The effectiveness of casual video games in improving mood and decreasing stress

Abstract

Stress related medical disorders such as cardiovascular disease, diabetes and depression are serious medical issues that can cause disability and death. Techniques to prevent their development and exacerbation are needed. Casual video games (CVGs) are fun, easy to play, spontaneous and are tremendously popular. In this randomized controlled study we tested the effects of CVGs on mood and stress by comparing people playing CVGs with control subjects under similar conditions. Electroencephalography (EEG) changes during game play were consistent with increased mood and corroborated findings on psychological reports. Moreover, heart rate variability (HRV) changes were consistent with autonomic nervous system relaxation or decreased physical stress. In some cases CVGs produced different brain wave, heart rate variability and psychological effects. These finding have broad implications which include the potential development of prescriptive interventions using casual video games to prevent and treat stress related medical disorders.

Full text

THE EFFECTIVENESS OF CASUAL VIDEO GAMES IN
IMPROVING MOOD AND DECREASING STRESS
Carmen V. Russoniello1, Kevin O’Brien1and Jennifer M. Parks1
Journal of CyberTherapy& Rehabilitation
Spring 2009, Volume 2, Issue 1
© Virtual Reality Medical Institute
Stress related medical disorders such as cardiovascular
disease, diabetes and depression are serious medical
issues that can cause disability and death. Techniques to
prevent their development and exacerbation are needed.
Casual video games (CVGs) are fun, easy to play, spon-
taneous and are tremendously popular. In this random-
ized controlled study we tested the effects of CVGs on
mood and stress by comparing people playing CVGs
with control subjects under similar conditions.
Electroencephalography (EEG) changes during game
play were consistent with increased mood and corrobo-
rated findings on psychological reports. Moreover, heart
rate variability (HRV) changes were consistent with
autonomic nervous system relaxation or decreased phys-
ical stress. In some cases CVGs produced different brain
wave, heart rate variability and psychological effects.
These finding have broad implications which include
the potential development of prescriptive interventions
using casual video games to prevent and treat stress
related medical disorders.
Corresponding Author:
Carmen Russoniello, Associate Professor and Director of the Psychosphysiology Lab and Biofeedback Clinic, East Carolina University,
RUSSONIELLOC@ecu.edu
1East Carolina University, Greenville, NC 27858-4353, U.S.A
Keywords. Casual Video Games, Electroencephalography
(EEG), Heart Rate Variability (HRV), Psychological Mood
BACKGROUND
According to the Casual Video Game Association there
are more than 200 million casual game players worldwide.
Gamers from a multitude of cultures, ages, and lifestyles
play electronic casual games using consoles, PCs and
online communities, handhelds and mobile phones. One
example of the popularity of casual video games can be
found in the fact that Microsoft Solitaire for Windows is
the most commonly opened application on Windows XP
(Casual Games Association, 2008). Casual video games
sometimes referred to as coffee-break or web games are a
booming business that is expected to grow to $55 billion
by 2009 (JWT Intelligence, 2006).
Casual video games (CVGs) defy a standard definition
because of the diverse nature of the games. Instead the
Casual Games Association, 2007 offers a functional defini-
tion that asserts that CVGs must be considered fun, quick
to access, easy to learn, and require no previous special
video game skills, expertise, or regular time commitment to
play. CVGs are based around familiar game concepts that
consumers played as children in arcades. They are usually
easy to pause, stop and restart. Casual games are usually
played in short increments at home and at work. Some
people, however, play for hours on end (Casual Games
Market Report, 2007).
According to anecdotal evidence and survey research, people
play CVGs for varied reasons including cognitive exercise, fun,
relaxation, and to reduce stress and improve mood. The Casual
Games Association says CVGs are viewed as important in
stress reduction during lunch or after work and CVG play has
begun to replace TV in this respect. A survey of gamers con-
ducted in 2006 (n= 2,191) revealed that casual game players
(71% daily use) view CVGs as more important in their leisure
time activities than TV, reading, or spending time with family
and friends. The survey also found that 88% of respondents
derived stress relief from playing. While casual gaming is pop-
ular among all groups they are particularly attractive to women
over 30. Retired men and woman also represent a large group of
casual gamers (Casual Video Games Association, 2007).
Stress and Health
A strong link between physical health and stress was estab-
lished more than a quarter century ago when researchers
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noted that exacerbation of tumor growth occurred follow-
ing acute exposure to uncontrollable stress (Sklar &
Anisman, 1979; Sklar & Anisman, 1981). It was postulat-
ed that stress influenced neurochemical, hormonal and
immunological changes which, in turn, exacerbated the
tumor growth but the mechanisms were not well under-
stood. Researchers exploring underlying causation began
focusing on the physiology of emotional response to psy-
chosocial stimuli adding to the understanding of how neu-
rochemical, hormonal and immunological changes occur
and contribute to dysfunction. These insights have led to
the current theory on human reactions to stress now char-
acterized as the “defense/fight or flight” and “defeat/immo-
bilization” responses (Folcov, 1988). In this model limbic-
hypothalamic patterns of response are integral and serve to
protect a person from adverse stimuli by mobilizing bio-
chemicals to aid in the response (Kudielka & Kirscbaum,
2007). Untoward stress or “distress” has a deleterious
impact on people and can directly affect both psychological
and physical conditions. If stress is not ameliorated it will
contribute to the development and/or exacerbation of ill-
ness and disease (Sapolski, 2004).
The term allostasis relates to a person’s ability to adapt to
adverse stimuli (McKewen, 1998). Allostatic load is con-
sidered the neurochemical, hormonal and immunological
costs of adapting to stress (Sternberg, 1997). The allostasis
model consists of four different causes of allostatic load that
require biological responses. 1. Frequent exposure to stress
2. Inability to habituate to repeated challenges 3. Inability
to terminate a stress response and 4. Inadequate allostatic
response (Webster, Tonelli & Sternberg, 2002). Under nor-
mal circumstances a person can manage their allostatic
load. However too often the demands of life overwhelm a
person’s normal coping abilities and additional help is
needed. Unfortunately, these self prescribed interventions
often involve potentially devastating after effects i.e. the use
of food, alcohol or drugs. Hence, people need to learn and
practice healthy methods to decrease stress and improve mood.
Psychological experiences can cause or be caused by stress.
Fear is a good example because it can be either real or imag-
ined. The body reacts as if it were real regardless. This expe-
rience in turn influences immune function and ultimately
the course of a disease. For instance, when a person
encounters a stressful circumstance, cortisol increases turn-
ing up energy producing mechanisms, while inhibiting less
essential functions. Specifically, cortisol has a significant
effect on numerous processes including metabolism, fluid
regulation, emotional and cognitive functioning and the
immune system (Thayer & Sternberg, 2006). Researchers
applying the Tier Social Stress Test for example, found cor-
tisol levels increased two to three-fold in about 70-80% of
subjects within 1 to 20 minutes after task demonstrating a
link between a psychosocial task and allostatic response
(Hjemdahl, 2002). When this short-term response is not
curtailed through the hypothalamic-pituitary-adrenal
(HPA) feedback loop or when the demand exceeds the per-
son’s capacity to respond, a number of changes occur which
can sometimes lead to physical and mental illness (Adinoff,
Iranmanesh, Veldhuis & Fisher, 1998).
Stress and Mood
Everyone at some point experiences sadness or the blues.
There are multiple causes for these feelings including situ-
ational circumstances such as losing a loved one, a job or
even by the weather which when wet and dreary can cause
a condition known as seasonal affective disorder syndrome
(SADS). Generally people will find social support, or a
coping activity that help them to improve their mood.
These activities vary from shopping to movies, exercise, and
recreational activities. The growing use of CVGs may be
directly related to their ability to assist in decreasing stress
and improving mood without the potential negative side
effects of other choices.
Depression is a clinical term used to describe extreme neg-
ative mood characterized by persistent sadness and impair-
ment in functioning. According to the National Institute
of Mental Health approximately 20.9 million American
adults, or about 9.5 percent of the U.S. population age 18
and older in a given year, have a mood disorder. Major
depression affects 14.8 million adults and is the leading
cause of disability for ages 15-44. Dysthymic disorder
affects approximately 1.5 percent of the U.S. population
age 18 and older in a given year or 3.3 million American
adults. The median age of onset of both disorders is
approximately 30 years (National Institutes of Mental
Health, 2008).
While individuals experiencing depression do not all
exhibit the same symptoms or the intensity, frequency and
duration there are commonalities that provide criteria to
define the disorder and those are: persistent sad, anxious or
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"empty" feelings; feelings of hopelessness and/or pes-
simism; feelings of guilt, worthlessness and/or helplessness;
irritability, restlessness; loss of interest in activities or hob-
bies once pleasurable, including sex; fatigue and decreased
energy; difficulty concentrating, remembering details and
making decisions; insomnia, early–morning wakefulness, or
excessive sleeping; overeating, or appetite loss; thoughts of
suicide, suicide attempts.
Stress and depression are inexorably intertwined. The com-
bined effect has dramatic physical and psychological conse-
quences. It is important therefore to develop and test new
interventions to determine if they can decrease stress and/or
improve mood. These interventions may eventually help
people manage their allostatic load and help ameliorate
symptoms of stress related medical disorders like cardiovas-
cular disease and depression.
Preliminary evidence suggests that non-pharmacological
interventions can help facilitate ANS and HPA balance
and thereby decrease stress and improve mood. For exam-
ple mindfulness-based stress reduction significantly
improved quality of life, symptoms of stress and sleep in
those with early stage breast and prostate cancer (Carlson,
Speca, Patel & Goodey, 2003). When researchers meas-
ured cytokine changes they found that T cell production
of IL-4 increased and IFN-y decreased. In addition, NK
cell production of IL-10 also decreased, prompting them
to conclude that there was a shift from one immune pro-
file associated with depressive symptoms to a more normal
immune profile. Using the same intervention another
study reported an overall reduction in mood disturbance
(65%) and a (31%) decrease in stress symptoms (Speca,
Carlson, Goodey & Angen, 2000).
Other novel interventions like music have been shown to posi-
tively affect the immune system. Significant increases in secreto-
ry immunoglobulin-A (S-IgA) were found after listening to
recorded, classical music (Abrams, 2001) and using music as a
vehicle for relaxation, researchers found IL-6 levels were signif-
icantly lowered afterwards whereas IL-1b, Il-10 remained
unchanged (Stefano, Zhu, Cadet, Salamon, Manitone, 2004).
Esch and colleagues report that complementary and alternative
medicine (CAM) therapies are important in producing ANS &
HPA balance as well as positively impacting the immune
response (Esch, Massimo, Bianchi, Zhu & Stefano, 2003; Esch,
Fricchione & Stefano, 2004).
Recreational activities provide a wide array of health ben-
efits and, as a result, have been used by humans since the
beginning of recorded history for excitement, relaxation,
fitness, sport, meditation and fun (O’ Morrow, 1989).
Among the numerous studied benefits are social interac-
tion and physical activity(Wankel, L. M., & Berger, B. G.
1990), mental distraction (Wassman & Iso-Ahola, 1985),
and laughter (Stone, 1992). In general, good things hap-
pen to people when they are having fun. Psychological
constructs attempting to explain the benefits of recreation
include a positive mental state coupled with a feeling of
relaxation and being in balance. One psychologist called
this hyper-focused state "flow,” noting that participants
in a variety of recreational activities consistently report
positive mental outcomes (Csikszentmihalyi, 1997). The
physiological processes that underlie the psychological
balanced state known as flow are very important as
knowledge of them will help with the understanding of
these types of interventions but we are just beginning to
see the connections.
A preliminary link between the HPA (hypothalamic-pitu-
itary-adrenal) axis, mood and recreation has been estab-
lished with decreases in cortisol and mood reported after
therapist directed recreational activity (Russoniello, 1991;
2008). According to the findings of these studies, which
involved adults being treated for acute alcoholism, recre-
ational activities can decrease stress and improve mood. The
findings revealed that plasma cortisol levels were signifi-
cantly lowered after participation in low physical intensity
board games/card games and produced an autonomic nerv-
ous system relaxation response. Casual video games have
become the board and card games of today. Many are very
similar to the board games of yesteryear, they are simply
modernized for today’s Internet based world. This study
tested whether there would be a similar autonomic nervous
system response while playing CVGs. If there is a consis-
tent integrated positive HPA axis response while playing
casual video games similar to board games then this poses
the intriguing possibility of prescribing CVGs to ameliorate
stress related medical disorders.
Formal research surrounding video gaming has been
focused primarily on negative effects such as violence and
addiction (Anderson & Bushman, 2001; Lee & Vessey,
2000; Clay &. Richards 2005; Funk, 2005; Wallenius,
Punamäki & Rimpelä. 2007). There are just a few studies
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that mention positive effects of gaming such as a means
to; develop social relationships (Hutchinson, 2007), facilitate
education (Simpson, 2005) development skills and multi-task-
ing (Agosto, 2004). Little is known about the positive health
effects of CVG play and even less about the physiological
processes or health benefits that underlie participation.
METHODS
The purpose of the study was therefore to determine
whether casual video games could improve mood and/or
decrease stress in players using valid and reliable psycholog-
ical and physiological measures. Specifically this study test-
ed whether playing three popular casual video games;
Bejeweled 2 (BJW 2), Bookworm Adventures (BWA)
and/or Peggle (PGL) could change the autonomic and cen-
tral nervous systems consistent with decreased stress and
improved mood.
Subjects
One hundred and forty three (n=143) participants were
recruited for the study and one hundred and thirty four
(n=134) were included in the data analysis. Nine partici-
pants were excluded, as data was unsalvageable due to
improper data collection (sensor came off, software was
mistakenly not started). There were 57 females and 44
males. The average age of all participants was 24 years.
Participants were recruited from fliers placed in and
around the campus community. Most of the subjects were
students, faculty members and staff at the university. The
study was explained to the participants who signed an
informed consent form before being included. Participants
then supplied demographic information and completed
the Profile of Mood States questionnaire. At this point, an
envelope with random assignments was opened by the par-
ticipants. This revealed their designated group. If assigned
to the experimental group participants chose one of three
casual video games to play. If assigned to the control group
participants completed an Internet task that involved
searching for articles on health related topics and placing
them in a folder on the desktop.
Experimental participants chose which game that they
wanted to play from three popular video games that met
the functional definition of a CVG. BJW 2 is a matching,
sequencing game where participants string together jewel-
like objects for points. PGL is a pachinko/pinball type of
game that allows participants to gain more control as they
clear strings of multi-colored balls for points and BWA is a
crossword/scrabble type puzzle game where participants
gather points by building words and progress through an
animated adventure. Once a game was chosen, sensors were
connected and signals were checked, participants played
the game uninterrupted for twenty minutes.
The control participants were seated in front of the same
computer in the same chair and hooked to measuring
equipment in the exact manner as the experimental group.
The control group was then instructed to surf the internet
looking for articles related to health and to put them into a
file on the desktop for twenty minutes.
Measurement of Mood
It was hypothesized that playing casual video games
would result in decreases in left frontal alpha power,
increases in right frontal alpha power and overall alpha
symmetry when compared to controls. Increases in alpha
power in the left hemisphere are associated with nega-
tive mood, depression and avoidance/withdrawal behav-
iors. Conversely, decreases in left alpha power improve
mood and decrease avoidance/withdrawal behaviors.
Decreases in right hemisphere alpha power are also asso-
ciated with negative mood. Conversely, increases in right
alpha power improve mood and increase
approach/engage behaviors. The ratio between right and
left brain alpha has also been used to measure emotion-
al stability/mental relaxation (Davidson, 1988: Fox, 1991
and Monastra, 2003).
Some therapies have been successful in helping people
change dysfunctional brain activity associated with
depression and stress to positive states associated with
relaxation and alertness (Field, Grizzle, Scafidi, Abrams,
Richardson, Kuhn, & Schanberg, 1996; Field, Grizzle,
Scafidi, & Schanberg, 1996; Field, Ironson, Scafidi,
Nawrocki, Goncalves, Pickens, Fox, Schanberg & Kuhn,
1996 and Marshall & Fox, 2000). In this study the effects
of CVG play on mood were tested to determine if they
would produce similar results using EEG measurements
and following the alpha/mood assessment protocol estab-
lished and tested by Davidson (1988). Changes in the
CNS or alpha brain wave activity were recorded using a
10 channel electroencephalography device (Mind Media
Corporation, 2008).
All participants were prepared by locating and marking F3,
F4 and CZ using the 10/20 standard measurement cap.
The sensor placement sites were cleaned using alcohol
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pads. Active EEG leads were placed at F3 and F4. The ref-
erence sensor was placed at CZ. The ground lead placed on
C7. Signal impedance was kept below 25,000K Ohm per
manufacturers recommendations for alpha recordings. In
addition, the EEG signal was visibly inspected prior to
recording for extraneous signal noise. If necessary, adjust-
ments were made before data recording began.
PROFILE OF MOOD STATES
To quantify emotional changes participants completed a
self-administered psychological assessment of mood using
the Profile of Mood States (POMS) assessment. The
POMS (McNair, Lorr & Droppleman, 1981), is a factor
analytically derived inventory that measures six subscales:
tension, depression, anger, vigor, fatigue, and confusion and
can be used with “Last Week” and “Right Now” administra-
tions. Internal consistency for the POMS has been report-
ed at .90 or above. Test re-test reliability is reported
between .68 and .74 for all factors. Construct and predic-
tive validity have been established in four areas: brief psy-
chotherapy, controlled outpatient drug studies, studies of
response to emotional conditions and studies of concurrent
validity coefficients and other POMS correlates (McNair,
Heuchert & Shilony, 2003).
Measurement of Physical Stress
Heart Rate Variability (HRV) is a physiological measure-
ment that directly reflects a balance of the autonomic
nervous system regulation, which has control over the
human body. HRV is a multidimensional measurement of
sympathetic and parasympathetic nervous system inner-
vations of the heart. HRV reflects the state of sympathet-
ic (stress, anxiety) or parasympathetic (relaxation, calm-
ness) activation in the body. Heart rate variability (HRV)
is considered a marker of cardiac parasympathetic and
sympathetic activity and is of great interest to health care
practitioners (Malliani, Lombardi & Pagani, (1994);
Kleiger, Stein, Bosner & Rottman, (1992); Pomeranz
Macaulay & Caudill, (1985).
Heart rate variability (HRV) provides an accurate assess-
ment of autonomic nervous system stress based upon vari-
ability in the inter-beat interval of heart beats (Task force
of the European Society of Cardiology and the North
American Society of Pacing and Electrophysiology, 1996).
A robust HRV is associated with balance between the sym-
pathetic and parasympathetic branches of the autonomic
nervous system (ANS). In this study HRV changes were
used as a measure of ANS change (Hayano, Sakakibarea, &
Yamada, Yamada, Mukai, Fujinami, Yokoyama, Watanabe
& Takata, 1991). HRV was recorded during the entire ses-
sion using a small ear clip sensor. Both time and frequency
parameters of HRV were used to determine the effects of
CVGs on the ANS.
HRV was recorded using photoplethysmography (PPG)
technology. PPG was developed in the 1960’s and 1970’s
by psychophysiology researchers. PPG is based upon the
premise that all living tissue and blood have different
light-absorbing properties. PPG works by placing a pho-
tocell clip on the participant’s ear that converts light to
electrical energy. The blood in the ear lobe scatters light
in the infrared range, and the amount of light reaching
the cell is inversely related to the amount of blood in the
ear lobe. Hence, when blood vessels in the earlobe dilate,
the increased blood flow allows less light to reach the
photocell, when blood vessels constrict, blood flow is
decreased and increased light reaches the photocell
(Cohen, 1995).
PPG measures pulse volume or phasic changes, which are
related to beat variations in the force of blood flow. These
beat-to-beat changes in peripheral blood flow reflect the
heart’s interbeat intervals similar to ECG. PPG there-
fore, gives summary information reflecting both cardiac
and blood vessel components and is an accurate measure
of cardiac function when compared to electrocardiogra-
phy (Cohen, 1995; Russoniello, Mahar, Rowe,
Pougatchev & Zirnov, 2003).
STATISTICAL ANALYSIS
A repeated measures design was employed to study the
impact of different games on the variables and to contrast
with the control group. Since the experimental and the con-
trol group both did activities requiring similar physical and
cognitive involvement, and the study was exploratory in
nature, the level of significance was set at p=<.1. The least
significant difference (LSD) was used for the post hoc
analysis. Cohen’s Delta or d (Cohen, 1988) is a measure of
effect size or the standard mean difference. Cohen’s d is a
standard measure used to calculate treatment effect and
describes differences in means relative to an assumed com-
mon variance. According to Cohen, effect size changes can
be classified as: small (.20); medium (.50); and large (.80).
In this study Cohen’s d was used to show large changes oth-
erwise not detected due to large variances.
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RESULTS
Participating in CVGs produces changes in brain waves
consistent with improved mood. Remarkably, different
games affected brain waves in unique ways. For example
BJW 2 players (Table 1) experienced significant decreases
in left alpha power when compared to controls. Participants
who played PGL experienced significant increases in right
alpha power while playing (Table 2) but did not statisti-
cally differ from the control group due to very large vari-
ations in individual brain waves. Cohen’s d, used to statis-
tically equalize differences between groups (d= 1.8), illus-
trates there was a very large difference between PGL and
control groups.
Casual Video Games, Stress and Mood
Left Alpha
Changes
md sd df p
Control
Group (n=22)
.99 1.5 25 .50
Bejeweled 2
(n=28)
-3.3 1.3 31 .014†
†Significantly differs from control p=.032
Table 1
Right/Left
Alpha Ratio
Changes
md sd df p
Control
Group (n=22)
.17 .19 21 .37
Bejeweled 2
(n=26)
.31 .19 25 .093†
†Significantly differs from control p=.071
Table 3
Right Alpha
Changes
md sd df p
Control
Group (n=22)
.427 10 21 .996
Bejeweled 2
(n=29)
17.9 9 28 .048
Table 2
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Playing BWA significantly improved the right/left brain
alpha ratio (Table 3) another indicator of improved mood
and the changes were significantly different from control.
All three games improved mood and affected alpha brain
wave activity differently.
Changes in psychological mood reported on the POMS cor-
roborated EEG findings as the overall impact of all three
games significantly differed from the control group (p=.007).
BJW, BWA and PGL pre-post game changes and compar-
isons with the control group are presented in (Table 4).
Russoniello, O’Brien and Parks
Overall
POMS
Changes
md sd df p
Control
Group (n=31) 2.6 2.4 30 .284
Bookworm
Adventures
(n=29)
7.9 2.5 28 .000
Bejeweled II
(n=38)
-11.3 2.3 37 .002†
Peggle
(n= 36) -14.9 2.3 35 .000††
†Significantly differs from control p=.009
†† Significantly differs from control p=.000
Table 4
Changes in
Tension
md sd df p
Control
Group (n=31) -1.6 .70 30 .022
Bookworm
Adventures
(n=29)
-7.9 2.5 28 .005
Bejeweled II
(n=38)
-11.3 2.2 37 .000
Peggle
(n= 36) -14.9 2.3 35 .000†
†Significantly differs from control p=.026
Table 5
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Individual POMS subscales, tension, depression, anger, vigor, fatigue and confusion changed as follows.
Participants reported significant decreases in POMS tension (Table 5) after each game. Overall, CVGs reduced tension
versus control (p=.003). Participants that played PGL reported the largest decreases in tension.
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Changes in
Anger
md sd df p
Control
Group (n=31) -.77 .56 30 .169
Bookworm
Adventures
(n=29)
-1.0 .58 28 .076
Bejeweled II
(n=38)
-2.2 .50 37 .000††
Peggle
(n= 35) -2.1 .53 34 .000†
†Significantly differs from control p=.084.
††Significantly differs from control p=.069.
Table 7
Changes in
Depression
md sd df p
Control
Group (n=31) -1 .58 30 .084
Bookworm
Adventures
(n=29)
-1.7 .59 28 .004
Bejeweled II
(n=38)
-1.6 .52 37 .002
Peggle
(n= 36) -1.8 .53 35 .001
Table 6
POMS Anger scores decreased after all three CVGs (Table 7). BJW 2 and PGL significantly differed from the control
group. The reductions in anger are contradictory to the notion that all video games provoke violence.
Participants reported decreases in the POMS Depression sub scale scores after all three games (Table 6). While none of
the games statistically differed from the control, secondary analysis with Cohen’s d revealed large decreases in depression
scores after all three, PGL (d= 1.4); BWA (d= 1.2); BJW 2 (d= 1.1) games when compared with the control group.
The overall effect of all three CVGs and control in increasing vigor was statistically significant (p=.018). Individual games
changes are presented in Table 5. Changes in vigor after playing BJW 2 were statistically different from the control group.
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Changes in
Vigor
md sd df p
Control
Group (n=31) -1.4 .79 30 .180
Bookworm
Adventures
(n=29)
-1.5 .72 28 .865
Bejeweled II
(n=38)
-.14 .81 37 .037†
Peggle
(n= 36) -.34 .74 35 .643
†Significantly differs from control p=.007
Table 8
Changes in
Fatigue
md sd df p
Control
Group (n=31) -1.4 .53 30 .010
Bookworm
Adventures
(n=29)
-.18 .55 28 .001
Bejeweled II
(n=38)
-2.8 .48 37 .000†
Peggle
(n= 36) -3.6 .49 35 .000††
†Significantly differs from control p=.053
††Significantly differs from control p=.003
Table 9
The overall effect of CVGs on fatigue versus control was statistically significant (p=.061). Individual games changes are
listed in Table 9. BJW 2 and PGL both had significant positive impacts on fatigue versus control.
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Changes in
Confusion
md sd df p
Control
Group (n=31) -.26 .46 30 .576
Bookworm
Adventures
(n=29)
-1.2 .48 28 .010†
Bejeweled II
(n=38)
-2.0 .42 37 .000††
Peggle
(n= 36) -2.3 .43 35 .000††
†Significantly differs from control p=.025
††Significantly differs from control p=.000
Table 10
†Significantly differs from control (p= .051)
Table 11. Heart Rate Variability Changes
Control
n=30
md se df p B II n=40 md se df p
HR -.82 .61 29 .184 -1.6 .53 39 .003
TP 488 151 29 .002 394 130 39 .003
VLF -106 100 29 .290 -198 87 39 .024
LFN 1.8 2.7 29 .521 5.8 2.4 39 .015
HFN 1.7 2.7 29 .533 6.3 2.3 39 .008
HF/LF -.24 .32 29 .46 .6 .28 39 .034†
Casual Video Games, Stress and Mood
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62
PHYSICAL STRESS CHANGES
In this study the game BJW 2 had the greatest impact of all
three games on physical stress. Participants who played
BJW 2 experienced statistically significant decreases in
ANS activity with corresponding increase in variables asso-
ciated with positive cognitive engagement. All HRV
parameters changed significantly when measured pre-post
game play including TP (p. = 003). When compared to
control participants BJW 2 players experienced
decreases in: heart rate (d= 1.3), VLF (d= 1) and corre-
sponding increases in LFN (d= 1.6) and LF/HF ratio
(d= 1.2). These findings support the theory that some
CVGs do decrease physical stress and presents a possi-
bility that CVGs produce a “more power with less
effort” ANS effect.
The overall effect of all three games on confusion (Table 10) was statistically significant (p=.09). BWA, BJW 2 and PGL
all significantly decreased confusion when compared with the control group. The improvement in cognition was very dra-
matic and begs the question of whether these games could assist in Alzheimers and other dementia type disorders.
JCR_inga_3:Layout 1 12/06/09 17:39 Page 62

DISCUSSION
Changes in EEG recorded in this study support the
hypothesis that playing a CVG of your choice can improve
your mood and decrease your stress. Remarkably all three
games had different yet complimentary mood lifting
effects. BJW 2 decreased left alpha brain waves associated
with a decrease in withdrawal and depressive type behaviors
and PGL increased right alpha brain wave activity associ-
ated with excitement or euphoric behaviors. BWA on the
other hand increased the stability of alpha brain waves
between the left and right side of the brain.
The POMS scores on Total Mood Disturbance significant-
ly changed for all three games supporting the theory that
while there were effects on brain wave activity in different
parts of the brain, the end result was improved perceived
mood. Significant subscale changes in anger, tension, vigor,
depression, fatigue and confusion by different games and not
by others again seems to infer that there are specific changes
associated, to a degree, with particular games and not so
much with others. If these finding are consistently upheld
then protocols with treatment specificity could be developed
to take advantage of CVGs that produce specific results.
Changes in HRV during BJW 2 were consistent with a
recent report by Peng, Henry, Mietus, Hausdorff, Khalsa,
Benson, & Goldberger, (2004) in which they revealed that
TP and low frequency norms increased while very low fre-
quency activity decreased after the relaxation response and
meditation exercises. When changes after BJW 2 were
compared with the control group a similar “more power
with less exertion” profile emerged, which provides a poten-
tial framework for future research.
Many modern medical disorders are stress related and the
need for effective interventions that are low cost and help
ensure compliance is high. The potential of CVGs to
become an intervention is encouraged by the results of this
study. Future studies can build upon this work by studying
the impacts of CVG play on conditions such as depression,
anxiety, autism, and stress related medical disorders such
diabetes and cardiovascular disease.
The limitations of this study included a lack of measure-
ment for respiration and the variability of physiological
data which, in some cases, made it difficult to determine
changes if they existed. In future studies blue tooth tech-
nology should be used to reduce lead noise. Respiration rate
should be recorded to determine its impact on HRV vari-
ables. When possible neuroendocrine markers like cortisol
or salivary amylase should be added to get a psychoneu-
roendocrine picture of changes.
Finally, psychophysiological measurement provides a
method for understanding the mind/body effects of games
and can therefore help in game modification and develop-
ment. For instance while a person is being measured phys-
iologically their reactions to different aspects of the game
are recorded. These can be relaxing or stressed reactions or
they can be excitement. Depending on the goal of the game
a programmer could increase or decrease the amount of a
certain variable (i.e. music, visuals etc.) to increase or
decrease the effect. A game that is physiologically tailored
to meet individual specific human needs seems plausible in
the near future.
Russoniello, O’Brien and Parks
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