Video game helps teens cope with COVID-19
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A free video game titled Shadow’s Edge helps players cope with the isolation, desolation and fear caused by stressors like COVID-19, the game’s developer told Healio Primary Care.
Rosemary Lokhorst said the game uses narrative therapy and artistic expression to enable players to save the city — called Shadow’s Edge — that has been destroyed by a storm. The game’s content was approved by psychologists and a worldwide advisory board of current and former players.
“Shadow’s Edge asks questions such as ‘Do you ever think that people don’t see the real you, but they see a mask? How does that make you feel?’ Players then write their answers in a journal connected to the game and receive spray paint to draw the mask on a structure that needs to be rebuilt,” Lokhorst said. “This allows them to process their emotions, how they can respond to their emotions and what they can do to change them.”
Throughout the game, “players get tools that make the city full of color and beauty, enable plants to grow and repair buildings,” she said. “Players start incorporating the narrative therapy and artistic expression in their real lives and discover new meaning to life, with the goal of improving the player’s emotional well-being as they rebuild the city.”
Players have the option of sharing pictures of their reborn city in an Instagram-like community and connect to others. The game was originally intended for children and teenagers with chronic and terminal illnesses, but it has been modified to address emotions and feelings prompted by COVID-19, Lokhorst said.
Shortly before graduation season started, we saw that stress was a big topic in the journals. Players felt that they were missing out or that they were academically behind,” she said. “After players described their feelings, we give them a coloring exercise to calm them down and information about breathing exercises that you see in cognitive behavioral therapy.”
According to Lokhorst, Shadow Edge’s appropriateness for helping players cope with isolation, desolation and fear was validated in a 2017 study with the University of Twente. She said after 5 weeks, more than 75% of the 55 participants — all patients with emotional and/or physical challenges — reported increases in traits such as optimism, mindfulness, awareness and positive self-identity. The results of a 12-month validation at Ann & Robert H. Lurie Children’s Hospital of Chicago that wrapped up earlier this year with 192 patients in remission or final treatments for a disease should be published in August.
Shadow’s Edge is available via the Apple App store and on Google Play. There are no ads and no in-game purchases, Lokhorst said.
Perspective
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Christopher Hagan, PhD
I have never played Shadow’s Edge, but its developers suggest it helps players improve their emotional state. That’s great if the game really does that, but that does not necessarily mean the game will address the underlying anxiety or depression that a player may have. In addition, while a documented increase in positive emotions is good, that does not guarantee that negative emotions decreased or that the players gained new skills to cope with or resolve their real life negative emotional states. If this game is able to translate into using an ability to process emotions or resolve stress into real world situations, that is great, but it has yet to be shown.
Similarly, a player who masters a video game touted to boost memory skills will likely not remember the name of their new neighbor any better. The player will only improve their memory as it pertains to playing the video game. Such claims, including that of skill improvement, is only validated while the player is playing the game or shortly thereafter. This is a significant limitation that hinders the reputed success of many therapeutic video games.
While Shadow's Edge may act as a therapeutic tool, it should not replace professional mental health care, especially given the increase in suicide risk that has developed in light of the financial distress and social isolation that has been brought on by COVID-19. Patients experiencing suicidal crises should be encouraged to reach out to a mental health provider and/or contact the National Suicide Prevention Lifeline at 800-273-TALK.
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Katherine Pannel, DO
The social isolation of the COVID-19 pandemic has prompted many people to find different ways of being socially interactive.
I briefly reviewed Shadow Edge’s content and it does seem to provide a sense of community that could be helpful to those suffering from mental illness. The game also offers a positive experience to those who engage in self-expression.
While I do not think video games should be the primary tool to treat mental illness or replace in-person therapy, depending on the type of video game used, video games are a great tool to have in the treatment toolbox.
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Hallie Zwibel, MPH, DO, FAAFP
Video games will not cure anxiety or depression, but certain types of video games can be helpful in reducing the number of symptoms among persons who are suffering from depression or anxiety. Many of the video games that have been studied in this way have neuro or biofeedback mechanisms that train the body to reduce its physical and emotional levels of tension. There is also some research that suggests casual video gaming can reduce overall stress and anxiety.
When patients mention they play video games, physicians should tell patients to weigh the pros and cons of the game vs. their objectives from playing the game, since not all video games are created equally. Playing a video game that contains violent and graphic images is not relaxing and is not going to decrease stress or anxiety, whereas a video game that is evidence-based and developed to help reduce anxiety probably will. I have never played Shadow’s Edge so I cannot comment on specific content, but I do know that it was developed by a person with a PhD in cognitive behavioral therapy.
Patients should also be told to play video games in moderation. Something that is good in the short term could be harmful long term. When it comes to playing video games, a half-hour of play should be fine. But if a patient reveals that he or she is playing for 8 to 10 hours a day, he or she is starting to incur some negative effects that stem from that sedentary behavior.
Reference: Pine R, et al. Games Health J. 2020;10.1089/g4h.2019.0132.
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