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1 // Safe. Healthy. Resilient.
Videogames and
Wellbeing: A
Comprehensive
Review
Gaming Research Group, Young and Well Cooperative Research Centre
Dr Daniel Johnson
Associate Professor Christian Jones
Dr Laura Scholes
Michelle Colder Carras
2 // Safe. Healthy. Resilient.
Videogames and Wellbeing: A
Comprehensive Review
Gaming Research Group, Young and Well Cooperative
Research Centre
Dr Daniel Johnson
Director, Games Research and Interaction Design Lab
Queensland University of Technology
Associate Professor Christian Jones
Associate Dean of Research
University of the Sunshine Coast
Dr Laura Scholes
University of the Sunshine Coast
Michelle Colder Carras
Johns Hopkins University
ISBN: 978-0-9871179-4-6
Suggested citation: Johnson, D, Jones, C, Scholes, L & Carras, M 2013 Videogames and Wellbeing,
Young and Well Cooperative Research Centre, Melbourne.
© Young and Well CRC 2013
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be
reproduced by any process without prior written permission from the Young and Well CRC. Requests
and enquiries concerning reproduction and rights should be addressed to the Chief Executive Officer,
Young and Well CRC, 17 / 71 Victoria Crescent, Abbotsford VIC 3067, Australia.
Copies of this report can be downloaded from the Young and Well CRC website,
youngandwellcrc.org.au
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Young and Well Cooperative Research Centre
This research and report was supported by the Young and Well Cooperative Research Centre.
The Young and Well CRC is an Australia-based, international research centre that unites young people
with researchers, practitioners, innovators and policy-makers from 75 partner organisations across the
not-for-profit, academic, government and corporate sectors. Together we explore the role of technology
in young people’s lives, and how it can be used to improve the mental health and wellbeing of those
aged 12-25. The Young and Well CRC is established under the Australian Government’s Cooperative
Research Centres Program.
As part of Young and Well CRC, the Gaming Research Group aims to directly tackle the question of
how existing commercial games impact mental health and wellbeing.
youngandwellcrc.org.au
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About the Authors
Dr Daniel Johnson is the director of the Games Research and Interaction Design Lab at the
Queensland University of Technology. Daniel has completed Bachelors and Honours degrees in
Psychology, a Graduate Certificate in Higher Education and a doctorate on the psychology of human-
computer interactions and videogames. His research interests are motivations for videogame play and
the impact of videogames on wellbeing. He has also worked in the games industry for companies such
as NextGenVideos and The Binary Mill. He recently completed a year as a post-doctoral fellow at the
University of Cambridge Well-being Institute where he remains an affiliate.
Associate Professor Christian Jones is the Associate Dean of Research at the University of the
Sunshine Coast, and is also director of the Engage Research Lab where the team researches and
develops technologies such as computer games, apps, social media and interactive artworks.
Christian’s projects include free-to-use computer games for child safety which are used by schools
around the world and have won gold awards for crime prevention, apps to treat Alzheimer’s Disease,
apps to support children with Autism, and social media games for teenage girls to prevent alcohol
misuse. He is passionate that computer games can improve mental wellbeing and be part of developing
health societies.
Dr Laura Scholes completed her PhD at the University of Queensland. Her thesis examined the
influence of dominant discourses of masculinity on primary school boys' reading experiences in the
classroom. Currently her work in the School of Early Childhood at the Queensland University of
Technology includes teaching in a range of areas and research project management. Laura has been
involved in research to enhance boys' literate outcomes, to examine games based approaches to
learning, and in the development of a computer game for child safely. Originally a primary school
teacher, Laura has experience and an interest in the role of technology in learning.
Michelle Colder Carras is a PhD candidate in the Department of Mental Health at the Johns Hopkins
Bloomberg School of Public Health. Her academic research focuses on the use of technology and
mental health, including the risks and benefits of online videogames and other interactive
media. Current projects include an assessment of technology use in mental health service users and a
review of longitudinal research on the negative outcomes of video game play. Michelle’s thesis project
involves the use of latent variable modeling techniques to distinguish profiles of internet and game use
and how these profiles are associated with later mental health outcomes.
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1. Executive Summary
Responding to concerns about the negative impacts of videogames on young people’s mental health, as
well as emerging evidence of positive impacts of videogames, the Young and Well CRC’s Gaming
Research Group have compiled this report on the state of play of research linking videogame play and
flourishing mental health. The report specifically explores the role of videogames in young people’s lives
and how technology can be used to improve mental health and wellbeing. It is designed to develop
understandings about the positive intersection of gaming and wellbeing, to document evidence
regarding links between videogames and positive mental health and to provide guidelines for use by
other researchers as they design specific tools and games to improve mental health and wellbeing for
young Australians.
There is a range of evidence suggesting that videogames have a positive impact on young people’s
wellbeing. Existing research suggests that videogames contribute to young people’s emotional, social
and psychological wellbeing. Specially, videogames have been shown to positively influence young
people’s emotional state, self-esteem, optimism, vitality, resilience, engagement, relationships, sense of
competence, self-acceptance and social connections and functioning. Emerging research suggests that
how young people play as well as whom they play with may be more important in terms of wellbeing
than what they play. Further research is needed to explore key questions including the moderating
influence of personal characteristics on the relationship between videogames and wellbeing and
extending existing research by replicating findings across game types, demographic samples and play
environments.
ABOUT THE GAMING RESEARCH GROUP
The Young and Well CRC’s Gaming Research Group brings together a group of researchers with a
range of expertise in videogames and health-related research in order to directly tackle the question of
how existing commercial games impact mental health and wellbeing, and specifically seek to identify
links between video game play and models of flourishing in mental health.
The group will be positioned to advise other projects in the Young and Well CRC regarding the
employment of games, game design techniques and games-related technologies to maximise young
people’s engagement with the tools and programs produced by the Young and Well CRC.
METHODS
The Gaming Research Group conducted a comprehensive review of international research linking
videogame play with positive wellbeing. Papers were drawn from existing paper repositories as well as
targeted searches in key areas of focus. Over 200 research papers were identified, reviewed and
analysed.
KEY FINDINGS
The key findings of this review are:
• There are many creative, social and emotional benefits from playing videogames, including violent
games (Kutner & Olson 2008).
• Although ‘excessive’ gamers showed mild increases in problematic behaviors (such as somatic
symptoms; anxiety and insomnia; social dysfunction, and general mental health status), it was non-
gamers who were associated with the poorest mental health correlates (Allahverdipour et al 2010).
• Frequency of play does not significantly relate to body mass index or academic grade point average
(Wack & Tentelett-Dunn 2009)
• Videogames have been found to be an effective play therapy tool. Children can be helped to change
their views of themselves and the world around through metaphors in games, e.g., ‘the force’ in
Lego Star Wars, gaining ‘attributes’ in SSX-3 (snowboarding), and conquering ‘quests’ in
RuneScape (Hull 2009).
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Positive Emotional Impact
• Moderate videogame play can contribute to positive emotions (Allahverdipour, Bazargan,
Farhadinasab & Moeini 2010; Kutner & Olson 2008; Ryan, Rigby & Przybylski 2006; Przybylski,
Ryan & Rigby 2009; Wang, Khoo, Liu & Divaharan 2008).
• Moderate videogame play can contribute to emotional stability (Przybylski, Weinstein, Murrayama,
Lynch & Ryan 2011).
• Moderate videogame play can contribute to reducing emotional disturbances in children (Hull 2009).
• Positive mental wellbeing has been associated with videogame play as a means of relaxation and
stress reduction (Russoniello, O’Brien & Parks 2009; Snodgrass, Lacy, Dengah, Fagan & Most
2011; Wack & Tantleff-Dunn 2009).
• Depressed mood has been found to be significantly lower in the moderate players of videogames
compared to those who ‘never’ play videogames and those who play videogames to excess (Durkin
& Barber 2002).
• Non-gaming has been found to put boys, in particular, at greater risk for problems. Boys who did not
play any videogames during a typical week had a higher risk of emotional disturbance compared to
children who were using games for emotional regulation — to help them relax, to forget problems, or
to feel less lonely (Kutner & Olson 2008).
• Children play games as a means of mood alteration or ‘letting off steam’ in response to problems
with friends or parents. Feelings of anger, guilt, or frustration were dissipated after some time spent
in game play resulting in players feeling much happier (Colwell 2007).
• It appears that children and adolescents deliberately choose to play videogames in the knowledge
that they will feel better as a result (Colwell 2007).
Healthy Relationships and Social Capital
• Videogame players report higher levels of family closeness, less risky friendship networks and better
attachment to school than non-players (Durkin & Barber 2002).
• Moderate videogame play among young men can provide a healthy source of socialisation,
relaxation, and coping (Wack & Tantleff-Dunn 2009).
• Videogaming among college-aged men has been seen to provide a healthy source of socialisation,
relaxation, and combating stress (Wack & Tentelett-Dunn 2009, Snodgrass, Lacy, Dengal & Fagan
2011; Snodgrass, Lacy, Dengah, Fagan & Most 2011; Snodgrass et al 2012).
• Massively Multiplayer Online Role Playing Games (MMORPG) players under the age of 18 have
been found to feel that the friendships they formed online were comparable or better than their real
life friendships (Yee 2006).
• World of Warcraft (WoW, an MMORPG) players have reported creating social capital through online
game play with players using the game to extend real life relationships, meet new people and form
relationships (Williams et al 2006).
• The social interactions that occur within and outside of MMORPG play have been found to be highly
social, providing opportunities to create strong friendships and emotional relationships (Cole &
Griffiths 2007; Yee 2006). As Cole & Griffiths (2007) found in their study of 912 self-selected
MMORPG players from 45 countries, the social interactions in online gaming form a considerable
element in the enjoyment of playing. This type of game play can be extremely social with a high
percentage of gamers making life-long friends and partners.
• 76.2% of male and 74.7% of female players had made good friends within online games suggesting
that MMORPGs are highly socially interactive (Cole & Griffiths 2007].
• In a WoW study, two fifths of participants said they would discuss sensitive issues with their online
gaming friends that they would not discuss with their real life friends, and with female players more
likely to do so (Cole & Griffiths, 2007).
• In the WoW study, two fifths of participants had met with online friends in real life situations,
suggesting that online gaming is a social activity or facilitates social activity (Cole & Griffiths 2007).
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Self Esteem
• Self-esteem was higher in the moderate videogame players, while self-concept was higher amongst
players compared to non-players (Durkin & Barber 2002).
• Videogame play may allow players to express themselves in ways they may not feel comfortable
doing in real life because of their appearance, gender, sexuality, and/or age (Coles & Griffith 2007).
• The anonymity and fantasy of MMORPG virtual worlds can free players from their real life history
and social situation, allowing them to be more like the person they wish to be (Bessiere, Fleming &
Kiesler 2007).
• This opportunity can increase their feelings of self-confidence and self worth, potentially impacting
positively on psychological health (McKenna & Bargh 1998, 2000).
• Players whose characters display desirable qualities could imagine themselves as different and try
to emulate their characters’ better traits (Bessiere et al 2007).
FUTURE RESEARCH OPPORTUNITIES
While there is evidence of a range of positive impacts of videogames on wellbeing as well as indications
of pre-existing characteristics that may lead to some young people being vulnerable to negative impacts
of videogames much further research is needed.
• Broadly, there is a need to continue to explore the nature and extent of the wellbeing benefits of
videogames. Knowledge of when, how and for whom there is a positive impact of videogame play
will allow for healthy engagement by young people with videogames and the leveraging of
videogame play for maximum benefit.
• It is not yet clear to what extent the benefits of videogame play can be adapted to therapeutic
settings. Research is needed to explore how and when the positive impacts of videogame play can
be leveraged in a clinical setting.
• There is evidence that the degree of violence in videogames is not a key factor in determining
players enjoyment (Przybylski, Ryan & Rigby, 2009), however research is needed to determine
which combinations of game content, individual characteristics (such as psychosocial vulnerability or
youth), play environments and styles of play may have a negative influence on players.
• The findings suggest that the amount of play may be less important for wellbeing than how
videogames are played, whether they are played with others, and with whom they are played.
However, further research is needed to identify guidelines regarding the amount of certain types of
play that are most likely to lead to positive impacts on wellbeing and when there is a risk of negative
impacts.
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Table of Contents
1. EXECUTIVE SUMMARY ......................................................................................... 5
2. INTRODUCTION AND CONTEXT .......................................................................... 9
2.1 Introduction ......................................................................................................................................... 9
2.2 Background ....................................................................................................................................... 10
2.2.1 Violent Videogames ....................................................................................................................... 10
2.2.2 Games and Addiction ..................................................................................................................... 10
2.2.3 Videogames for positive wellbeing ................................................................................................. 11
3. WELLBEING FRAMEWORK ................................................................................ 12
3.1 Definition of Flourishing Mental Health ............................................................................................. 12
3.2 Comprehensive review protocol ........................................................................................................ 12
4. FINDINGS ............................................................................................................. 14
4.1 Positive Characteristics / Affect ......................................................................................................... 14
4.1.1 Positive Emotion / Emotional Stability ............................................................................................ 14
4.1.2. Self-esteem ................................................................................................................................... 16
4.1.3 Optimism ........................................................................................................................................ 18
4.1.4 Vitality ............................................................................................................................................. 19
4.1.5 Resilience ....................................................................................................................................... 20
4.2 Positive Functioning .......................................................................................................................... 20
4.2.1 Engagement ................................................................................................................................... 20
4.2.2 Positive Relationships .................................................................................................................... 22
4.2.3 Competence (Achievement) ........................................................................................................... 23
4.2.4 Self-acceptance ............................................................................................................................. 23
4.2.5 Personal Growth ............................................................................................................................ 24
4.3 Positive Social Functioning ............................................................................................................... 25
4.3.1. Social Coherence .......................................................................................................................... 26
4.3.2. Social Integration .......................................................................................................................... 27
4.4 Diversity in Videogames .................................................................................................................... 27
4.4.1. Females Play Games Too ............................................................................................................. 27
4.4.2. LGBTQ Characters In and Players of Videogames ...................................................................... 28
5 FUTURE RESEARCH ............................................................................................ 29
5.1 Videogames have mental health benefits – even violent videogames .............................................. 29
5.2 Pathological gaming and the psychosocially vulnerable ................................................................... 29
5.3 How much is too much videogame play? .......................................................................................... 30
5.4 Videogames for wellbeing therapy .................................................................................................... 30
5.5 Playing with online and real life friends ............................................................................................. 30
5.6 World of Warcraft is only one videogame – what about the others? ................................................. 31
6. REFERENCES ...................................................................................................... 32
!!
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2. Introduction and Context
2.1 INTRODUCTION
Mental health is recognised by governments around the world as crucial to the wellbeing of individuals
and societies. It is considered essential to human welfare and to sustained economic and social
development (World Health Organisation 2001, 2010; Funk Drew, Freeman, Faydi, World Health
Organisation 2010; Herrman, Saxena & Moodie 2005). Flourishing mental health has been defined as a
combination of feeling good and functioning effectively resulting in high levels of mental wellbeing
(Huppert & So 2013). A conceptual definition of flourishing builds on the recognition that to flourish is
more than the absence of disorder with flourishing conceived as the opposite of mental disorder, rather
then its mere absence (Huppert & So 2013). Flourishing refers to the experience of life going well
including a combination of feeling good and functioning effectively (Huppert & So 2013). A conceptual
framework for flourishing wellbeing includes definitions of the features of positive wellbeing and builds
on the seminal work of Huppert and So (2013), Keyes (2005) and Seligman (2011). Mental disorders,
however, are universal and present in all people of all regions, all countries and all societies (WHO
2001; Australian Bureau of Statistics 2007; Herrman et al 2005). Within Australia, mental disorders are
the leading cause of disability burden (Vos & Mathers 2000) with this trend increasing rapidly. With at
least one in five Australians believed to have a mental health disorder, mental health has become one of
Australia's National Health Priority Areas (ABS 2007).
This report prepared by the Gaming Research Group specifically explores the role of videogames in
young people’s lives and how videogames can be used to improve mental health and wellbeing. It is
designed to develop understanding about the positive intersection of gaming and wellbeing, to
document evidence regarding the links between videogames and positive mental health, and to provide
guidelines for use by other researchers as they design specific tools and games to improve mental
health and wellbeing for young Australians.
Within this report, 'videogames' is used to refer to electronic/digital games played on personal
computers, home consoles (e.g., Microsoft Xbox, Sony Playstation, Nintendo Wii), tablets (e.g., iPads),
mobile devices (e.g., smart phones, handhelds like Nintendo 3DS) and the world wide web (e.g., via
Facebook or other websites). ‘Young people’ refers to individuals aged from 12-25, consistent with
Young and Well CRC’s age category for young people. These young people have increasing access to
computers and videogames with this mode of entertainment offering increased opportunities to be part
of a multi player environment (Brand 2012; Johnson, Smith, Willis, Levine & Haywood, 2011;
Entertainment Software Association 2012).
National data collected as part of Interactive Games and Entertainment Association of Australia’s
(IGEA) 2011 survey of Australian computer game activities highlights these changes. The data was
published as Digital Australia 2012 (Brand 2012). As part of this study, a random sample of 1252
Australian households including 3533 woman, men, girls and boys responded to more than 80
questions in an online survey. According to the report, 95% of homes with children under the age of 18
have a device for playing videogames, and 94% of children aged between 6 and 15, and close to 90%
of people aged 16-25 played videogames (Brand 2012). Of note, the data shows that digital games are
not a solitary activity as 70% of those surveyed indicated that they played digital games with others
either in the same room or over the Internet (Brand 2012). There have also been changes in terms of
female gaming engagement and in the seven years from 2005-2011, the proportion of gamers who were
female increased steadily from 38% to 47% (Brand 2012). Equal representation of female gamers to
males is predicted as imminent (Brand 2012).
It is also informative to look at the types of videogame play that people prefer. Nearly one in five gamers
play social network games and one in 10 report their enjoyment for massive multiplayer games (Brand
2012). The growing social and online play is driving interest with one in five gamers ‘motivated’ or ‘very
motivated’ to sign up to a faster broadband service for game downloads and online play (Brand 2012).
While there is an increase in social network gaming within Australia, sales of games indicate there is
currently a preference for family games (19%) followed by Action (18%), First-Person Shooters (15%),
and Sports and Racing games (9% each) (Brand 2012).
10 // Safe. Healthy. Resilient.
2.2 BACKGROUND
2.2.1 Violent Videogames
Traditionally, much of the research on videogames has focused on the negative effects of playing such
games. However the impact of violent videogames is currently contested and it is argued that research
reporting the effects of violent games on aggression has room for improvement. The existing body of
research has been criticised for concerns about publication bias and an emphasis on the use of
laboratory measures of aggression that exaggerate relationships between videogame violence and
aggression and do not accurately predict real life behaviour (Boyle, Connolly & Hainey 2011; Ferguson,
2007; Kutner & Olson 2008; Sherry 2004, 2007).
More recent research includes studies focusing on longitudinal measures that attempt to demonstrate
causal relationships between violent videogames and aggression. Many of these studies rely on self-
reported measures of aggressive feelings or attitudes (Lemmens et al 2011; Möller & Krahé 2009;
Anderson et al 2010; Shibuya, Sakamoto, Ihori & Yukawa, 2008), while other studies include self-
reported counts of aggressive behaviours (Shibuya et al 2008; Bucolo 2011) or combined teacher and
peer ratings (Gentile & Gentile 2008). While some of those studies do report associations between
earlier violent videogame play and later self-reported aggression (Anderson et al 2010; Bucolo 2011;
Möller & Krahé 2009) or combined peer-and teacher-reported aggression (Gentile & Gentile 2008),
others do not support long-term direct effects of violent videogames on self-reported physical
aggression (Lemmens et al 2011; Shibuya et al 2008). For a more complete exploration of these issues
and the research regarding long-term outcomes of videogame play, see Carras et al (in prep).
While there is ongoing discourse concerning the possible influence of violent videogames, research
focused on motivations for play has shown that once needs for feelings of competence and autonomy
are accounted for in determining game enjoyment, the degree of violence in games does not uniquely
predict the desire for or the enjoyment of game play (Przybylski, Ryan & Rigby 2009). In short, violence
is not an important factor in contributing to game enjoyment; players play violent games for the same
reasons they play other games, such as enjoyment of the challenge and the freedom to act in a virtual
world (Przybylski, Ryan & Rigby 2009).
Focusing on violent videogames as a precursor to aggression and violence amongst young people may
cause parents, social activists and public-policy makers to ignore the much more powerful and
significant causes of violence amongst young people that have already been well established, including
a range of social, behavioural, economic, biological and mental-health factors (Kutner & Olson 2008;
Ferguson et al 2013).
2.2.2 Games and Addiction
Although the terminology is still being debated (Lemmens et al 2011) some researchers have begun to
voice concerns about pathological gaming as a legitimate behavioural disorder. To this end, the
American Psychiatric Association has recently designated “Internet Gaming Disorder” as a condition
requiring further study (American Psychiatric Association, 2013). Some studies of small groups of
players who spend excessive amounts of time on games have shown that symptoms of addiction can
arise including withdrawal, preoccupation, loss of control, and interpersonal or intrapersonal conflicts
(Gentile, 2009; Grüsser, Thalemann & Griffiths 2007), while other studies fail to support links between
heavy play and negative psychosocial outcomes in non-addicted gamers (Lemmens et al 2011, Van
Rooij et al 2011). Although longitudinal research on pathological gaming is relatively scarce, three
studies evaluate the psychosocial predictors and outcomes of pathological gaming among adolescents
(Lemmens et al 2011, Gentile et al 2011, Van Rooij et al 2011). Gentile et al using a broad definition of
pathological gaming (endorsing five or more items on a 10-item scale), grouped children according to
changes in their self-rated pathological gaming over time (Gentile et al 2011). These authors evaluated
a large number of potential risk factors for the development of pathological gaming and concluded that
time gaming as well as psychosocial factors such as impulsivity, social competence and emotional
regulation all predicted the development of pathological gaming. They also found that those who
became pathological gamers were more likely to show increased scores on scales measuring ADHD,
anxiety, and depression.
Consistent with Gentile and colleagues’ research, Lemmens and colleagues also found that lower
psychosocial wellbeing was generally a precursor of pathological gaming, with diminished social
competence, increased loneliness, and lower self-esteem predicting an increase in pathological gaming
six months later (Lemmens et al 2011). They also found that pathological gaming was associated with
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even greater amounts of gaming six months later, as well as increases in self-reported physical
aggression for boys. Finally, a study by Van Rooij and colleagues (2011) of online gamers points to the
persistence of pathological gaming over the course of a year, with half of a group of pathological gamers
(described as having both heavy play and high self-reported addictive use) showing continued
pathological use a year later. In sum, the research suggests lower psychosocial wellbeing is more likely
to be a cause rather than a consequence of internet gaming addiction (Chak & Leung 2004; Ko et al
2005), but that harm may result from play that is rated by players as addictive.
Przybylski, Weinstein, Ryan, and Rigby (2009) conducted research exploring the consequences of
different styles of engagement in videogame play (further details in Vitality section). The researchers
were particularly interested in how need satisfaction in other areas of life moderated the relationship
between videogame play and wellbeing. Based on a large sample (n=1324) of videogame players, they
established that high levels of basic psychological need satisfaction were positively related to
harmonious passion for videogame play (the activity is personally important, freely chosen and in
harmony with other aspects of life), whereas low levels of need satisfaction were related to obsessive
passion for videogame play (the activity is experienced as a compulsion and conflicts with other facets
of life). In turn, harmonious passion contributed to enhancing experiences of play and game enjoyment
energy post-play but did not influence amount of play. In contrast, obsessive passion contributed to a
disordered pattern of play including greater amounts of play, higher tension post-play, and less game
enjoyment for players of some game types (Przybylski, Weinstein, Ryan & Rigby 2009).
According to self-determination theory research, the internalisation motivation for life pursuits (including
passion for videogame play) and wellbeing are both direct consequences of the satisfaction of
psychological needs (Deci & Ryan 2000; Ryan & Deci 2008). Findings within this study indicated that
the quality of play moderated the influence of quantity of play on post-play energy, life satisfaction and
positive mental health (Przybylski, Weinstein, Ryan & Rigby 2009). Significantly, in terms of post-play
energy, high levels of play paired with low levels of obsessive passion resulted in higher levels of post-
play energy (Przybylski, Weinstein, Ryan & Rigby 2009).
2.2.3 Videogames for positive wellbeing
Recently, there has been significant interest in the links between videogame play and positive wellbeing
(see Allahverdipour, et al 2010; Barr, Khaled, Noble & Biddle 2006; Colwell 2007; Boyle, et al 2011;
Durkin & Barber 2002; Hull, 2009; Przybylski et al 2011; Ryan & Deci 2008; Snodgrass, Lacy, Dengah,
Fagan & Most 2011; Wang et al 2008). To date most of the existing literature on gaming has been
inconsistent and has often focused on aggression. However, over the last five to ten years, increasing
attention has been given to the possibility of games improving health and wellbeing (Desai, Krishnan-
Sarin, Cavallo & Potenza 2010). A number of more recent studies have reflected this shift considering a
nuanced approach to the positive and negative influences of game play and the number of significant
studies that demonstrate clear benefits to individuals who spend time in game play. There is also
increased concern that the potential value of videogames has not been sufficiently considered
particularly in terms of the benefits for young people at risk (Kutner & Olson, 2008).
There is a gap in the literature in terms of a lack of an explicit review of this emerging research
examining the benefits of gaming articulated in these studies and the demonstrated links to positive
social and emotional wellbeing (Kutner & Olson, 2008; Allahverdipour, Bazargan, Farhadinasab, &
Moeini, 2010) (Kutner & Olson, 2008; Allahverdipour, et al, 2010). As contemporary research provides
examples of the benefits of gaming the question then becomes more about optimal levels of game play,
the influence of factors such as gender, subgroups and associated experiences, and the interplay of
particular genres on wellbeing.
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3. Wellbeing Framework
Understanding the relationship between videogames and positive wellbeing involves first defining what
constitutes flourishing mental health and then systematically examining empirical research to ascertain
evidence of factors linking the complexity of game play with positive mental health and wellbeing of
young people.
3.1 DEFINITION OF FLOURISHING MENTAL HEALTH
Flourishing is considered by Keyes (2002) as the epitome of mental health in adults. Flourishing adults
posess: high levels of emotional wellbeing; are happy and satisfied; tend to see their lives as having a
purpose; feel some degree of mastery and accept all parts of themselves; have a sense of personal
growth in the sense that they are always growing, evolving, and changing; have a sense of autonomy
and an internal locus of control; and choose their fate in life instead of being victims of fate.
Keyes further argues that mental health does not imply an absence of mental illness but rather is the
presence of positive mental health. An individual described as flourishing will have a combination of high
levels of emotional wellbeing, psychological wellbeing, and social wellbeing (Keyes 2002, 2007).
3.2 COMPREHENSIVE REVIEW PROTOCOL
The Gaming Research Group conducted a comprehensive review of international research linking
videogame play with positive wellbeing. To minimise bias, protocols were developed leveraging
established criteria for a ‘systematic review’ (MacDonald 2000). These protocols involved clear definition
of the research focus, transparency in the reporting of search methods, comprehensive searches for
published and unpublished studies, criteria for assessing the quality of studies, peer review to reduce
bias, and explicit reporting of the findings (Evans & Benefield 2001). Following Evans and Benefield's
(2001) framework steps were taken in a comprehensive search to examine empirical research findings
within the constructs defined in the flourishing wellbeing framework.
Prior to this research review, the Gaming Research Group collated a repository of empirical research
papers focusing on videogame play. This repository was created by a group of academics in the fields
of psychology, human-computer interaction, social sciences, humanities, education and health. The
collection of over 200 research papers was reviewed and analysed in terms of the flourishing wellbeing
framework constructs identified based on the work of Huppert and So (2013), Keyes (2005) and
Seligman (2002, 2011).
The flourishing wellbeing framework in Table 1 (Vella and Johnson in prep) provided a starting point for
identifying positive mental health. The wellbeing indicators fall into three categories namely: positive
characteristics/affect, positive functioning and positive social functioning. The literature search was then
extended to academic electronic database searches to identity any recent literature published relating to
videogame play and positive health, and key terms associated with Positive Affect, Positive Functioning
and Positive Social Functioning (see Table 1). Academic electronic database searches were conducted
to identify relevant literature published in the past 10 years that included empirical research findings
linking videogames and positive wellbeing within the defined framework. Peer review by several
members of the team ensured the research reported included quality studies that followed rigorous
methodological protocols.
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TABLE 1. Comparison of Wellbeing Related Terms Used by Key Authors
Seligman (PERMA)
Keyes
Huppert & So
Positive Psychological
Characteristics / Emotional
Wellbeing
Positive Emotion
Positive Affect
Positive Emotion
Life Satisfaction
Emotional Stability
Vitality
Optimism
Resilience
Self-Esteem
Positive Psychological Functioning
Engagement
Engagement
Positive Relationships
Positive Relationships
Positive Relationships
Accomplishment
Environmental Mastery
Competence
Meaning
Purpose in Life
Meaning
Self-Acceptance
Personal Growth
Autonomy
Positive Social Functioning
Social Acceptance
Social Actualisation
Social Contribution
Social Coherence
Social Integration
Building on the work of Huppert and So (2013), Keyes (2005) and Seligman (2011), the three categories
of positive characteristics/affect, positive functioning and positive social functioning are considered in
the following sections.
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4. Findings
4.1 POSITIVE CHARACTERISTICS / AFFECT
4.1.1 Positive Emotion / Emotional Stability
While traditionally research has suggested that videogames contribute to negative outcomes,
increasingly empirical research highlights positive outcomes associated with game play. Emerging
research suggests that moderate game play may contribute to positive emotions (Allahverdipour et al
2010; Kutner & Olson 2008; Ryan et al 2006; Przybylski, Weinstein, Ryan & Rigby 2009; Wang et al
2008), emotional stability (Przybylski et al 2011), and reducing emotional disturbances in children (Hull
2009). Positive mental wellbeing has also been associated with game play as a means of relaxation and
stress reduction (Russoniello et al 2009; Snodgrass, Lacy, Dengal & Fagan 2011; Wack & Tantleff-
Dunn 2009).
Consideration of the relationship between game play and measures of psychological adjustment has
contributed to our understandings of the potential for gaming to contribute to emotional wellbeing. To
this end, Durkin & Barber (2002) examined the relationship between game play and several measures
of adjustment for 1304 high school students, finding that videogame play was unlikely to be harmful and
instead was often associated with positive outcomes. The survey data used in this study was taken from
Wave 5 of the Michigan Study of Adolescent Life Transitions (MSALT), an ongoing longitudinal
investigation examining participants’ normative and non-normative life transitions from early
adolescence through adulthood (Durkin & Barber 2002). As part of the study a sample of 16-year-olds
were identified as individuals whose involvement in computer game play was ‘never’, ‘low’, or ‘high.’
Participants were asked to indicate how often they used a computer to play videogames with responses
ranging from 1 (never) to 7 (daily). Participants who checked 1 were put into the ‘never’ group, those
who checked 2, 3, 4, or 5 were put into the ‘low’ group, and those checking 6 or 7 were put into the ‘high’
group. The study was concerned with videogames in general and did not collect detailed information on
the participants’ particular game preferences. Differences were then identified between these groups on
measures of adjustment, self-concept, risk behaviour, school achievement, and social involvement.
Emotional benefits of game play
There were advantages to adolescents in the low and high play groups compared to the young people
who reported that they never played games (Durkin & Barber 2002). Specifically, depressed mood was
significantly lower in the low use group compared to the ‘never’ and ‘high’ groups who reported similar,
higher levels. Self-esteem was also higher in the low use group, with self-concept regarded higher by
players than non-players with high use players scoring the highest in this domain.
Both groups of players also reported higher levels of family closeness and less risky friendship networks
than non-players, with attachment to school also higher in these two groups (Durkin & Barber 2002). It is
suggested that direction of effect is bidirectional, and that videogame play itself both affects
psychological adjustment and is a normative part of life for psychologically well-adjusted young people
(Durkin & Barber 2002). Implications of this study indicate that the amount of game play young people
engage in is a moderating factor on their personal wellbeing.
In a similar manner, Allahverdipour and colleagues (2010) also suggest there is a relationship between
the amount of game play and psychological mental health status. In a cross-sectional study to describe
patterns and correlates of videogame use in a random sample of middle-school students, moderate
game players reported better mental health compared to non-gamers and excessive gamers
(Allahverdipour et al 2010). Participants included 444 students ranging from 12-15 years who completed
a General Health Questionnaire (GHQ) to assess their mental health. The GHQ measured the
subjective symptoms of psychological distress, somatic manifestations often associated with anxiety
and depression, relationship difficulties, and social, family, and professional roles; and subscales of
somatization, anxiety, social dysfunction, and depression (Goldberg & Hillier 1979).
Participants spent an average of 6.3 hours per week playing videogames with 47% reporting that they
had played one or more intensely violent games including: Dead or Alive, Def Jam, Doom, Driver, Mortal
Kombat, Grand Theft Auto, Resident Evil, and Prince of Persia (Allahverdipour et al 2010). Moreover,
92% of boys and 96% of girls played videogames although boys typically played games with greater
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duration than girls (Allahverdipour et al 2010). Playing videogames may have different social
implications for girls than for boys as it was boys, but not girls, who admitted playing videogames
excessively and reported more aggressive behaviours (Allahverdipour et al 2010). However, it is the
amount of game play that appears significant with moderate gaming among young men providing a
healthy source of socialisation, relaxation, and coping (Wack & Tantleff-Dunn 2009). In terms of amount
of play, ‘non-gamers’ were those who did not play at all, for those who did play, ‘low’ was defined as 1-6
hours per week, ‘moderate’ as 7-10 hours per week, and ‘excessive’ as more than 10 hours per week.
The Allahverdipour et al (2010) study found a curvilinear relationship between videogame playing and
mental health with ‘moderate’ gamers faring best. Although ‘excessive’ gamers showed mild increases
in problematic behaviours (such as somatic symptoms; anxiety and insomnia; social dysfunction, and
general mental health status), it was non-gamers who indicated the poorest outcomes on these
constructs (Allahverdipour et al 2010). Non-gaming has been found to put boys, in particular, at greater
risk for problems. This effect for non-gamers has also been reported by others who found gaming
positively contributed to creative, social, and emotional benefits (Kutner & Olson 2008).
There is concern that the potential benefits of videogames (including some games with violent content)
have not received enough attention. Kutner and Olson, co-directors of the Harvard Medical School
Center for Mental Health and Media, are psychiatrists who share this concern. Recently they aimed to
identify ‘markers’ of increased risk for young people’s emotional problems conducting a large-scale
study funded by the Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice.
The study involving 1,254 children in grades seven and eight, and 500 of their parents. They found that
boys who did not play any videogames during a typical week had a higher risk of emotional disturbance,
and that children were using games for emotional regulation — to help them relax, to forget problems, or
to feel less lonely, adding impetus for further consideration of the role of videogames for positive
wellbeing (Kutner & Olson 2008). Significantly, they also documented many creative, social and
emotional benefits from videogame play including violent games.
Kutner and Olson’s (2008) study included questions to participants about access to electronic games,
game preferences and exposure, and context of and motivations for game use. Children were asked to
list five games that they had played a lot in the past six months to assess violent content exposure.
Electronic games were defined as computer games, videogames (Xbox, PlayStation, GameCube etc.)
and handheld games (Game Boy etc.). As there has been little research about the use of games for
children with emotional and mental health problems the study also identified children with symptoms of
depression (feeling sad, hopeless and worried, having less fun and feeling down on themselves) and
experiences of game play (Kutner & Olson 2008). Two-thirds of the children meeting the threshold for
depression agreed they played games to forget problems, and depressed children were more likely than
other children to play to feel less lonely and effectively manage anger. Two-thirds of girls said they
played games to create another world (Kutner & Olson 2008).
The impact of violent videogames
Playing M-rated games was common among these children aged 12-14 with 44% of boys and 20% of
girls playing one or more intensely violent games such as Grand Theft Auto series although boys were
five times more likely than girls to have played. The top five M-rated game series included: Grand Theft
Auto, Halo, Def Jam, True Crime, and Driver (Kutner & Olson 2008). Boys were more likely than girls to
play at least one M-rated game. While the survey did find correlations between M-rated violent game
play and some common childhood problems such as aggressive behaviours or school problems this risk
was for both boys and girls (Kutner & Olson 2008). The survey results however, were cross-sectional,
and therefore did not show causality. In fact, most children who played violent games did not have
problems (Kutner & Olson 2008). There appears to be a need for further examination to identify
combinations of game content, children’s characteristics, and game play environments that may
promote aggressive behaviour, increase fear, or desensitise children to violence (Olson, et al 2007). Of
note, many of the boys in this study described using violent videogames to manage their emotions and
to deal with anger, frustration and stress (Kutner & Olson 2008). A more nuanced approach to
understanding the role of violent videogames includes understanding the potential benefits of game play
for wellbeing, and the complexities associated with aggressive behaviours including the multiplicity of
influences that go well beyond the boundaries of gaming. According to Kutner and Olson (2008) much
of what has been written in the popular press about violent videogames and the link to violent
behaviours has been based on misunderstandings and flawed research.
Using game play for stress relief was also important for participants in a study conducted by Colwell
(2007). In this study focus groups were conducted, followed by a content analysis, with items
corresponding to emerging themes identified in previous research for use in a quantitative survey
(Colwell 2007). Fourteen group focus discussions were conducted in two primary (boys and girls 8 to
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11-years-old) and three secondary schools (boys and girls 11 to 15-years-old) about leisure activities,
computer game play, game preferences, changes in play over time, and reasons for game play. The
follow up survey included 482 school students (257 boys and 225 girls), with age range 11 to 15-years-
old from two primary and two secondary schools (Colwell 2007). Companionship, preference to friends,
fun challenge, and stress relief were found to be significant factors.
Game play for children in the Colwell (2007) study, was said to be used as a means of mood alteration
or ‘letting off steam,’ following problems at school, or with friends or with parents. Feelings of anger,
guilt, or frustration were then dissipated after some time spent in game play, with players then feeling
much happier (Colwell 2007). Children had an understanding of the mood altering benefits of their play
and explicitly made a choice to engage with games as they managed their emotions. As gaming was
used for altering mood after an upset or while feeling anger to a more positive mood, it would appear
children and adolescents may deliberately choose to play, in the knowledge that they will feel better as a
result (Colwell 2007). To this end, children enjoyed playing a wide range of game genres with racing
games (e.g., cars racing), puzzle games (brainteasers), role play games (the player can take on another
identity), shoot ‘em up games (shooting and killing using a variety of weapons) and beat ‘em up games
(punching and/or kicking), sports games (e.g., golf simulations), and platform games (usually running
and jumping onto platforms) mentioned (Colwell 2007). Girls expressed a preference for puzzle, role
play, and platform games, whereas boys preferred games which involved action such as racing games,
sports games, and beat and shoot ‘em ups (Colwell 2007).
In sum, there is clear evidence that moderate levels of play can have a positive influence on
emotions and emotional stability. Specifically, videogame play can lead to improved mood,
reduced emotional disturbance, improve emotion regulation, relaxation and stress reduction.
Importantly, moderate play was associated with better outcomes than either excessive play or a
lack of play. Most importantly, there is a lack of negative impact for the majority of young
players.
4.1.2. Self-esteem
Self-esteem influences psychological wellbeing and includes one’s perceptions of their ideal and actual
self-concepts (Rogers & Dymond 1954; Mann, Hosma, Schaalma & de Vries 2004). Evaluation of one’s
self-concept is dependent on appraisals, social comparisons and self-attributions (Rosenberg, Schooler
& Schoenbach 1989). Divergence and convergence of actual self-characteristics and ideal self-
characteristics can lead to feelings of disappointment or feelings of joy and happiness respectively
(Ryan & Deci 2000). Contexts that support the satisfaction of psychological needs, such as experiences
of autonomy and competence, can reduce perceived discrepancies between actual and ideal
characteristics enhancing a positive sense of wellbeing (Ryan & Deci 2000).
As noted earlier, Durkin and Barber (2002) also found low amounts of game play associated with higher
self-esteem although girls were found to have more depressed moods and lower self-esteem than boys
regardless of game play. Videogame play was also a predictor for self-concept including perceptions of
intelligence, mechanical repairs and computer skills. Individuals who never played games report lower
self-concepts in intelligence and computer skills than those who played low or high amounts of games
and less mechanical ability than those who played high amounts (Durkin & Barber 2002). Those who
played higher amounts of videogames also reported higher computer skills than those who played lower
amounts. Lemmens and colleagues (2011) also measured adolescents’ self-esteem using a six-item
self-esteem scale. The measure considered self-acceptance, self-respect and generally positive self-
evaluation. They also found a gender differences with girls indicating that they were lonelier (t (542) =
4.70, p < .05) and had lower self-esteem (t (542) = 4.71, p < .05) than adolescent boys. Causal
interpretations found problematic gaming may not present a primary condition in itself and may be
symptomatic of other underlying conditions or problems with diminished social competence and lower
self-esteem a predictor of problematic gaming.
Ryan et al (2006) suggest that the psychological ‘pull’ of games is largely due to their capacity to
engender feelings of autonomy, competence and relatedness, and that to the extent they do so can be
experienced as enhancing psychological wellness including self-esteem. Their study included a
modified 10-item general subscale of the Multidimensional Self-esteem Inventory and assessed self-
esteem pre- and post-play. Here the focus was on the short-term effects of pre- and post-game
experiences of particular games. Participants who experienced competence satisfaction experienced
increased self-esteem and positive affect, whereas individuals who were more autonomous in their
playing experienced overall higher self-esteem and positive mood (Ryan et al 2006). Participants who
experienced autonomy and competence in play showed positive outcomes, explaining why for some
people gaming provides pleasure and perhaps restoration (Ryan et al 2006).
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The genre of the game is significant and can lead to differences in terms of meeting psychological
needs. Participants in Ryan et al’s (2006) study were exposed to solitary game play and multi-player
environments within a four-phase research design. Within the first three phases of the study cohorts of
male and female undergraduate students played simple popular platform games, 3D adventure games,
‘rail-shooter’ ‘fighting’ and ‘arcade-racing’ games. Phases one to three examined individuals playing 1, 2
and 4 games, showing that perceived in-game autonomy and competence were associated with game
enjoyment, preferences, and changes in wellbeing pre- to post-play (Ryan et al 2006). The fourth phase
included 730 members of an online Massively Multiplayer Online (MMO) community. Members
completed a survey about past experience in MMO environments. As MMOs are rich in content and
provide opportunities for interaction between players, the psychological need for relatedness also
emerges as an important satisfaction that promoted a sense of presence, game enjoyment, and an
intention for future play (Ryan et al, 2006). Results indicated relations between autonomy and
competence satisfactions in solitary game play, and the addition of relatedness in multi-player
environments. Autonomy, competence and relatedness not only motivate further play, but can also be
experienced as enhancing psychological wellness including post play self-esteem.
Lemmens et al (2011) were also interested in the relationship between adolescents’ videogame play
and self-esteem. The study examined the psychosocial causes and consequences of pathological
gaming among 11 to 17-year-old adolescents using a two-wave longitudinal survey (Lemmens et al
2011). In this study, pathological gaming was measured using a previously validated game addiction
scale (Lemmens et al, 2009) designed to reflect DSM-IV criteria for pathological gambling that
addresses the addiction domains of salience (thinking a lot about games), tolerance (spending
increasing amounts of time gaming), mood modification (playing games to forget about problems),
relapse (trying to reduce play time without success), withdrawal (feeling bad when not able to play),
conflict (having fights with others about time spent playing), and problems (neglecting other activities in
order to play). The scale included one item for each domain; each item was evaluated over the last six
months. Items could be rated from 1 (never) to 5 (very often), and the authors defined pathological
gaming as having a mean score of 3 or higher, i.e., showing most signs of pathological gaming over the
previous six months.
The first wave included 1024 adolescents from four schools of secondary education throughout the
Netherlands with a follow up six months later with 941 adolescents. Of these respondents, 543 had
played videogames throughout the two waves and had fully completed both questionnaires. The
research design included a six-item self-esteem scale by Rosenberg et al (1989). The scale measures
feelings of self-acceptance, self-respect and generally positive self-evaluation. In this study girls were
again found to indicate they were lonelier and had lower self-esteem than adolescent boys across both
waves (Lemmens et al 2011). Finding indicated lower psychosocial wellbeing was generally an
antecedent of pathological gaming as diminished social competence, increased loneliness, and lower
self-esteem predicted an increase in pathological gaming six months later (Lemmens et al 2011). There
was also a reciprocal relation between loneliness and pathological gaming implying that loneliness is
both a cause and a consequence (Lemmens et al 2011). These findings are particularly interesting in
terms of causal relations as much of the literature implies diminished psychosocial wellbeing is a
consequence of pathological gaming. The findings are also noteworthy as they indicate the need to
consider subgroups of young people who may be more vulnerable to adverse affects of gaming and the
need to consider the importance of the amount of time spent in game play for positive wellbeing.
Furthermore, as psychosocially vulnerable gamers are particularly susceptible to pathological
involvement with online games (Smyth, 2007) the format of game play is also a significant factor for
consideration in terms of game play and wellbeing.
Videogames and Self Concept
The potential of videogames to put players in touch with ideal aspects of themselves is associated with
the motivational appeal and emotional impact of gaming (Przybylski et al 2011). Przybylski and
colleagues (2011) tested the hypothesis that engagement in videogames allows players to experience
their ideal self-characteristics. They examined the relationship among three complementary constructs:
ideal self-characteristics, or how people would like to experience themselves; game self-characteristics,
or how individuals experience themselves when playing videogames; and actual self-characteristics, or
how people are in their everyday lives (Przybylski et al 2011).
The first stage of this study included 144 undergraduates (48 male, 96 female; mean age = 19.83 years,
SD = 1.19 years) who responded to introductory questionnaires, played three different videogames, and
completed questionnaires after each game. The second stage of the study involved 979 computer and
video-game players (829 males, 150 females; age range = 18–48 years, M = 23.18 years, SD = 4.84
years) who completed a set of questionnaires. In both stages of this study, four items were adapted to
18 // Safe. Healthy. Resilient.
assess motivation to play videogames to assess positive and negative post-play affects (Przybylski et al
2011). Ideal self, actual self, and game self-characteristics were assessed with three repetitions of a 30-
item personality inventory with immersion assessed with the nine-item Presence subscale of the Player
Experience of Need Satisfaction Scale (Przybylski et al 2011).
The first stage of the study included participants playing three popular videogames. These games were
selected because they could be played using simple controls yet provided diverse challenges
embedded in accessible narratives, and received above-average rating on imagination, self-confidence,
and open mindedness experienced while playing (Przybylski et al 2011). Bookworm required players to
use their lexical abilities; Peggle evoked visual and spatial skills; and Bejeweled asked players to match
patterns. The second stage of the study extended the investigation by studying a sample of self-
selecting video-game players (Przybylski et al 2011). These participants reported playing a majority of
socially oriented games with diverse array of narratives and ready-made roles with the most popular
games being team-based competition games (24%), such as Team Fortress 2, and online role-playing
games (19%), such as World of Warcraft (Przybylski et al 2011). Also popular were action and
adventure games (14%), such as Legend of Zelda; strategy games (12%), such as Star-Craft 2; and
offline role-playing games (12%), such as Final Fantasy with the remaining selections (19%) belonged
to an assortment of genres and included The Sims and Guitar Hero (Przybylski et al 2011).
It was anticipated that players would be drawn to games that allowed them to experience their ideal self-
characteristics. Using laboratory and observational designs, the study found convergence between
people’s experience of themselves during play and their concept of their ideal selves which was then
related to enjoyment of play and positive shifts in affect (Przybylski et al 2011). Games were intrinsically
motivating for players who felt a gap between how they perceived themselves and who they would like
to be. Opportunities for real self/ideal self-convergence provided positive experiences for players by
reducing discrepancies and potentially increasing feelings of happiness. In turn, this congruence
between a person’s ideal and actual self-concepts was positively linked to psychological wellbeing and
self-esteem. Positive experiences of ideal self-characteristics during play then became a great motivator
for players.
In summary, videogame play is associated with greater self-esteem regarding intelligence,
computer skills and mechanical ability. Additionally, the experience of feelings of competence,
autonomy and relatedness during videogame play is associated with higher self-esteem and
positive affect.
4.1.3 Optimism
Optimism has consistently been related to health and wellbeing. Self-efficacy expectations, as a
representation of a capable self, and perceived social support, as a representation of a helpful world,
shape optimism (Karademas 2005). Optimism in turn predicts satisfaction with life and depressive
symptoms: indicators of wellbeing (Karademas 2005). Optimism reflects an overall positive appraisal of
the future and of the things to happen (Karademas 2005). Children who experience an emotional
disturbance of sadness view the future with hopelessness, futility, lack of control and with a reduced
perception of their sense of self worth (Hull 2009). A positive view of the future requires a positive
appraisal of the context, relationships and a belief that things are going to become better. A recent study
demonstrated the effectiveness of videogames as a play therapy tool for children suffering from an
emotional disturbance of sadness including pervasive feelings of irritability, loss of enjoyment in
activities previously enjoyed, withdrawal from friends or family, decline in school performance, and
hopelessness (Hull 2009). For the children involved in this study their sense of sadness and
hopelessness about the future also indicated a reduced sense of optimism.
The positive role of videogames in play therapy with children
The play therapy study involved six boys, ages 9 to 14, referred for treatment by psychiatrists and
school psychologists as they were suffering with the specific criterion of sadness. First, the study
identified the depths of sadness for the participants including self worth problems, self-image problems,
father and family issues, and school performance problems. Second, the study demonstrated the use of
the games as a play therapy tool in terms of communication between therapist and participant and the
use of metaphor in game play. Finally, the study explained how each participant experienced new
growth and change specifically in the areas of gaining new coping skills, gaining a greater sense of self
worth, and experiencing a lessening of sadness.
Videogames were an effective play therapy tool building rapport, providing a vehicle for communication,
and providing metaphors as a therapeutic foundation for growth and change (Hull 2009). Again
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particular games provided specific opportunities to develop wellbeing as children worked through a
range of challenges. For example, children experienced ‘the force’ in Lego Star Wars, gaining
‘attributes’ in SSX-3 (snowboarding), and conquering ‘quests’ in RuneScape helping participants to
change their views of themselves and the world around them (Hull 2009). The metaphor of a power or
strength that comes from within was demonstrated by games like Naruto, Transformers, or Lego Star
Wars. Transformers also provided opportunities to liken the ‘Decepticons’ (robot-like creatures who are
trying to take over the earth and make it their home) to the bullies that plagued the boys at school (Hull
2009).
Overall, the findings from the study supported the fact that children suffering from emotional
disturbances encounter difficulties academically, emotionally, and socially, and supported the
usefulness of video and computer games as a play therapy tool with children suffering from the
emotional disturbance of sadness. After six sessions of play therapy with videogames, the lessening of
sadness was observed by the children’s teachers, caregivers and by the children themselves.
Lessening of sadness provided each of the participants a new way of looking at themselves and how
they viewed the future with new hope. Subsequently there were also positive changes in related family
issues, social issues, school issues, as well as behavioural problems. However, it should be noted that
no control condition was used in the study so further research is needed to confirm Hull’s (2009)
findings and to ensure, for example, that the findings were not due simply to regular interaction with the
researchers.
Although the study described provides important initial support for the usefulness of
videogames as a play therapy tool and possible links between videogame play and optimism
there is a dearth of research in this area. Further research regarding this possible relationship
is needed.
4.1.4 Vitality
Vitality, or the energy available to the self, is a significant indicator of health and wellbeing (Ryan & Deci
2008). Przybylski et al (2009b) examined the wellbeing outcomes of wanting to or having to play
including the consequences of different styles of engagement in videogame play. The study examined
how self-controlling regulation of behaviour (obsessive play – having to play) depletes vitality and
energy while autonomous self-regulation of behaviour (harmonious play – wanting to play) does not
(Ryan & Deci 2008). It was anticipated that vitality would correspond with activities or contexts that
engendered basic psychological need satisfactions including competence (i.e., feeling effective),
relatedness (i.e., feeling significant and connected), and autonomy (i.e., feeling volitional rather than
controlled) as defined by self-determination theory (see Deci & Ryan 2000; Ryan & Deci 2008). Self-
determination theory and a dualistic model of passion were applied to gain a better understanding of the
causes and consequences of players’ feeling that they have to, instead of want to, play videogames
(Przybylski et al, 2009b).
For the study 1,324 (1,168 male) videogame players ranging in age from 18 to 43 years were recruited
from a popular online community that provides a forum for discussions about videogames and Internet
culture (Przybylski et al 2009b). Items were presented on Likert scales and open-ended questions to
measure: game type, trait level need satisfaction, harmonious passion and obsessive passion, game
enjoyment, weekly play time, post play energy and tension, life satisfaction, psychological and physical
health (Przybylski et al 2009b). Post-play energy and tension was measured via the energy and tension
subscales of the Activation-Deactivation Adjective Checklist developed by Thayer (1986). Participants
were asked to rate 10 mood adjectives relating to how they felt after playing their favoured game
(Przybylski et al 2009b). Terms used reflected energy and vitality (e.g., active, energetic, vigorous), and
tapped tension and anxiety (e.g., jittery, clutched up, fearful). Titles of the games enjoyed by participants
were categorised into five distinct game genres with games represented including first-person shooters
(316), massively multiplayer online games (309), role-playing games (284), strategy games (223), and
action-adventure games (192) (Przyblski et al 2009b). It was found that for those engaging with
videogames harmoniously greater hours of play were associated with greater post-play energy. In
contrast, for those engaging with videogames in an obsessive manner, greater hours of play were
associated with reduced post-play energy.
This suggests that how young people engage with videogames (harmoniously or obsessively),
is more important in terms of the impact of videogame play on wellbeing that which videogames
they play. Specifically, where harmonious engagement occurs vitality is likely to result and
moreover, more videogame play can lead to greater vitality.
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4.1.5 Resilience
Resilience refers to an individual’s ability to cope with stress and adversity. It includes the capability to
resist, adapt and strengthen oneself as a result of interacting with the environment and the processes
that either promote wellbeing or protect against the influence of risk factors (Zautra, Hall, & Murray
2010). There have been a number of studies that examine the relationship between videogame play and
stress reduction (Allahverdipour et al 2010; Ogletree & Drake 2007; Snodgrass, Lacy, Dengal & Fagan
2011; Wack & Tantleff-Dunn 2009). Recent studies demonstrate the role of game play in stress
reduction especially for college-aged males (aged 18-32 with mean age of 20.48) who may rely upon
moderated levels of videogame play as a healthy source of socialisation, relaxation, and coping during
their college years (Wack & Tentelett-Dunn 2009).
Wack & Tentelett-Dunn (2009) examined electronic game play and obesity, the social/emotional context
of electronic game play, and academic performance among 219 college-aged males. Participants
completed an online questionnaire that asked them a range of questions including game play habits (i.e.,
frequency of game play, preferred game genre, age of commencement of game play, specific items to
gauge social context of electronic game play) as well as information about participant demographics,
including age, ethnicity, grade point average (GPA), height, weight, and relationship status (Wack &
Tentelett-Dunn 2009). Respondents were also asked to carefully recall their game play behaviour and
provide details regarding frequency of play, types of games played, and length of play in a retrospective
daily diary format (Wack & Tentelett-Dunn 2009).
Within this context there was a significant positive correlation between frequency of play and self-
reported frequency of playing when bored, lonely, or stressed in contradiction to general conceptions of
electronic gaming as detrimental to functioning (Wack & Tentelett-Dunn 2009). These young males
reported a weekly average of 9.73 hours of game play with frequency of play not significantly related to
body mass index or grade point average. There was also no significant mean differences between other
variables related to social functioning (e.g., relationship status) and frequency of electronic game play,
revealing no obvious trends in interpersonal functioning for those who play games more or less
frequently (Wack & Tentelett-Dunn 2009). Other media usage was either not related to frequency of
electronic game play as for magazines or was inversely related, as with the frequency of consumption of
television suggesting that these individuals may be more selective with their choice of media (Wack &
Tentelett-Dunn 2009). Significantly, results suggested that gaming among college-aged men might
provide a healthy source of socialisation, relaxation, and combating stress (Wack & Tentelett-Dunn
2009). These findings are consistent with others who have found that the high level of engagement
evoked by some types of game play contributes to stress reduction (see Snodgrass, Lacy, Dengal &
Fagan 2011; Snodgrass, Lacy, Dengah, Fagan & Most 2011;Snodgrass et al 2012).
These findings suggest that in many cases, videogames offer a form of catharsis such that
playing them reduces stress and provides an opportunity to relax and socialise. This suggests a
likely connection to resilience, though further research (incorporating specific measures of
resilience) is needed to answer this question thoroughly.
4.2 POSITIVE FUNCTIONING
4.2.1 Engagement
Engagement with a task has been associated with increased happiness as people tend to be less happy
when their minds are wandering (Killingsworth & Gilbert 2010). Even when thinking about pleasant
topics, people are happier when they focus on a specific task at hand (Killingsworth & Gilbert 2010).
Engagement refers to an emotional involvement or commitment to some object or domain of interest, to
the experiential intensity of a relationship or interaction, and also to one’s temporal involvement or
interactions with activities and social partners in the immediate environments (Shernoff 2012). There is a
strong relationship between engagement and positive wellbeing (Shernoff 2012). Of critical importance
young people who are interested and involved in skill-building and productive pursuits score higher on
measures of psychological adjustment, including measures of self-esteem, responsibility, competence,
and social relations (Jessor & Jessor 1977; Shernoff 2012). Positive and engaging experiences then
become pivotal for positive wellbeing amongst young people (Shernoff 2012). Intrinsically interesting
activities that evoke intense concentration and enjoyment have been described as creating flow or
optimal experience as part of the endeavor (Csikszentmihalyi 1998, 2008).
Recently, Snodgrass and associates examined different types of videogame play experiences and the
effects they can have on players’ lives, including their levels of stress, satisfaction and happiness (see
21 // Safe. Healthy. Resilient.
Snodgrass, Lacy, Dengah, Fagan & Most 2011; Snodgrass, Lacy, Dengal & Fagan 2011; Snodgrass et
al 2012). These studies examined the popular Massively Multiplayer Online Role-Playing Game
(MMORPG), World of Warcraft (WoW). The central premise was based on the assumption that WoW
and similar games can be thought of as new ‘technologies of absorption’ — contemporary practices that
can induce dissociative states in which players attribute dimensions of self and experience to in-game
characters, with potential psychological benefit or harm (Snodgrass, Lacy, Dengal & Fagan 2011).
The study involved the research teams own in-game observations, 30 qualitative interviews with WoW
players and a 100 item formal Web survey. Interviews first elicited responses related to gamers’
motivations and goals, play styles, favourite and least favourite aspects of WoW and social interactions
in the game (Snodgrass et al 2011). Players were then asked to expand on their positive and negative
experiences within WoW and finally, the cultural conceptualizations of success and wellbeing in both
real life and in this game-world were explored (Snodgrass et al 2011). Based on interviews, an
‘Absorption-Dissociation’ Scale was constructed for inclusion on the web survey (Snodgrass, Lacy,
Dengah, Fagan & Most 2011). About half of respondents reported WoW as increasing their happiness,
and an even larger fraction reported that WoW helps them ‘relax and combat stress’ and that it
increases their ‘life satisfaction’ (Snodgrass, Lacy, Dengah, Fagan & Most 2011). Most respondents did
not feel that WoW play increased stress in their lives, but nearly one-third agreed at some level that it
did. Experiencing an immersive state of consciousness and hence dissociation has been linked to both
positive and negative mental health outcomes. Immersive states have been found to be both normal
and desirable by players with two-thirds of the web survey sample reported having at times immersive
experiences. Some players used game absorption and dissociation therapeutically, reporting that such
experiences enhance their perception that WoW contributes to their happiness and life satisfaction.
Certain vulnerable players however dissociated too deeply into WoW, losing control of their game-play
and were no longer able to effectively extricate themselves (Snodgrass, Lacy, Dengah, Fagan & Most
2011).
Findings affirmed that dissociation can be positive and normal and that altered ‘absorbed’ states of
consciousness that many gamers reached, such as the ‘dissociative’ identification some gamers have
with their characters, provide some gamers with relaxation as well as some of the most satisfying,
meaningful experiences of their lives (Snodgrass, Lacy, Dengah, Fagan & Most 2011; Snodgrass et al
2012). Experiences of ‘absorption-dissociation’ explain the positive therapeutics of the game, which
combines relaxation alternating with mildly stress-inducing flow states (Snodgrass, Lacy, Dengah,
Fagan & Most 2011). Positive stress helps players achieve ‘flow’ and the experience of being in the
‘zone,’ as players are pushed by the game’s tasks and challenges where there is likelihood of
experiencing success (Csikszentmihalyi 2008). The two states of experience and consciousness are
achieved if players imaginatively immerse themselves in this game-world and feel heavily identified with
their character-avatars (Snodgrass, Lacy, Dengah, Fagan & Most 2011). This deep immersion can
divert attention from real-world stress, allowing gamers to more readily reach deeply relaxed, even
meditative, states of play (Snodgrass, Lacy, Dengah, Fagan & Most 2011).
However, there were also occasions when certain forms of dissociation were problematic. As much as
absorptive pleasures can be therapeutic a certain proportion of WoW players find their play deeply
distressing and problematic (Snodgrass, Lacy, Dengah, Fagan & Most 2011). As WoW promotes
dissociative experiences, especially in conjunction with stress relieving and producing mechanisms,
certain players experienced negative addiction (Snodgrass, Lacy, Dengah, Fagan & Most 2011). While
some players are able to use game absorption and dissociation therapeutically reporting that such
experiences enhance their perception that WoW contributes to their happiness and life satisfaction,
other players dissociated too deeply into WoW and lose control of their game-play (Snodgrass, Lacy,
Dengah, Fagan & Most 2011). As WoW is so engaging and pleasurable, in certain circumstances it can
be used to excess (Snodgrass, Lacy, Dengah, Fagan & Most 2011).
In sum, this research suggests that the experience of engagement while playing videogames
can have a positive influence on wellbeing. However, excessive game play can become
problematic. This is supported by other studies previously reported in this review where the
amount of game play was found to be significant in moderating the potential wellbeing benefits
(see Allahverdipour et al 2010; Durkin & Barber 2002) but should be considered in tandem with
findings identifying the influence of the nature of engagement (harmonious or obsessive,
Przybylski, Weinstein, Ryan & Rigby 2009) as well as the influence of pre-existing psychosocial
vulnerability (Lemmens et al 2011, Van Rooij et al 2011).
22 // Safe. Healthy. Resilient.
4.2.2 Positive Relationships
The term friendship and how we define relationships appears to be shifting as many young people today
form and maintain what they consider friendships online (Amichai-Hamburger, Kingsbury & Schneider
2013). Friendship is important for the psychosocial adjustment and wellbeing of children, adolescents
and adults (Bagwell & Schmidt 2011). The digital world is changing the logistics of many friendships
although it would seem that just as in the past there remain deep, close friendships and more shallow
ones and these friendships, involving different degrees of closeness, occur both on and offline (Amichai-
Hamburger et al 2013). The social interactions that occur within and outside of MMORPG play have
been found to be highly social providing opportunities to create strong friendships and emotional
relationships (Cole & Griffiths 2007; Yee 2006). Interestingly, online MMORPG gamers under the age of
18 have been found to feel that the friendships they formed online were comparable or better than their
real life friendships (Yee 2006). WoW players have reported creating social capital through online game
play with players using the game to extend real life relationships, meet new people and form
relationships of varying strength (Williams et al 2006).
Some argue for the stimulation hypothesis in terms of friendships, suggesting that online communication
is being used to enhance both the quantity and quality of communication between friends, leading to
greater closeness and intimacy (Valkenburg & Peters 2011). The Snodgrass, Lacy, Dengal & Fagan
(2011) study reported above also considered the differences between playing WoW with individuals
known outside of the game and playing with people met online. Playing with offline friends who are also
friends in real life was healthier as interactions helped regulate game play (Snodgrass, Lacy, Dengal &
Fagan 2011). Playing with real life friends also allowed players the added benefit of transferring positive
gaming experiences into real life and mediating immersive experiences (Snodgrass, Lacy, Dengal &
Fagan 2011). Game play with friends appeared to make it harder to immerse, impacting on some of the
stress reduction benefits although also potentially reducing the risk of problematic play and addiction
(Snodgrass, Lacy, Dengal & Fagan 2011). Playing with real life friends also allowed players of WoW to
share their experiences of success and achievement to bolster and repair their feelings of worth and
esteem, as players temporarily live as heroes, defeating evil even when the odds are against them
(Snodgrass, Lacy, Dengal & Fagan 2011). Players are then able to transfer in-game accomplishments
and status to their real life networks of friends and family (Snodgrass, Lacy, Dengal & Fagan 2011).
Playing WoW in this way creates cognitive and social bridges between on- and offline worlds providing
more objective perspective on MMO use and allowing better self-regulation (Snodgrass, Lacy, Dengal &
Fagan 2011). Therefore, playing with friends has the potential to affect levels of problematic play by
mediating immersion and enhancing real life relationships increasing social and psychological resilience
(Snodgrass, Lacy, Dengal & Fagan 2011). Seminal studies also add credence to this concept as game
play is not always a solitary activity but often is a social activity involving many players with emotional
and social factors motivating play (Colwell 2007; Hull 2009; Trepte, Reinecke, & Juechems 2012; Wack
& Tantleff-Dunn 2009).
Cole & Griffiths (2007) found in their study of 912 self-selected MMORPG players from 45 countries,
that social interactions in online gaming form a considerable element in the enjoyment of playing. This
type of game play can be extremely social with a high percentage of gamers making life-long friends
and partners. The Cole & Griffiths (2007) study included 70% males (n = 641), and 29% female (n =
261), and 1% who did not supply their gender (n = 10) with the mean age of 23.6 years. Participants
were asked to complete an online questionnaire that was divided into five sections. Participants
provided demographics (gender, age, country of residence, and which game was played and how
often); information about friendships within the game (attraction to other players, and meeting online
friends in real life); topics that players might discuss with their online friends; information about their
gaming motivation; and responded to questions about their personality type (Cole & Griffiths 2007).
WoW was the most popular MMORPG for participants in this study, more popular among females than
males, with this gender difference attributed to the social and visual nature of the game (Cole & Griffiths
2007). Significantly, 76.2% of male and 74.7% of female players had made good friends within online
games, suggesting that MMORPGs are highly socially interactive. Of interest, two fifths of participants
(39.3%) said they would discuss sensitive issues with their online gaming friends that they would not
discuss with their real life friends, with females being more likely to do so (Cole & Griffiths 2007). Also of
interest, 42.8% of participants had met with online friends in real life situations, again suggesting that
online gaming is a social activity or facilitates social activity (Cole & Griffiths 2007). In fact, 31.3% of
participants had found themselves attracted to another player (26.2% males compared to 42.3%
females) suggesting that MMORPGs offer a safe environment for players to become emotionally
involved with others (Coles & Griffiths 2007). It would appear that virtual gaming may allow players to
express themselves in ways they may not feel comfortable doing in real life because of their appearance,
gender, sexuality, and/or age (Coles & Griffiths 2007).
23 // Safe. Healthy. Resilient.
In sum, there is clear support for the notion that videogames offer an opportunity for social
connection in terms of the building and fostering of positive emotional relationships and
friendships. There is also evidence to suggest that playing with friends from outside the game
world further increases the associated wellbeing benefits. Finally, there is emerging evidence
that videogames may allow players to express themselves in ways they may find difficult in the
real word – further research is required to confirm this possibility and to fully assess the
associated implications.
4.2.3 Competence (Achievement)
As detailed previously Ryan and colleagues (2006) suggested that the psychological ‘pull’ of games is
largely due to their capacity to engender feelings, including competence, therefore enhancing
psychological wellness. Competence is a psychological need that includes the need for challenge and
feelings of being effective (Ryan et al 2006), therefore factors that enhance the experience of
competence (such as opportunities to acquire new skills or abilities, to be optimally challenged, or to
receive positive feedback) enhance perceived competence (Ryan et al 2006). Competence is enhanced
in gaming contexts where game controls are intuitive and readily mastered, and tasks within the game
provide ongoing optimal challenges and opportunities for positive feedback (Ryan et al 2006). Ryan et al
(2006) found the desire for future play was predicted by feelings of presence and players self
determined needs for competence, autonomy and relatedness.
Yee (2006) and Suznjevic and Matijasevic (2010) both found achievement was an important motives for
playing MMORPG games. Yee (2006) conducted an online survey with 6675 (male = 5939, female =
736) users of MMORPGs over a three-year period and examined participants’ demographics,
motivations and experiences. The study used quantitative survey data to explore the significance and
salience of the relationships that form in MMORPGs, the degree of emotional investment in the
environment, and whether real life leadership skills could be acquired in the online environment (Yee,
2006). Demographic composition of MMORPG users and their usage patterns was obtained,
exploratory factor analysis of the different motivators was conducted, and the salience of the
relationships and emotional experiences derived from the online environments was examined (Yee
2006).
MMORPGs appealed to a broad age range (M age= 26.57, range = 11-68) in this study (Yee 2006). It
was however female players who were more driven by the Relationship factor and more likely to use the
MMORPG environment to build supportive social networks, supporting findings reported by Cole &
Griffiths (2007) and Snodgrass, Lacy, Dengal & Fagan (2011) that online gaming can support positive
relationships. Male players in this cohort were significantly more likely to be driven by the Achievement
factor (Yee 2006). The ‘Achievement’ factor measured the desire to become powerful in the context of
the virtual environment through the achievement of goals and accumulation of items associated with
power (Yee 2006). While some users participated in the environment to make friends and form
supportive social networks others used the environment to become powerful through the achievement of
goals (Yee 2006).
In sum, videogames (as a function of intuitive controls, ready mastery, optimal challenges and
positive feedback) have been shown to lead to feelings of competence and achievement for
players. Such feelings have been shown to have a positive influence on wellbeing.
4.2.4 Self-acceptance
Virtual self-enhancement through online game character development is attractive for individuals
dissatisfied with aspects of themselves (Bessiere et al 2007). Individuals with a marginalised self-
identify seek affirmations in their use of the Internet (McKenna & Bargh 2000). Opportunities to create a
presence in an online world, such as spaces provided in MMORPGs, allows a player’s character to
interact with others freely, anonymously providing a means to escape poor self-evaluation by eschewing
negative traits and enacting a better virtual self (Bessiere et al 2007). People with larger discrepancies
between their actual self versus their ideal self have higher depression and lower self-esteem (McKenna
& Bargh 2000). Therefore the ability to create characters that embody aspects of players’ ideal selves
has implications for players’ psychological wellbeing (Bessiere, Fleming & Kiesler 2007; Przybylski et al
2011).
Bessiere and colleagues (2007) examined identity exploration possibilities presented by online
multiplayer games when players used graphics tools and character-creation software to construct an
avatar, or character. They predicted World of Warcraft players would create their main character to
reflect their ideal self. The study involved a survey via the Internet to a sample of WoW players.
24 // Safe. Healthy. Resilient.
Participants included 51 valid participants ranging in age from 18 to 27-years-old with a mean of 21
years who were primarily male (43 men, eight women) (Bessiere et al 2007). The respondents
answered questions about WoW, their actual self, their character, and their ideal self. An adjective rating
method based on Big Five Personality Inventory (Donahue & Kentle 1991) was used to assess the
different self and character views. The survey included 44 items in five categories: conscientiousness
(e.g., thorough, reliable, organized), extraversion (e.g., talkative, energetic, assertive), neuroticism
(depressed, worried, nervous), agreeableness (e.g., trusting, forgiving, kind), and openness to
experience (e.g., creative, artistic, inventive) (Bessiere et al 2007). Participants rated how similar each
personality characteristic was to their actual and ideal selves and also evaluated their primary WoW
character. To examine whether the player’s character was viewed as more ideal than player’s actual self
a paired t-test was implemented to find the differences between the self-discrepancy and the character
discrepancy. Findings were significant for three of the five personality dimensions: conscientiousness,
extraversion, and neuroticism were all found to differ (Bessiere et al 2007).
The study also examined whether people with poorer psychological wellbeing were more likely to see
their character as realising aspects of their ideal self. To this end a mixed-model analyses of variance
on the personality dimensions was conducted. Participants with high depression scores, as compared
with low depression scores, (a) had much lower actual self views and (b) created characters who were
close to their ideal (Bessiere et al 2007). That is, those with lower levels of psychological wellbeing rated
their characters as much better than themselves allowing them to be more like the person they wished
to be within the anonymity and fantasy of the game world. This data suggests that MMORPG virtual
worlds offer players the opportunity to create idealised characters as alternative selves as, on average,
participants rated their virtual character as being more conscientious, extraverted, and less neurotic
than themselves (Bessiere et al 2007). Significantly, this trend was reported more among those who
were more depressed or had lower self-esteem.
Results from this study support the idea that the game world’s anonymity and fantasy frees players from
their real life history and social situation, allowing them to be more like the person they wish to be
(Bessiere et al 2007). This opportunity may serve to reduce some people’s actual ideal self-discrepancy
and increase their feelings of self-confidence and self worth, potentially impacting positively on
psychological health (McKenna & Bargh 1998, 2000). Furthermore, potentially players whose
characters display desirable qualities could imagine themselves as different and reduce their ideal
actual self discrepancies dependent on the extent to which players try to emulate their characters’ better
traits (Bessiere et al 2007).
In sum, there is clear initial evidence of the positive impact of videogame play on self-
acceptance through the exploration of idealised characters and alternative selves. Further
research is needed to replicate this finding with other genres of games.
4.2.5 Personal Growth
When videogame play reduces players’ ideal actual self-discrepancies, there are significant
opportunities for personal growth (Bessiere et al 2007). Encouragingly, ideal self-representation has
positive benefits as such visual imagery techniques have been used to help drug addicts create ideal
self-representations in attempts to have them reject their addictive self (Avants et al1994). The study
above by Bessiere et al (2007) provides positive implications for developing young people’s personal
growth as does the study by Hull (2009) previously reported (see Optimism).
In play therapy conducted by Hull (2009), boys aged 9-14 who were suffering from sadness were
referred for treatment by psychiatrists and school psychologists and underwent significant personal
growth. After engaging in the challenges provided by the videogames used in the therapy participants
parents and teachers reported an increase in the boys self worth (Hull 2009). Furthermore, the increase
in self worth in turn brought about an increase in coping skills, and gaining new coping skills brought
about newfound self worth (Hull 2009). Videogames selected for therapy provided metaphors that
related to inner values such as strength and courage (Hull 2009). For example, one participant ‘John’
identified with the game Naruto and the idea of inner strength and courage used to demonstrate for him
the ‘power’ of ignoring the bullies. ‘John’ then experienced change within himself (‘I feel good, I’m
feeling powerful’) (Hull 2009). Similarly, ‘Geoff’ revealed feeling better about himself by being able to
ignore the negative comments from bullies and also experienced a change in his thinking. The
‘attributes’ of strength, courage, and bravery in videogame play were used to deal with those who made
fun of him and he reported ‘It makes me feel better about myself because I don’t have to believe what
they say about me. I know that I’m smart and when I play the game I feel smart. But I also know that I
am smart in real life (Hull 2009, p. 98).’ Within this study there was growth for participants in relation to
25 // Safe. Healthy. Resilient.
gaining new coping skills, increasing the participant’s sense of self worth, and helping to lessen the
sadness experienced.
While there is clearly potential for personal growth through videogame play and important initial
evidence of a small sample experiencing growth through play, further research is needed to
replicate this finding with a larger sample.
4.3 POSITIVE SOCIAL FUNCTIONING
MMOs are one of several online ‘places’ in which social interaction might occur and are unique in the
fact that they collect and mix people pursuing goals in three-dimensional space (Williams et al 2006).
WOW creates an engaging and highly social space for millions of players. It is a vibrant space
populated with a range of social experiences ranging from ephemeral impersonal groups to sustained
and deep relationships that extend offline (Williams et al 2006). Games such as WOW include structure
and rule sets impacting on what kinds of people play, what they do, and how and why they interact with
one another (Williams et al 2006). As part of game play social organisations are created with the design
encouraging the formation of persistent player associations (Taylor 2003).
Socialisation is a significant motivational factor for WoW players. This motivational influence was
identified recently in a study of Spanish WoW players (Fuster, Oberst, Griffiths, Carbonell, Chamarro &
Talarn 2012). In this study by Fuster et al (2012), the aim was to assess the psychological motivations
of playing WoW and examine how they related to socio-demographic variables and gaming styles. The
study implemented a questionnaire to assess motivations for gaming including: socialisation, exploration,
achievement, and dissociation. Socialisation was one of the main motivational factors and gamers were
found to prefer the Player-versus-Player element of the game (Fuster et al 2012). While the game
includes players grouping together in guilds and working towards common goals, the Player versus
Player aspect includes players forming strategic alliances to deal with arising conflicts, battles and wars
with players forming strategic alliances that require mutual interaction in order to fight between factions
and groups of players (Fuster et al 2012).
The sample for this study included 253 Spanish WoW players who were all young males between the
ages of 16 and 35 years of age. Following the pilot study, the survey instrument comprised of 32 items
including demographics and dedicated items on socialisation (n=6), power (n=6), exploration/discovery
(n=5), escape and evasion (n=8), and identity (n=6). Survey respondents were all Spanish speaking
online gamers with a mean age of 22.2 years (SD = 4.4 years); the median was 21 years, and ages
ranged from 16-35 years (Fuster et al, 2012). Factor analysis of the questionnaire scores showed the
presence of four motivations for gaming: socialisation, exploration, achievement, and dissociation all of
which showed high levels of internal consistency (Fuster et al 2012).
The three items for socialisation referred to the relational component of the game, establishment of
friendships with other players, and feeling supported by them. Exploration included five items related to
discovery of the game, its history, and the various phenomena that occur within the game. Achievement
included five items referring to dominance, leadership, prestige and achievement of goals. Dissociation
included seven items related to identification with the avatar, and with evasion of, or escaping from,
reality (Fuster et al 2012). Players were very interested in socialisation, relating with others via the game,
establishing friendships with other players, and feeling supported by them (Fuster et al 2012). They
exhibited medium-high interest in exploration, the discovery of the game and development of the
adventures involved (Fuster et al 2012). Interest levels in leadership, prestige, and achievement of were
medium low. While there were relatively low scores on dissociation that was associated with low levels
of identification with their avatar, and low levels of escape from reality (Fuster et al 2012).
For this Spanish cohort of players the strongest motivation for playing WoW was socialisation, with
these players preferring to play with other players, something that appears to avoid serious dissociation
and potential addiction (Fuster et al 2012). There was a broad range of ages and occupations
suggesting diversity among WoW players, and contradicting stereotypes about gaming addicts. The
typical online gamer in the study was a young male student with a medium-high educational level (96%).
And while players dedicated a considerable amount of time to the game (a mean average of 22.6 hours
per week), playing on both weekdays and at weekends, the number of hours per week spent playing did
not decline with age (Fuster et al 2012). Findings from this study suggest that online game
environments such as WoW are attractive beyond adolescence and have the potential to provide
healthy spaces for socialisation. While this study was conducted in a specific cultural context, with a
limited number of participants, further exploration of the role of socialisation in MMORPGs in terms of
positive wellbeing appears warranted.
26 // Safe. Healthy. Resilient.
This research provides clear evidence of socialisation as a key motivation for videogame play. It
should be noted that genres of videogames other than MMORPGS also offer opportunities for
socialising with other players. For example first-and third-person-shooters and sport games
almost always include online multiplayer modes that allow for both competitive and cooperative
play. Similar modes are also sometimes included in action games, platforming games, puzzle
games and other genres. To this end, Johnson and Gardner (2010) found differing genres of
games to result in varying experiences of autonomy but similar levels of competence and
relatedness. However, to date, there is less research on the social components of such games
and this is an area worthy of further research.
4.3.1. Social Coherence
The concept of social cohesion can be defined as a willingness of individuals to cooperate and work
together to achieve collective goals (Jeannotte et. al. 2002). When WoW players work together in guilds
they often participate in highly structured organizational experiences working towards common goals.
Williams and colleagues (2006) were interested in the social environments provided by participation in
guilds such as WoW. They examined the social dynamics of guilds and formal practices adopted within
different guilds when the structures have a relaxed atmosphere with corresponding structure such as a
guild known as the ‘the tree house,’ or when they are highly structured, hierarchical organisations such
as the guild known as ‘the barracks’ (Williams, et al 2006). Essentially they were interested in the size,
structure, formal practices and individual experience within social groups formed as player guilds. The
study they initiated with a survey and network mapping of players was based on interviews with online
players finding that the majority of high-centrality respondents belonged to the more structured guilds,
whereas low-centrality respondents tended to be affiliated with unstructured groups (Williams et al 2006).
Centrality refers to how often the character grouped with others in their guild with those who grouped
more often thought to be more ‘central’ or social hub-like members of their guild (Williams et al 2006).
Therefore players in formally structured guilds tended to have a more social experience than others.
These social experiences had the potential to provide opportunities for developing highly structured
organisations that involved participants working towards a common goal.
As part to the Williams et al (2006) study 48 male and female participants (numbers and ages not
specified) were involved in interviews to explore player behaviours, attitudes, and opinions; the
meanings they make; the social capital they derive; and the networks they form and to develop a
typology of players and guilds (Williams et al 2006). While largely exploratory, this study contributed
some interesting findings in terms of the social nature of WoW players’ experiences, as interviews
revealed that players used WoW to extend real life relationships, meet new people, form relationships of
varying strength, and also used others merely as a backdrop (Williams et al 2006). The moderating
factor was the game’s mechanic, which encouraged some kinds of interactions while discouraging
others (Williams et al 2006).
The organisational design of WoW player guilds can be considered a network and player behaviours
and group behaviours vary according to game goals, personal preferences, and player awareness
(Williams et al 2006). Playing WoW is then social like a team sport, which has its own rules, literal
boundaries, and social norms (Williams et al 2006). There is however self-initiated tactics, team
strategies, styles, and goals that make the play space a stage for socialisation, organisation, and
networks (Williams et al 2006). Game guilds can be considered organisations as they arise from people
able to communicate working towards a common goal (Williams et al 2006). Formal practices within
guilds included mission statements, recruitment and expulsion policies, and external Web sites and
these became more likely as guild size increased (Williams et al 2006). Some guilds relied on relatively
haphazard policies and procedures, and were more likely to contain social tensions, misunderstandings,
and fights. Guilds with clear policies and procedures managed tasks better and had generally happier
members (Williams et al 2006). Implications of this study indicate that social capital was created during
game play and civic revitalization is possible for some players and in a new way (Williams et al 2006).
When players knew each other beforehand, WoW was an important way for them to maintain and even
reinforce their relationship although for most others, it was an entrée to bridging social capital that could
build up into something more over time—ranging from a few weeks to a year (Williams et al 2006).
In sum, there is clear evidence of social coherence occurring as part of Massively Multiplayer
Online Role-Playing Games in the form of guilds and the sharing of common goals. Further
research is needed to explore whether this relationship exists in other videogame genres.
27 // Safe. Healthy. Resilient.
4.3.2. Social Integration
Social integration requires understanding a common language, common laws and working towards a
common set of values. Again, WoW provides participants opportunities for social experiences that
include team work and collective game play towards common goals. Billieux et al (2013) were interested
in the motives of WoW players and found that team work and competition were significant for
participants engaged in WoW as these are associated with fast progression in the game (Billieux et al
2013). In this study Billieux et al (2013) recruited a sample of 690 World of Warcraft players who had
their avatar monitored for eight months. These participants completed an initial online survey about their
motives to play while their actual in-game behaviours were measured through the game’s official
database. While there were some association between problematic use and advancement and
escapism the longitudinal analysis showed that high involvement in the game is not necessarily
associated with a negative impact upon daily living.
The majority of participants in this study were male (87.10%) ranging in age from 18-66 years (M =
26.22, SD = 8.14 years). Participants represented a number of countries including France (73.6%),
Switzerland (18.8%), Belgium (4.8%) or other countries (2.1%) and non-reported (0.7%) (Billieux et al,
2013). Participants were employed (54.9%), undergraduate students (37.5%), and unemployed (5.5%)
or did not indicate their profession (2.1%). The Motivation to Play in Online Games Questionnaire
(MPOGQ) developed by Yee (2006) to measure players’ motives to engage in online games was the
instrument used in this study.
The comparison of cross-sectional and longitudinal analyses highlighted that advancement and
mechanics motives are associated with higher achievement scores in the game in the cross-sectional
analysis (data collected in the initial survey), however, optimised progression in the game (data
collected through avatar monitoring) is better predicted by other motives, such as teamwork or discovery,
as well as by being affiliated to a guild. Players motivated by advancement and mechanics eventually
display elevated ranking in the game but longitudinal data suggested that this will require more time and
effort if they are not motivated by both discovery and cooperation with other players which generally
involves joining a network of players in a guild (Billieux et al 2013).
There is evidence of social functioning, social relationships and social coherence as part of
videogame play and it is likely that in some cases this results in social integration. Further
research is needed to explore the extent to which videogame play with friends contributes to
social integration beyond the game world.
4.4 DIVERSITY IN VIDEOGAMES
4.4.1. Females Play Games Too
While there are games targeted at female gamers there is some concern that gender stereotyping is still
prevalent within many games casting male characters as warriors for battling and female characters as
damsels who ask for help (Dickey 2006; Ong & Tzuo 2011). The stereotypical and unrealistic hyper-
sexualised portrayal of both mens’ and womens’ physical appearance, behaviours, and personalities
has been critiqued and debated (Reinhard 2006). These concerns however are decreasing due to a rise
in powerful female characters, an increasing trend for women to be used as the sole protagonists and
greater understanding of female preferences. Jade, the protagonist of Beyond Good and Evil and Chell,
from Portal are recognised as strong and confident female characters that have not been hyper-
sexualised. These characters are part of the change associated with game character development in
modern videogames that includes women as active and self-reliant. While concerns remain about
depictions of gender within videogames, it is clear that the situation is improving.
Moreover, there is greater understanding of what females want from a game and their perception that
game narratives should be purposefully designed with opportunities to manage power, customize game
characters, disrupt gender stereotypes and negotiate between girls‘ and boys‘ roles and identities (Ong
& Tzuo 2011). Having the option to create a female character or an ambiguously gendered character is
a way for girls to manage power relations. Significantly, and contrary to stereotypical expectations girls
are not averse to battling and may enjoy battling and violence in moderate doses, while others may
even enjoy a high dose of battling in their game play (Ong & Tzuo 2011). Furthermore, there is evidence
that for many genres, there is not a great deal of difference in preferences across gender with similar
numbers of males and females listing adventure games, strategy games and fighting games as their
favourites (Brand 2012). However on some genres, there is evidence of a difference in preferences – for
28 // Safe. Healthy. Resilient.
example, more females have indicated a preference for puzzle games and more males indicating a
preference for first-person shooters and sport games (Brand 2009).
4.4.2. LGBTQ Characters In and Players of Videogames
While historically it can be observed that sexual diversity has been lacking in videogames, the situation
appears to be changing. Recent examples include the incorporation of same-sex romances in the Mass
Effect series, the option for same-sex couples to marry in The Sims 3 and examples of same sex
attraction among young people in games like Bully. It seems likely that as designers become more
focused on building deep, fully developed characters this trend towards diversity will continue.
Interesting, in ethnographic research conducted with an online community of gay videogame players
(Shaw 2012) it was found that the representation of diversity of characters in videogames was less
important to the community than a safe online space to express one’s identity as a gay gamer.
Concerningly, in a large scale survey (over 10,000 respondents) survey of videogame players, over
80% of respondents had heard homophobic language used among their gaming community (Rockwood,
cited by Sliwinski 2007). While this is alarming and clearly an area for future focus, it is simultaneously
encouraging to note that events such as ‘Electronic Arts Full Spectrum’ and ‘GaymerX’ are appearing
and providing a focus for exploring LGBTQ issues around videogames.