Young people, video games and good mental health
1) Half of all cases of mental illness start before the age of 14
The chances are that if someone is going to develop a mental health disorder it will happen when they are a young person. Studies have found that half of all cases of mental health disorders start by the age of 14 and three quarters by the age of 24 (Kessler et al, 2005).
At the moment 1 in 10 young people aged 5-16 in Great Britain have a clinically diagnosed mental disorder (Green et al., 2004) and these young people are more likely to experience the adult counterpart of this mental illness when they grow up. For example, young people who experience depression in mid-adolescence (14-16) are more likely to experience major depression and anxiety disorders as adults. Similarly, young people with juvenile anxiety disorders are at a higher risk of anxiety disorders, major depression and substance misuse in early adulthood, and are less likely to go on to higher education. This link between youth and adult mental illness persists even once other social, family and individual characteristics are taken into account (Fergusson & Woodward, 2002).
Not only are young people with mental illness more likely to develop the adult counterpart of their illness, they also have an increased risk of developing other mental health problems. Take conduct disorder, for example, which is characterised by a pattern of repeated and persistent misbehaviour. Approximately 40–50% of children with conduct disorder go on to develop antisocial personality disorder as adults. However, having conduct disorder as a child is also linked to mania, schizophrenia, obsessive-compulsive disorder, major depressive disorder and panic disorder in later life (Richardson and Joughin, 2002)
These studies all go to show the importance of developing good mental health of young people as by developing good mental health in them, you are also ensuring a healthier adult population in generations to come.
2) Not all of those who need help with their mental health are getting it
Many people who currently need help are not in touch with services that could provide them with this help. For example, it is estimated that a third of those with depression and half of those with anxiety disorders remain undiagnosed and untreated (McCrone et al. 2008).
Young people find it particularly hard to seek help. YoungMinds, a charity that works to improve the mental health and emotional wellbeing of young people, found that just over a quarter of 9-16 year olds (26%) felt it was easier to tell someone they didn’t feel well physically compared to telling someone they felt distressed or unwell mentally. This figure rose to over two-thirds (67%) for young people aged 17-25 (YoungMinds, 2006). Worryingly then, this indicates that as a young person gets older it becomes increasing difficult to express these types of feelings.
One reason given by YoungMinds for the difficulty in seeking help was the social stigma still attached to mental health problems. YoungMinds were told by a range of people, including parents, professionals who work with young people, and the young people themselves, that stigma has “a tremendous impact on children and young people”. They explained that because of the stigma surrounding mental health issues children and young people felt unable to talk about their distress leading to them isolating themselves, suffering from verbal abuse and being bullied. This, in turn, could lead to them becoming more seriously ill. Such a vicious cycle results in the young person often reaching crisis point before receiving the support and services that they need.
It is clear then, that an intervention that offers easy and anonymous access to tools that can improve mental health and wellbeing would be beneficial, especially for young people who find it so difficult to seek the help they need.
3) Better wellbeing can prevent mental health problems
Until relatively recently the main approaches for addressing mental health focused on treating those experiencing mental health problems and initiatives which tried to reduce the risk of those groups deemed at high risk of developing mental health problems. However, the focus has begun to shift away from these approaches as ways of preventing mental health problems and towards developing and protecting positive mental health or mental wellbeing.
Good mental health or mental wellbeing is more than the absence of mental illness. The World Health Organisation defines positive mental health as: "a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community… Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity." (WHO, 2013)
4) Regulating emotions is a key part of developing wellbeing
A key aspect in developing good mental wellbeing is the ability to regulate your own emotions. For example, studies have found that people who are able to manage their emotions better are less susceptible to anxiety.
Emotional regulation involves understanding and managing emotions, being aware of your own emotions, recognising and labelling these emotions, and the ability to deal with and change your response to emotions (Pitskel et al. 2011).
The good news is that we all regulate our emotions in some ways - it is human nature to try to make ourselves feel better if we feel sad or angry. Some strategies we use for regulating emotion, while seemingly helpful at the time, are counterproductive in the long term. Drowning your sorrows by drinking alcohol, for example, may make you feel better in the short term but may leave you feeling even worse once you begin to sober up.
There are, however, a whole spectrum of positive strategies which people use to regulate their emotions, from distracting themselves (taking a break, having a cup of coffee) and re-evaluating the issue (looking on the bright side), through to intentional techniques such as meditation and practising mindfulness.
So, how do young people, whose mental health is clearly of high importance, regulate their emotions? Well, like all of us they use a number of different strategies but we do know that for some young people, playing on video games is one of those strategies (Kutner & Olson, 2008).
5) Video games are promising as a way of helping young people regulate their emotions
There is an increasingly strong body of evidence around the benefits of using mindfulness to help people regulate their emotions (Williams & Penn, 2011). Mindfulness is a mind-body based approach that helps people change the way they think and feel about their experiences, especially stressful experiences. It involves paying attention to your thoughts and feelings so you become more aware of them, less enmeshed in them, and better able to manage them (Halliwell, 2010).
Because there is such strong evidence that mindfulness helps people regulate their emotions, the techniques used in mindfulness are a good place to start when looking at potential mechanisms which could help to develop someone’s ability to regulate their emotions.
The challenge faced is that not many children and young people know about or practise mindfulness. However, most children do play video games of some kind, and we know some young people use playing them for emotional regulation. Therefore it would be really interesting if it was possible to incorporate elements of mindfulness into video games and consequently improve how effective video games are at helping young people to regulate their emotions.
A starting point for this is to look at the similarities that already exist between meditation and video games and the potential to build on these. But as well as building mindfulness techniques into video games, we should also learn from video games, looking at what makes them so attractive to young people, and how they keep people playing. After all, you can make the most effective game in the world at regulating emotions but if no-one plays it then it is actually not effective at all.
So, what are the elements that meditation and video games share?
They both encourage regular practice:
In mindfulness: Setting aside time to practice on a regular basis is a core part of the mindfulness practice. Often you are encouraged to have a regular time set aside for formal practice e.g. 15 minutes every morning, but also to do shorter, more sporadic mindfulness exercises e.g. when waiting in a queue, or when on the tube.
In video games: Young people already play video games regularly. Different video games require different amounts of time repetition. Long content-heavy games, such as World of Warcraft, often require long sessions of playing on regular basis, whilst games on the smartphone, such as Angry Birds, can be dipped in and out of for short periods.
What we can learn from video games:
Include a challenge: Video games use challenges to keep people practicing. This can be used to get people to do tasks they usually don’t want to do. For example the Wii Fit uses challenges, and sets targets for the players to keep them coming back to train.
Use fun and immersion: Part of the reason people keep coming back is the “fun” element of games - the escapism and entertainment. The game Zombies Run! is an audio app which places the runner as the lead character in a plot where they have to run away from Zombies following hot on their heels.This app makes their usual run a lot more entertaining and therefore increasing the chances of them keeping up their running sessions.
Both result in concentration and flow:
In mindfulness: Concentration is key to the mindful practice, with concentration on the breath and body being the cornerstone of the technique. Once meditating there is also the flow of taking each moment as it comes and becoming absorbed in that moment to the exclusion of other thoughts.
In video games: Whilst playing a game there is sometimes sustained concentration on the game itself resulting in a state of flow where they are within that moment, focusing solely on the game to the exclusion of other sensory distractions.
What can we learn from video games:
Use mentally engaging tasks: Games like Tetris engage you to such an extent in the repetitive, simple but concentrated tasks that you can often get lost in the game.
Both encourage awareness of the situation around the individual:
In mindfulness: Mindfulness is about valuing and accepting the present moment. One technique it suggests is to practise paying close attention to the surrounding situation at that moment - including the sounds, smells, sights and feel of the moment.
In video games: Some games are attractive and engaging to players in part because they engage the sensory elements of the player - both through sight and sound.
What can we learn from video games:
Stimulate the senses: Ocean is a freeform game in which the player explores the visually rich landscape of the ocean floor. It is the high quality and detailed graphics that engage the player in the game.
Papa Sangre is a game that uses audio to engage the player. There is no graphic interface. Instead, a three-dimensional soundscape is modelled around the player and they have to tap the phone in two places to simulate walking.
Although seemingly very different, there are some clear similarities between mindfulness practice and playing video games which can be built on and learnt from. One area of development that has already begun to link these two fields is the use of biofeedback. This is what we will be investigating over the next few months and hope to share our findings on this exciting and rapidly changing area at the end of this period.
Fergusson DM, Woodward LJ. (2002) Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry 59(3):225-31.
Green, H., McGinnity, Á., Meltzer, H., Ford, T & Goodman, R. (2004) Mental healthof children and young people in Great Britain, 2004: A survey carried out by the Office for NationalStatistics on behalf of the Department of Health and the Scottish Executive. London: ONS.
Gregoire, C. (2013) Emotional Regulation Strategies May Influence Anxiety, Study Finds. The Huffington Post, [online] Available at: <http://www.huffingtonpost.com/2013/05/13/emotional-regulation-influence-anxiety-mental-health_n_3267476.html> [Accessed 4 December 2013]
Halliwell, E. (2011) Mindfulness Report. London: Mental Health Foundation.
Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K. & Walters, E. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication Archives of General Psychiatry 62(6):593-602.
Kutner L & Olson, C K. (2008) Grand Theft Childhood: The Surprising Truth About Violent Video games and What Parents Can Do, Simon & Schuster, New York.
McCrone P, Dhanasiri S, Patel A et al. (2008). Paying the price: the cost of mental health care in England to 2026. London: King’s Fund.
Pitskel, NB and Bolling, DZ and Kaiser, MD and Crowley, MJ and Pelphrey, KA (2011) How grossed out are you? The neural bases of emotion regulation from childhood to adolescence. Developmental cognitive neuroscience 1(3): 324-337.
Richardson, J & Joughin, C. (2002) Parent Training Programmes for the Management of Young Children with Conduct Disorders: Findings from Research. London: Royal College of Psychiatrists.
Williams M, Penman D. (2011) Mindfulness: a practical guide to finding peace in a frantic world. Piatkus
World Health Organisation (2013) Mental health: a state of well-being. Downloaded from <http://www.who.int/features/factfiles/mental_health/en/>
YoungMinds (2011). See beyond our labels: YoungMinds briefing on young people’s views about mental health. London, YoungMinds.