The lecture discusses the benefits and health risks of digital gaming, highlighting that action video games can enhance various cognitive skills while also noting potential issues like addiction and negative mental health effects. It emphasizes the importance of moderation, physical exercise, and healthy sleep patterns to mitigate risks associated with gaming. Recommendations for game educators include promoting a balanced lifestyle and encouraging social play among different age groups.

1. Digital games and health
Jaana Wessman
Prakticum, 8th & 29th Nov 2016

2. Who am I?
● PhD Computer Science
● Medical doctor specializing in child psychiatry (in my final year of training)
● Researcher of children & youth mental health (esp problem behaviors)
● Computer gamer (not a competing one)
● eSport spectator

3. What will I talk about today?
● benefits of digital gaming
● health risks of digital gaming
○ (“computer game addiction”)
● performance optimization for serious/professional gamers
● advice for game educators
(This lecture covers computer games played for recreation and/or competitively. By digital games I mean
computer games, console games, games on handheld devices and all other digital platforms. Games
specifically designed to improve a particular skill are excluded. I concentrate on mental health and
cognitive performance.)

4. Benefits of digital games

5. Visuomotor and attention skills
Clear, causal evidence from multiple intervention studies that playing action video
games improves
● ability to maintain visual attention
● multiple object tracking
● visual search performance, visual & spatial working memory
● task-switching speed, reaction speed
● mental 3D processing
● probabilistic inference?
Skill transfer to physical world, e.g. driving, has been proven.
Green & Bavalier, 2012, Learning, attentional control, and action video games. Curr Biol.
Chisholm et al, 2015, Action video game players' visual search advantage extends to biologically relevant stimuli.

6. Social benefits
Over 70 % of gamers regularly play with other people.
Players who play games that require teamwork are more likely to exhibit helpful
behaviors online and offline at least for a short time after the experience.
People who play MMOGs in organized groups (e.g. guilds) are more likely to be
engaged in social and civic movements in their everyday lives. (Causality?)
Experienced gamers are more persistent when facing increasingly difficult math
problems than non-gamers.
Granic et al. 2014, The benefits of playing video games. Am Psychol 2014.

7. Last but not least
Playing games is immensely enjoyable.
For most people who play, games give experiences of enjoyment, relaxation,
achievement and positive excitement.
Such experiences have a clear link to increased mental health.

8. Health risks of digital games

9. Are video games bad for you?
Playing computer games has been associated to:
● poor grades and worse work performance
● depression and anxiety
● aggressiveness, getting into fights
● conduct problems in children
● impulsiveness
● attention problems
● sleep problems
● worse physical health
● back, neck and shoulder pains
Andreassen et al, 2016, The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A
large-scale cross-sectional study. Psychol Addict Behav.

10. Causality?
Despite several attempts, researchers have failed to show a causal link of frequent
computer gaming to
● conduct problems
● depression and anxiety
● attention/concentration difficulties
● drug/alcohol use
● work or school performance
Parkes et al, 2013, Do television and electronic games predict children's psychosocial adjustment? Longitudinal research using the UK Millennium
Cohort Study
Brunborg et al, 2014, Is video gaming, or video game addiction, associated with depression, academic achievement, heavy episodic drinking, or
conduct problems?

11. Sleep!
Link between less sleep and poorer sleep quality and playing digital games,
especially late at night, has been shown.
● light wave-length?
● social synchronization?
● excitement?
Lack of sleep causes attention difficulties, impulsiveness, irritability, worse
cognitive performance, changes in mood, lack of motivation, weight gain, and can
even activate type II diabetes.
Exelmans et al, 2015, Sleep quality is negatively related to video gaming volume in adults.

12. Back, neck, and shoulders
● working or playing on a computer for prolonged periods causes more neck,
shoulder and back pains (self-reported)
● long-term effects of this are unclear
● physical exercise is probably protective
Silva et al. 2016. Prevalence of musculoskeletal pain in adolescents and association with computer and videogame use. J Pediatr

13. But what about “video/internet game addiction”?
Does it even exist?
Yes! But you do not get it from simply playing a lot. (About 1-5 % of gamers.)
“Gaming disorder” is a state where a person’s ability to function (e.g. in school or
work, with friends) is severely disrupted, and they spend their time obsessively
playing games. Play is obsessive and joyless, but the player is often unable to
stop.
Usually results from avoiding an existing problem (depression/anxiety, family
problems, problems at school/work) by escaping into games.
Turel et al, 2016, Health Outcomes of Information System Use Lifestyles among Adolescents: Videogame Addiction, Sleep Curtailment and
Cardio-Metabolic Deficiencies. PLOS One.

14. The vicious circle
Excessive
gaming /
internet use
Lack of sleep
“Real-life”
problems
Anxiety /
depression

15. You have a serious problem if
● you play, even though it’s not even fun anymore
● you frequently skip school, work, or social obligations because of games
● you cannot stop playing even though you have already decided to cut back
● you are unable to think about anything else when you are not playing
(Whether your actual problem are the games themselves is a matter for a
professional evaluation. It is very likely something else is the triggering cause.)

16. You risk your health with games if
● you do not sleep regularly and enough
● you do not get physical exercise
● you use games to run away from your problems instead of solving them
(That’s it.)

17. Performance optimization
for serious gamers (or serious anything)

18. Remember this list?
Computer gamers develop (and therefore gaming requires) the following skills:
● ability to maintain visual attention
● multiple object tracking
● visual search performance, visual & spatial working memory
● task-switching speed, reaction speed
● mental 3D processing
● probabilistic inference?
● persistence in the face of difficult tasks

19. “In a fight, somebody always has an edge.”
These days, it is no longer enough just to know the game.
Everyone who plays competitively/seriously knows the game.
You have find out what gives you a performance edge over the other guys (or the
game environment).
(“If you think the fight is fair, the other guys have it.”)

20. Physical exercise
Conclusive evidence that physical exercise improves (short-term and long-term)
● spatial memory
● attention control
● reaction time
● visual and verbal problem solving
● learning new skills
● tolerance of stress and ability to function under stress
● mood
● sleep quality
Smith et al, 2010. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med.
Schuch et al, 2016. Are lower levels of cardiorespiratory fitness associated with incident depression? A systematic review of prospective cohort
studies. Prev Med.

21. Mechanisms?
During the evolution of humans, exploration,
defense, foraging as well as cognitive skills
were tightly integrated to motor operations for
survival.
Hippocampus?
● “GPS of the brain”
● involved in short-term and long-term
memory
● growth and neurogenesis after exercise
NOTE: complex exercise and moving outside are
most beneficial for brain functions.
Baek. 2016. Role of exercise on the brain. J Exerc Rehabil.

22. Stress
Temporary stress related to the situation is not harmful, but might actually boost
problem solving and reaction times.
Chronic stress or stress unrelated to task at hand, however, will
● disturb your sleep
● increase feelings of fatigue
● increase your reaction time
● make you slower in visual and verbal recognition tasks
● cripple your ability to keep your attention at the task
Lupien et al, 2009. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci.

23. Sleep
Lack of sleep or bad quality of sleep causes
● attention difficulties
● impulsiveness
● inability to take into account all details when making decisions
● irritability
● worse performance in visual tracking tasks
● changes in mood
● lack of motivation
1 hour sleep deprivation = 0.5 ‰ blood alcohol content
De Bruin et al, 2016. Effects of sleep manipulation on cognitive functioning of adolescents: A systematic review. Sleep Med Rev.

24. The lift to success
Sleep
Exercise
Stress
Reduction
Success

25. Top three things to do outside of the game
1. Sleep
○ regularly
○ enough
2. Exercise
○ preferably daily
○ preferably something requiring spatial navigation (walking/running outside) and/or complex
co-ordination (dance, martial arts), or both (trail running, team sports)
3. Minimize unrelated stress
○ take care of your family obligations
○ take care of your school/work
○ have a Plan B
Serious competitive gaming requires leading a disciplined life. (Sorry about that.)

26. Advice for game educators

27. Do not artificially limit screen time
There is no evidence whatsoever that strict limits of screen time are necessary or
beneficial.
Instead, promote healthy lifestyle: sleep, diet, schoolwork, social interaction,
physical exercise. Encourage “media-free zones”, especially bedrooms at the
night-time to increase sleep time and quality.
What time remains, people should use for whatever they find enjoyable,
interesting, and relaxing. The requirement to spend all your free-time in an
educational manner is inordinate, also for children.
Brunborg et al, 2014, Is video gaming, or video game addiction, associated with depression, academic achievement, heavy episodic drinking, or
conduct problems?

28. Encourage social play
Small children should play with adults and talk about games with adults. (Learning
to talk, learning words for emotions, learning moral reasoning.)
Older children should play with friends and family. (Enjoying time together, sharing
interests, learning co-operation and prosocial behavior.)
Youth and adults should play with friends, family, and online communities.
(Teamwork increases prosocial behavior, reduces violent thoughts that result
from violent play. Social communication reduces stress.)

29. Content matters
Children should only play age-appropriate games. (Exceptions to be made only by
a guardian who knows both the game and the child.)
Adults should monitor themselves for their reactions to various games and
self-regulate as necessary.
Online communities should self-police for bullying and hate-speech and reward
prosocial behavior.
Carson et al. 2015. Systematic review of sedentary behavior and cognitive development in early childhood. Prev Med.

30. Do not separate games/internet from “real life”
● games are part of life
● games are played by real people
● those real people live in the real world
● they play with other real people
● all those real people have real feelings
● games cost real money
The experiences of learning and enjoyment are as real as those gained from
books, movies, other art, physical play, boardgames, travelling, and so forth.
Gaming friends are real friends.

31. If you are worried about someone’s gaming
● think through why you are worried about it
○ are they skipping school? or have they dropped out completely?
○ do they seem sad or distressed?
○ do they sleep or exercise too little?
○ are they lonely?
○ are they neglecting their family or friends?
○ are they unable to stop despite wanting to?
● then fix that problem
● if it ain’t broken, don’t fix it

32. Final words
Thank you. Remember to sleep.