" … some players have claimed that Pokémon Go has helped them with social anxiety, depression, and addiction … "

Video games do not have the best reputation when it comes to physical and mental health, and intense video game players are often portrayed in a fairly negative light in popular media. Unfortunately, research has at least somewhat supported this perception. Though playing video games in moderation can be a rewarding pastime1, researchers have found that excessive (> 4 hours per day2) or pathological video game play predicts poor outcomes. For example, there exists substantial evidence linking increased video game play to increased obesity among children3. Likewise, preliminary evidence suggests that playing video games can lead to greater caloric intake among adolescents4, which would increase their chances for becoming obese.

In the case of mental health, pathological video game play has been associated with worse performance in school and worse relationships with parents among adolescents5. Furthermore, a number of studies have found evidence that greater time spent playing video games is associated with increased symptoms of anxiety and depression1-2, and other work suggests that individuals can actually become addicted to video games under certain circumstances6-7. Given the above evidence, it might come as a surprise to hear individuals claiming substantial improvements in their mental disorders after playing a video game for hours at a time. However, players are anecdotally reporting such effects in regard to the new game, Pokémon Go. For instance, some players have claimed that Pokémon Go has helped them with social anxiety, depression, and addiction, and one player even reported they had seen the game help children with severe mental disorders at a hospital (all previous links may contain NSFW [Not Safe for Work] text). But how could a video game help with these disorders?

What is Pokémon Go?

For those unfamiliar with how the game works, player's seek to collect as many Pokémon, the little creatures that inhabit the game's world, as possible. The player can then challenge others for control over locations known as "gyms," which can give their team greater prestige (for a more detailed overview of Pokémon Go, check out this video). These game mechanics are fairly similar to those of the classic Pokémon card games released in the 90's – with one notable exception. Whereas in the old Gameboy games, you could do all of the above activities while seated on a couch, Pokémon Go requires you to leave your house to succeed. You cannot catch many if any Pokémon alone in your home, and you must traverse physical distances to have any chance of finding new or interesting specimens. In fact, you are most successful when surrounded by friends and/or strangers who can help direct you to the location of rare Pokémon. The game itself encourages social behavior by allowing players to share "lures," which attract Pokémon to a given place for anyone nearby to catch and often attracting an equal number of local players.

How is Pokémon Go like Therapy?

Oddly enough, these game mechanics closely mimic certain forms of cognitive behavioral therapy (CBT): specifically, behavioral activation and exposure therapy. In behavioral activation, traditionally used for helping depressed patients, therapists work with clients to identity behaviors or activities that they enjoy and to engage in those behaviors more often8. Though remarkably simple, this therapy has a strong track record of helping clients with depression, including major depressive disorder9-10. In other words, simply getting a depressed individual out of their house and interacting with others in a positive way can help them with their disorder, and initial evidence suggests that this treatment may help individuals with anxiety as well, particularly when it co-occurs with depression11.

Exposure therapy functions in a similar fashion. Originally developed by Joseph Wolpe, exposure therapy works to help clients with phobic fears, such as arachnophobia (the fear of spiders), by exposing them to the source of their fears12. Essentially, the therapist slowly exposes clients to the target of their fears while providing encouragement and helping them relax, which reduces clients' experience of fear. These same principles work with social anxiety disorder (previously known as social phobia13) with therapists slowly encouraging clients to engage in an increasing number of social encounters14.

Pokémon Go seems to follow the pattern of both of these therapies. It provides rewards and fun experiences but only for individuals who leave their homes. It also ensures that the player will encounter others playing the same rewarding game. Consequently, the social interactions that players have will typically be positive given that all parties are having fun. By providing such a rewarding context for social interactions and activity, the game makes it so that players will repeat these behaviors, leading to more positive experiences. To be sure, we must take all of this with a grain of salt. Thus far, we only have anecdotal evidence for these positive effects. However, these stories provide initial evidence that a game as simple as Pokémon Go may have an impact on individuals with mental disorders.

What does Pokémon Go tell us about the future?

Pokémon Go will most likely not serve as a long-term solution. In fact, evidence suggests that interest in the game may have already peaked, and if enough people stop playing the game, it loses its appeal as a means of encouraging positive social interactions15. However, it does serve as a real-world proof of concept that such games can help individuals who would otherwise not receive treatment. Importantly, Pokémon Go is not the only such game on the block. It was based on a previously existing game called Ingress, which also requires players to leave their homes and interact with others. Despite receiving less media attention, Ingress has its own body of dedicated players, numbering in the millions. Given the success of such games, they highlight a potential novel avenue for providing treatment to those who need it.

Date of original publication:

Sources

1. Mentzoni, R. A., Brunborg, G. S., Molde, H., Myrseth, H., Skouverøe, K. J. M., Hetland, J., & Pallesen, S. (2011). Problematic video game use: estimated prevalence and associations with mental and physical health. Cyberpsychology, behavior, and social networking, 14(10), 591-596.

2. Wenzel, H. G., Bakken, I. J., Johansson, A., Götestam, K. G., & Øren, A. (2009). Excessive computer game playing among Norwegian adults: self-reported consequences of playing and association with mental health problems. Psychological reports, 105(3 suppl), 1237-1247.

3. Vandewater, E. A., Shim, M. S., & Caplovitz, A. G. (2004). Linking obesity and activity level with children's television and video game use. Journal of adolescence, 27(1), 71-85.

4. Chaput, J. P., Visby, T., Nyby, S., Klingenberg, L., Gregersen, N. T., Tremblay, A., ... & Sjödin, A. (2011). Video game playing increases food intake in adolescents: a randomized crossover study. The American journal of clinical nutrition, 93(6), 1196-1203.

5. Gentile, D. A., Choo, H., Liau, A., Sim, T., Li, D., Fung, D., & Khoo, A. (2011). Pathological video game use among youths: a two-year longitudinal study. Pediatrics, peds-2010.

6. Mehroof, M., & Griffiths, M. D. (2010). Online gaming addiction: the role of sensation seeking, self-control, neuroticism, aggression, state anxiety, and trait anxiety. Cyberpsychology, behavior, and social networking, 13(3), 313-316.

7. Rehbein, F., Psych, G., Kleimann, M., Mediasci, G., & Mößle, T. (2010). Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey. Cyberpsychology, Behavior, and Social Networking, 13(3), 269-277.

8. Hopko, D. R., Robertson, S., & Lejuez, C. W. (2006). Behavioral activation for anxiety disorders. The Behavior Analyst Today, 7(2), 212.

9. Cuijpers, P., Van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical psychology review, 27(3), 318-326.

10. Mazzucchelli, T., Kane, R., & Rees, C. (2009). Behavioral activation treatments for depression in adults: a meta‐analysis and review. Clinical Psychology: Science and Practice, 16(4), 383-411.

11. Hopko, D. R., Lejuez, C. W., & Hopko, S. D. (2004). Behavioral activation as an intervention for coexistent depressive and anxiety symptoms. Clinical Case Studies, 3(1), 37-48.

12. Wolpe, J. (1958). Psychotherapy and reciprocal inhibition. Stanford, CA: Stanford University Press.

13. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

14. Feske, U., & Chambless, D. L. (1995). Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis. Behavior Therapy, 26(4), 695-720.

15. Allan, R. (2016, July 21). Has Pokémon GO peaked? The data say "Yes.". Survey Monkey Intelligence Blog. Retrieved from https://www.surveymonkey.com/business/intelligence/peak-pokemon-go/

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