Casual Video Games Demonstrate Ability to Relieve Stress, Improve Mood: Potential Clinical Significance Highlighted

East Carolina University's Department of Recreation and Leisure Studies revealed the results of a six-month long, randomized, controlled study that measured the stress-relieving and other mood-lifting effects of so-called "casual" video games. The three puzzle and word games used in the study, Bejeweled® 2, Peggle™ and Bookworm™ Adventures, are all made by PopCap Games, a leading publisher of casual video games. (PopCap underwrote the study and provided copies of the games for research purposes.) The hypotheses were tested using state-of-the-art technologies and methodologies to measure heart-rate variability (HRV), electroencephalography (EEG) and subjects' mood states pre- and post-activity (POMS). The study yielded significant findings in several areas while identifying potential therapeutic applications of casual games as a means of addressing serious mental and physical disorders. Due to the significance of the findings and their implications in health promotion, disease prevention and treatment, East Carolina University's Psychophysiology Lab and is planning to start clinical trials in the fall to determine the efficacy of these games and their prescriptive parameters.

In all cases, the changes in stress levels and mood were measured in comparison to a control group that experienced a Web-based activity similar in physical and mental nature to the game-playing groups. Full results of the study will be presented at the Games for Health Conference in Baltimore, Maryland by the director of the study, Dr. Carmen Russoniello, associate professor of recreational therapy and director of the Psychophysiology Lab and Biofeedback Clinic at ECU's College of Health and Human Performance. The study results will also be published in a peer-reviewed journal later this year. High-level findings of the study are provided below.

"I've conducted many clinical studies in the area of recreational therapy in the past, but this was the first one seeking to determine the potential therapeutic value of video games," stated Dr. Russoniello. "The results of this study are impressive and intriguing, given the extent of the effects of the games on subjects' stress levels and overall mood. When coupled with the very high degree of confidence we have in those results based on the methodology and technologies used, I believe there is a wide range of therapeutic applications of casual games in mood-related disorders such as depression and in stress-related disorders including diabetes and cardiovascular disease. Granted, this study was a first step and much more needs to be done before video games can be prescribed to treat medical conditions. However, these exciting results confirm anecdotal evidence that people are playing casual video games to improve their mood and decrease their stress, and herald casual games' potential in health promotion, disease prevention, and treatment of stress- and mood-related disorders."

Stress Relief

With respect to stress relief, measured primarily through HRV which captures sympathetic (fight or flight) and para-sympathetic (relaxation) nervous system activity by assessing the variability in the heart's "beat-to-beat" interval, Bejeweled was found to reduce physical stress activity by 54% compared to the control group. There was no statistical difference between male and female subjects. Peggle and Bookworm Adventures did not reduce subjects' physical stress levels significantly but did affect psychological tension, depression and other aspects of mood, in some cases dramatically (see below).

Changes in Aspects of Mood
Mood was measured in six different categories: Psychological Tension, Anger, Depression, Vigor, Fatigue and Confusion. Cumulatively, these six aspects of mood are called "total mood disturbance," with a decrease in total mood disturbance being a positive change in mood. In terms of total mood disturbance, Peggle had the greatest effect, improving mood by 573% across all study subjects compared to the control group (which saw a modest improvement in mood). Bejeweled 2 (435%) and Bookworm Adventures (303%) also had significant positive effects on subjects' overall mood. Interestingly, among those subjects who played Bejeweled 2, male subjects showed a 10% greater increase in total mood than female subjects, while females who played Peggle experienced a 40% greater improvement in mood than males who played that game. "It's not surprising that Peggle had the greatest effect on overall mood, given the game's over-the-top celebration of players' success each time they complete a level," noted Dr. Russoniello. "The other games also provide positive feedback to players, but not to the same extent or in the same ‘exhilarating' fashion."

Data from electroencephalography (EEG) supports the study's hypotheses and confirms the participant's psychological assessment (POMS). All three PopCap® games increased mood but in different ways. Peggle significantly increased positive approach/engage brain activity, especially in females — who accounted for 97% of the positive change. Bejeweled 2 significantly decreased brain activity associated with avoid/withdrawal activity. Males had a significant (191%) decrease when compared to females and significantly differed from the control group. Bookworm Adventures had the greatest impact on left brain - right brain synchrony (421% increase). Males had a 214% greater increase in mood after playing Bejeweled and a 78% increase in mood after playing Bookworm Adventures, compared to females. Age was an important factor as well. Those subjects under the age of 25 had a 156% increase in left brain alpha, indicating a substantial decrease in avoid/withdrawal brain activity when compared to those subjects age 25 and older. In addition subjects under 25 had a significant increase in right brain activity (318%) indicating that they also had an increase in approach/engage brain activity. On the other hand, those subjects age 25 and older experienced an 891% increase in right/left brain synchrony indicating a greater mental relaxation state. (Additional break-outs of the study data by gender and age are available online.)

Psychological Tension
Peggle had the greatest effect on psychological tension, with study subjects who played that game averaging a 66% reduction compared to 36% reduction among those who played Bejeweled 2 and 24% reduction among players of Bookworm Adventures. Specifically with respect to Peggle, female subjects accounted for two thirds of the overall reduction in tension after playing that game.

Anger
Bejeweled 2 and Peggle had similarly positive effects on subjects' anger levels, reducing anger by 65% and 63%, respectively. Bookworm Adventures had a more modest effect, reducing anger by 33%. Among female subjects, Peggle produced the greatest anger reduction, 86%. Men experienced the greatest reduction of anger while playing Bejeweled 2 (63%). "Peggle may have reduced anger more effectively in women due to its light-hearted characters and somewhat cartoony presentation featuring unicorns and rainbows," Dr. Russoniello conjectured. "For men, it's likely the nature of this game — Bejeweled 2 encourages focus, introspection and calmness — which facilitated a release of anger-oriented feelings like certain other therapeutic activities such as art."

Depression
All three games had similar effects on depression, reducing subjects' depressions levels by 45% (Peggle), 43% (Bookworm Adventures) and 37% (Bejeweled 2). Among men, however, Bookworm Adventures had the greatest depression-reducing effect, with male subjects accounting for 98% of depression reduction, on average, when playing that game. "All three games, but particularly Peggle, should be used in more focused trials with a group of clinically depressed subjects, to gauge the effects," suggested Dr. Russoniello. "If these games can reduce depression this significantly among a population of people who are not diagnosed with depression, the potential for positively affecting the mental state of someone who is in fact depressed is very significant."

Vigor
Vigor is the only positive variable reflected in the POMS and represents a state of increased mental energy. Bejeweled 2 increased vigor by an average of 210% among subjects who played that game. Bookworm (10%) and Peggle (24%) had modest affects on subjects' vigor levels. Among players of Bejeweled 2, females accounted for 59% of the overall increase in vigor.

Fatigue
Peggle had the most significant impact on fatigue, reducing it by an average of 61% among subjects who played that game. Bejeweled 2 (49%) and Bookworm Adventures (33%) also reduced fatigue. Peggle was nearly equally effective at reducing fatigue among male (52%) and female (48%) subjects.

Confusion
Compared to the control group surfing the Web for articles (which collectively experienced a modest decrease in confusion), all three games reduced confusion dramatically, suggesting that the rules, objectives and input controls for the game were very clearly understood by the subjects. Subjects playing Peggle saw confusion drop by an average of 486%, while those playing Bookworm Adventures (462%) and Bejeweled 2 (426%) also experienced sizable reductions in confusion. "These findings are especially intriguing as they present the possibility that casual games may be useful in ameliorating conditions such as attention deficit disorder, memory loss and general confusion attributed to dementia and Alzheimer's disease," said Dr. Russoniello.

Study Methodology
The study was conducted between October 2007 and April 2008 and included a total of 134 subjects. Thirty-one subjects served as members of the control group, tasked with surfing the Internet looking for journal articles. The experimental groups consisted of 31 subjects who played Bejeweled 2, 29 subjects who played Bookworm Adventures, and 36 subjects who played Peggle. The study included the collection of physical data (based on Heart Rate Variability (HRV) measurements) and psychological data (based on POMS (a profile of mood states pre- and post- activity) and electroencephalography (EEG) measurements) during a 5-minute baseline period and 15 minutes of game playing or (in the case of the control group) Internet surfing.

TGA Interview with NYCGameIndustry.com

Below is a recent Q&A with NYCGameIndustry.com

"Spotlight On" is a recurring feature on nycgameindustry.com that allows us an opportunity to get to know the passionate students, talented developers and professional companies which make up the New York video game industry even better. This month we sat down with The Game Agency, a marketing firm uniquely devoted to meeting the video game, interactive entertainment, and social media needs of clients.

NYCGI: What is The Game Agency and what is its focus?

TGA: The Game Agency is an awarding winning marketing firm that specializes in video games, interactive entertainment, and social media. Our employees have worked in every facet of the interactive software industry and we pride ourselves on delivering this medium to our clients. We leverage a deep network of developers, publishers, distributors and retailers to find new markets to create, market, and distribute content. Bringing content to life is fun and maximizing the reach and impact of that content is our sweet spot!

NYCGI: You recently developed a Facebook game for the Ghostbusters license. Have you seen an upward trend in requests for these social-casual games?

TGA: Social media has changed the way we communicate, both personally and professionally. Without a doubt, marketers are leveraging this medium to position and promote their message, engage dialogue and change behavior. According to a recent Nielsen study, social networks have become more popular than email with more people are now using social networks rather than email to communicate.

NYCGI: What are some ways that people are taking advantage of social networks?

TGA: Many different ways, however social gaming is actually among the most popular activity across the spectrum. On Facebook, the top 10 games have an average of 7 million active monthly users. Among these 10 games, 5 of them focus on building a community and interacting with others and almost every one of our clients wants to be part of this.

NYCGI: How do you make a successful app on an already heavily saturated social platform like Facebook?

TGA: At The Game Agency we have five rules when designing our games/apps for Facebook.

1. Keep Simple

Facebook is simple. The features on Facebook are simple. Our hypothesis is that no application which is more complex than the most complex feature on Facebook will succeed. The simpler you make your app the better it will do.

2. Be Social

Just because you’ve built it doesn’t mean the users will come. Facebook is still first and foremost a social platform. If your application has no social component it will fail to achieve its full potential. Make it a group effort or there will be little reason for people to install it.

3. Get Viral

Write an application which does nothing more than spread itself. If your idea is funny enough, like Vampires or Zombies and Mafia Wars, people will use it.

4. Stay Fun

We ensure that all of our designs incorporate game mechanics. Games are successful for many reasons but understanding the properties and mechanics of popular games and then deploying those properties in our social applications has proven a recipe for true success.

5. Quality Matters

This might be obvious, but quality matters. Apps like Mafia Wars, YoVille, Lil Green Patch and Causes provide a set of high-quality features. They are straight forward and very compelling. In addition, be prepared to deal with your growth. Predict how many users you’ll have in a few days, weeks, months, etc. If it’s more than you anticipated make sure you have the hardware to handle it— users will uninstall apps that are slow or broken, even if it’s not the apps’ fault.

NYCGI: Tell us a bit about the basic idea behind the Ghostbusters Facebook game.

TGA: Atari was looking to promote their Ghostbusters game (now available on PC, X360, PS3, PS2, Wii and DS) in the social media environment. The Game Agency's solution was to create an interactive Ghost Hunt (http://apps.facebook.com/ghostbusters-game/) that challenges players to search for ghosts, share their findings and slime their friends.

Ghosts can be found throughout Facebook profile and product pages, blogs, game sites and corporate websites. This game provides prizes including a custom Ghostbusters designed Dell computer, Intel Core Processors and copies of the Ghostbusters game. In its first month, the game had over 35,000 people sign up and over 1,000,000 slimes.

NYCGI: When a client approaches you with a request for a game, how much do they typically bring to the table and how much is TGA's creative input?

TGA: The Game Agency has 3 divisions: TGA Digital, TGA Events and TGA Public Relations. We have a variety of capabilities that we deploy for clients including game development, marketing, promotions, partnerships, media, licensing and public relations.

Every project is different but often our clients are looking to extend a current campaign via games. We get briefed about their brand, their consumer and the creative components already in the works and we challenge ourselves to deliver a compelling game strategy that will engage a target audience and achieve their overriding goals.
Sometimes we focus on online games, sometime we focus on mobile games, sometimes we focus on live events. We are lucky that our clients trust us to get our hands dirty with them.

NYCGI: What's the turnaround time on most of these projects?

TGA: There's no firm rule for turnaround. Some games take a few weeks to develop while others take up to a year. It all depends on the platform and the depth of the user experience. The average campaign is 3-6 months.

NYCGI: Do you foresee TGA working with any of the new motion-sensing technologies on display at this year’s E3?

TGA: 3D camera motion sensor games are one of our biggest initiatives right now. The Game Agency is working on one fitness game targeting Microsoft's project Natal’s launch and several games that will be introduced in 2010 with global brand and retail partners. We like to think of these games as the next-next generation in gaming. They all focus on getting consumers active utilizing the human body as a game controller.

The physical activity of running, jumping, crouching, balancing and many more moves allows players to advance through the game. This is cutting edge technology and a real jaw dropper for everyone we've shown it to so far.

NYCGI: What other game technologies are your teams excited about?

TGA: The Game Agency is working with Aspyr Media on a new Nintendo DS game called Treasure World. It's the world’s largest treasure hunt with hundreds of millions of treasure spots around the world. Players use the DS to find Wi-Fi signals and unlock content (characters, clothing, environments, etc.). Our team has established co-promotional programs with restaurant chains, malls, libraries and children's non-profits to engage kids nationwide. We are now focused on the using this game engine for companies trying to reach consumers and employees through custom game development on Nintendo DS and Wi-Fi USBs.

NYCGI: Do you see the industry trending towards casual or core gamers in the next five years?

TGA: The high growth area in gaming is casual. Core games and gamers will always play a huge role in shaping the gaming landscape but technology has thrown open the door for every company to utilize gaming for advertising, social engagement, public relations...even employee training. Whether online, mobile, console, handheld or events we expect more and more content to be introduced for the everyday person (kids, parents and grandparents). The better the hardware gets the lower the barriers are to engage.

NYCGI: Thank you so much for your time and best of luck with all those amazing projects!