Capitalizing upon the Attractive and Addictive Properties of Massively Multiplayer Online Role-Playing Games to Promote Wellbeing.

Abstract

Forty years after they were first introduced to the general public, video games have become firmly established into the mainstream of entertainment media. In parallel, early adopters and enthusiasts have become active scientists. As a result, interest in video gaming practices has shifted from an exclusive niche leisure activity to extensive social, commercial, cultural, medical, and psychiatric issues. An increasing number of studies on game-based treatments for various mental health disorders suggest that these approaches have the clear potential to promote cognitive and behavioral changes as well as symptom relief (1–10). Game-based approaches for mental health disorders are still in an early stage of development and validation. Some interesting results have emerged, however. The inclusion of gaming tools within digital therapies has been assessed in several trials that studied participants with various sociodemographical profiles and disorders (11–13), including promising preliminary work in participants suffering from psychotic disorders (8, 12). Controlled studies on the assessment of digital serious games targeting depression (2, 11) and cognitive training in older adults (4) found promising findings, as did controlled studies on non-digital serious games developed to reduce delusional convictions in psychotic patients (1) or to promote smoking cessation (5). Also, two randomized, controlled studies showed that playing casual video games 30 min per day during 1 month (Tetris, Bejeweled) had positive effects on depressive and anxious symptoms (14–16). It was furthermore shown (in spite of controversy) that game and video game practice may have a positive impact through the transfer of cognitive skills acquired in the game to functional competences (17, 18), although see Ref. (19, 20). A meta-analysis (21) on the effect of video game play on information processing showed minor effects on executive functions and small to moderate effects on visual, auditory, spatial imagery, and motor skills. Another meta-analysis on the effect of brain-training games in older adults (22) showed a significant, if very small, improvement in cognitive testing after training, suggesting that some transfer of competence had occurred (albeit in a limited fashion). Data on naturalistic use (in milieu use outside the scope of specific research programs) of internet-based therapies suggest that these programs are appealing for many users, particularly so for people who could benefit significantly from such treatments (23). Naturalistic use, however, appears associated with high levels of attrition. For instance, in a study of an internet treatment program for depression, less than 4% of community users completed at least three modules out of five compared with 53.8% of participants in the controlled trial (24–26). Attrition issues were also observed across digital games-related studies. Less than one-third of the 1622 adolescents allocated to a computerized game for binge drinking prevention returned to the second session and none of them completed all five sessions (27). One of the ways to tackle the problem of attrition would be to develop interventions that succeed in increasing the commitment of the participants, possibly via the use of serious games tools (28). The important retention problems encountered in internet treatments, particularly among spontaneous community users, contrasts with the great success of games played for leisure, and, especially, massively multiplayer online role-playing games (MMORPGs) (29), which are sometimes associated with addictive use (30, 31). This opinion paper discusses how the attractive properties of video games, particularly those of MMORPGs, given their success and online setting, could be mobilized to promote wellbeing.