled with small study sizes and lingering biases against what many considered a juvenile or even anti-social pastime.

Even the video game industry has been unsure of what to make of the research, instead focusing primarily on the enjoyment aspect of game design.

But Russoniello, who has studied the physical and mental effects of recreation for 20 years, says he believes those perceptions are changing. For example, his sickle cell anemia study will be held in a clinical center operated by the highly selective and influential National Institutes of Health. In addition, insurance companies and a leading philanthropic organization have begun throwing big money behind video game research.

“Ten years ago, they would have laughed me out of that place,” he said. “But there’s an acceptance of things. (Video games) aren’t panaceas but they have their place and we need to find where that place is.”

The Robert Wood Johnson Foundation announced in May that it would provide more than $2 million in grants for a dozen studies on the use of computer games for health. The projects include using active video games, such as the Nintendo Wii, to encourage weight loss in children and seeing whether playing a driving-type video game improves cognitive and visual functions in senior citizens.

This year’s Games for Health conference, an annual get-together for medical scientists to review the latest in games-related research, drew more than 320 attendees, up from 120 when the meetings began four years ago, co-founder Ben Sawyer said.

Among those attending this year’s conference were representatives of such major health care organizations as Humana Inc., Cigna Corp. and Kaiser Permanente, which have all launched gaming projects in the past year.

Cigna, for instance, is distributing copies of the HopeLab-developed game “ReMission” to oncologists to give to their teenage cancer patients. The sci-fi shooter lets players blast cancer cells while learning how the disease progresses and what they can do to improve their health and well-being.

“Frankly, teens are a difficult group to reach,” said Joe Mondy, assistant vice president of IT communications. “We think a video game approach reaches those kids where they are.”

As happens in other areas of health, the research is actually trailing behind public behavior.

A recent customer survey by Seattle-based PopCap Games Inc., maker of such casual games as Bejeweled, found that more than 20 percent of respondents identified themselves as having some level of physical or mental disability, and most of those said they used games as part of their therapy.

One of them is Gail Nichols, 48, who said she has used video games to combat severe depression since the mid-1990s.

The northeast Kansas resident, who said she suffers from post-traumatic stress disorder and other ailments, said she carries a Nintendo DS or Gameboy with her when she travels in case she begins feeling anxious or confused in public.

“If I get stressed out, my service dog is there with me. I’ll pull (the game) out of her pack and between her being there with me and sitting there playing the game I won’t be so nervous about people around me,” Nichols said. “I would hope the medical community will add this to their bag of tricks.”

Researchers say the difference in the perception of video game-related studies is partly related to recent advances in biofeedback technology that have allowed scientists to provide more specific evidence of how the games affect players. They can track heart rate, brain wave activity, changes in skin temperature or sweat production that can indicate a player’s stress or relaxation.

“The research is delving more into how do these changes happen, why do these changes happen,” said Debra Lieberman, a researcher at the University of California-Santa Barbara and program director for Health Games Research, an arm of the Robert Wood Johnson Foundation. “We have more tools to really understand what’s going on with people when they play games.”

In a study released earlier this year, Russoniello showed that playing casual games improved the moods of his study participants, lowering stress and anxiety levels. While linking game-playing and happiness may seem logical, Russoniello now had the biofeedback proof.

“The kicker was the EEG; we found brain waves that were consistent with improved mood,” he said. “That gets people’s attention. They can’t say anymore, ‘That’s nice, but how do you know?’”

While the technology for measuring video game effects has gotten better, the audience for games has gotten larger and more diverse.

The Entertainment Software Association, which represents game publishers, said 63 percent of the U.S. population now plays video games. While 28.2 percent of players are under the age of 18 and 62 percent are male, adult women make up 33 percent of players and 26 percent of players are over the age of 50.

PopCap spokesman Garth Chouteau said it’s no wonder the therapeutic uses of video games didn’t become apparent until the industry moved away from appealing to just young men.

“The people with those medical infirmities weren’t playing video games, weren’t aware of them, had been told to some extent through the marketing and advertising that those games were not for them,” Chouteau said.

Interest in so-called “serious games,” educational programs developed to teach diabetic children to monitor their diet or help adults stop smoking, has been increasing for years.

But it’s not clear that the mainstream games industry is ready to embrace therapeutic games.

Chouteau worries that attempts to focus on that market could result in games no one wants to play.

Jason Della Rocca, executive director of the International Game Developers Association, said he wasn’t aware of any commercial game designers incorporating medical research into their products.

But he also said video games’ biggest strength is their ability to transport players away from themselves and their problems, which ultimately may be the best medicine.

“In their quest to make the game more fun to play, does that mean it’s a more therapeutic game to play? If so, it wasn’t intentional,” Della Rocca said. “It seems this idea of making things more fun has some good consequences.”

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