Electronic Gaming Therapy: A Cognitive-Behavioral Approach To Integrating Video Game Technology With Therapy.

Drew C. Messer, J. D., Ph.D.; Brian H. Moyer, Ph.D.; Elizabeth S. Messer, LCSW

As professionals in the 21^st century, we find ourselves surrounded by technology. The purpose of technology is to make our lives more efficient and more effective. Technology does not create or fix, but in the hands of a creator or a fixer, it can be a helpful tool. Some of the best selling technology is related either directly or indirectly to electronic games. Children and adolescents find electronic games to be engaging and reinforcing. Manipulating and interacting with video game technology in an appropriate and meaningful manner requires a basic set of sensory skills, gross and fine motor skills, and cognitive and affective skills. The growing popularity of multiplayer games makes social skills increasingly relevant. We are harnessing these attributes and finding that our clients are implementing better social skills, are interacting more with peers, and are improving their coping skills.

How we came to use video game technology in our practice of psychology.

The first documented case of play therapy was in the early 1900's when Sigmund Freud recommended play to the father of a 5 year old patient named "Little Hans." Since that time, play has been used to assess children, teach them empathy, and address emotional as well as behavioral issues.

The first commercially successful use of video game technology was arcade games, such as Atari Pong, released in 1972. Video game technology for the home began appearing a few years later, around 1975, with the development of console-based games. Present day examples include Microsoft's Xbox 360, Sony's Playstation 3, and Nintendo's Wii. Handheld video games first appeared on the market in 1976, and eventually evolved into products like the Nintendo DSi and the Sony PSP, and now are moving into cell phones and IPods. The use of personal computers as a platform for video game technology did not gain widespread popularity until the 1980's.

In 1992, while doing post-doctoral work as a psychotherapist at a residential facility in Philadelphia for children and adolescents with disruptive behavior disorders, Dr. Brian Moyer was faced with the challenge of engaging residents who made it clear that they did not wish to be engaged. Not having a great deal of resources but armed with a laptop and computer games like Monopoly, Wheel of Fortune, and Wolfenstein 3D, Dr. Moyer blended personal computer (PC) video games with therapy as a way of overcoming resistance to the idea of therapy and the stigma that can be attached to it. Playing video games together helped to create a trusting relationship with the therapist and improved treatment compliance.

Dr. Messer began integrating video game technology into the practice of psychology in 2001 while serving on active duty with the United States Navy in a Postdoctoral Fellowship in Child Psychology at the University of Oklahoma. He started with hand-held video games, using them to distract patients undergoing medical procedures in the Hematology-Oncology Clinic. Dr. Messer next used structured group play of console-based video games in 2002 to serve elementary and middle school students with childhood developmental disorders (CDD's) on an overseas military base. The school-based programs were a fun way to build trust, communication, and relationships with peers and involved students playing multiplayer video games that were structured to promote cooperative play and that required teammates to communicate.

In 2006, the school-based video-game program was modified and offered at a commercial electronic gaming establishment in Amherst, New York. As before, the initial focus was on facilitating appropriate peer interactions during group play of video games; in contrast, however, the new program added exercises before and after game play for learning social and coping skills and incorporated trained college student volunteers to socially reinforce appropriate behavior during game play. The new program also began offering a parent support group, led by Mrs. Messer, which met while the children participated in group.

Independently, Dr. Messer implemented a program using structured play of video games at a state psychiatric facility for adults with severe mental illness in 2007. Structured play of PC-based games has been considered to be an evidence-based practice for remediating neurocognitive deficits associated with a wide range of disabilities, from individuals with developmental delays to persons with serious mental illness to persons with Traumatic Brain Injury (see for example, Klingberg et al., 2005 [RoboMemo]; Hogarty, Greenwald, & Eack, 2006 [Cognitive Enhancement Therapy]; Medalia, Revheim et al., 2001 [Neuropsychological Educational Approach to Rehabilitation (NEAR)]). The program substituted off-the-shelf console-based video game technology as a way of promoting intrinsic motivation and task engagement for building basic cognitive functions like sustained attention and effort, active information processing, and impulse control. The use of the Wii gaming console allowed the patients to practice gross motor skills as well. Undergraduate and graduate student interns were trained to facilitate appropriate fine or gross motor movements and social engagement during game play.

We established Electronic Gaming Therapy, Inc. at our current private practice setting in Williamsville, NY, with the goal of integrating video game technology into our clinical practices. Video game technology is not used in every session nor is it used with every client, but it has become a tremendous tool to accentuate a more traditional cognitive-behavioral therapeutic approach with many of our clients.

How we are using video game technology today.

Upon hearing that we incorporate video game technology in our practice, we typically get two questions. First, how can video games be therapeutic? Second, what type of client benefits from this type of therapy?

For clients with moderate to severe cognitive deficits, the targeted skills are the neurocognitive functions and processes needed to manipulate and interact with video game technology in an appropriate and meaningful manner, including sensory skills, gross and fine motor skills, basic communication skills, and basic cognitive functions. We track the frequency and intensity of training sessions needed for mastering the skills.

For clients with mild to moderate cognitive deficits, the targeted skills are those psychological functions and processes needed to play video games with others in an appropriate and meaningful manner. Skill training starts with learning to play with an adult, then with a peer, and finally as part of a group activity.

For identified individuals, families, and groups we create digital avatars early in the treatment process. Creating digital avatars is typically fun and promotes relationship building. The process of creating an avatar reveals clinically relevant information on a number of dimensions, including coping and problem solving strategies, relationship styles, social and communication skills, and self-control.

For the designated individuals and families, we typically start all sessions off with a brief (5-10 minute) multiplayer game. This approach of encourages participation in therapy by pairing it with the desired activity of video game play. Carefully selected and structured video game play creates a safe and trusting environment, fosters the development of relationships, promotes participation in subsequent phases of therapy. We teach children and parents to utilize video game technology as a behavior management tool by offering the opportunity to play another multiplayer game during the final 5-10 minutes of the session.

For groups, as soon as a client arrives at the practice we encourage him or her to join in cooperative, multiplayer gaming prior to the start of the session. We found that this helps many of our clients begin the transition to group and it provides another opportunity to reinforce appropriate social and coping skills. We use video game technology to present psycho-educational materials for teaching social and coping skills. Because most families are using video game technology, we can set up schedules and procedures for reviewing the material at home. Finally, we use carefully selected and structured multiplayer games to create situations for practicing skills. We teach parents how to structure play at home in a way that promotes social and coping skills.

New Location!

5888 Main Street
Williamsville, NY 14221
(716) 961-9435

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Electronic Gaming Group Therapy

• EVERY MONDAY, open ended
• 5:30PM - 6:30PM K to 4th grade
• 6:45PM - 7:45PM 5th to 8th grade
• 8:00PM - 9:00PM 9th to 12th grade

Supervised Group Electronic Gaming (SGEG) Program

• 13-17 years olds on Friday evenings 7:00 to 10:00

What is Electronic Gaming Therapy?

Children can find talking to a therapist to be intimidating or even embarrassing. Some children find peer interactions to be just as difficult. EGT is a technique of using electronic games to take the pressure off of interacting with the therapist and with peers by focusing instead on the games. Just as you may find it easier to talk to your child about their day at school while driving in the car than over the dinner table, talking about feelings and problems can be easier while playing a game.

Therapists have been using board games designed to focus on feelings for decades; however, in this day and age our children typically find these types of games under-stimulating and difficult to relate to. The EGT approach is to treat children's interest in video and computer games as a strength, and to use electronic gaming as a way of motivating a child to participate in and benefit from therapy.

EGT in a formal group therapy setting provides the opportunity for our children to learn and practice social skills, problem solving skills, and emotional control with their peers without the pressure of a more intense face-to-face situation.

What is the Supervised Group Electronic Gaming Program?

Multiplayer electronic gaming is a recreational activity, and like other recreational activities properly structured, it can provide wonderful opportunities for social and emotional growth. Unfortunately, more and more multiplayer gaming is taking place on-line, thereby greatly reducing the opportunity for interpersonal interaction.

The SGEG Program is an educational-recreational program that provides a setting for adolescents and young adults to get together and play multiplayer video and computer games with THEIR PEERS IN PERSON. Trained EGT Inc. staff provide oversight and supervision of health and safety rules. Mandatory instructional training on rules, facilitation of team play and tournaments, and pre-and post-gaming exercises are also part of the program. Licensed mental health providers are on-call for emergencies.