Potential Clinical Significance Highlighted in First-of-Its-Kind 6-month Research Project Establishes Effects of Puzzle and Word Games on the Human Body and Mind
East Carolina University’s Department of Recreation and Leisure Studies today 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, the leading developer and 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 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 on May 8, 2008 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. Additional data, including detailed charts, can be found at http://www.ecu.edu/biofeedback.
“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.”
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.)
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.
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.”
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 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.
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.
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.
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.
PopCap Games (http://www.popcap.com) is the leading multi-platform provider of “casual games” — fun, easy-to-learn, captivating computer games that appeal to everyone from age 6 to 106. Based in Seattle, Washington, PopCap was founded in 2000 and has a worldwide staff of over 180 people in Seattle, San Francisco, Chicago, Vancouver, B.C. and Dublin. Its games have been downloaded more than 1 billion times by consumers worldwide, and its flagship title, Bejeweled, has sold more than 10 million units across all platforms. Constantly acclaimed by consumers and critics, PopCap’s games are played on the Web, desktop computers, myriad mobile devices (cell phones, smartphones, PDAs, Pocket PCs, iPod and more), popular game consoles (such as Xbox), and in-flight entertainment systems. PopCap is the only casual games developer with leading market share across all major sales channels, including Web portals, retail stores, mobile phones and MP3 players, and game device manufacturers.