The Psychological and Physical Effects of Video Game Play

From light and food to singing and dancing, our world is characterized by phenomena, events, and processes that have a physical and psychological effect on us. Our environment and our experience shape us—physically and mentally. Games work in a similar fashion. A game is any mental and/or physical activity that is defined by goals, rules, challenges, a feedback system, and voluntary participation (Game, n.d.; McGonigal, 2011; Prensky, 2001). A video game is a complex form of digital media that incorporates these gamic properties, and it requires the active interaction between a human and computer (Galloway, 2006; Wardrip-Fruin, 2009). Both games and video games train intellectual skills as well as improve physical skills, and through learning in a meaningful context, i.e. skills learned and applied in the game’s world, games utilize play and situated cognition on practical and relevant levels to affect and develop their players (Van Eck, 2006).

As Salen and Zimmerman (2004) state, a game is a system that results in quantifiable outcomes. Video games are the popularized, digital form of games, and through their inherent properties, video games are a perfect tool to quantifiably measure a number of physical and mental capacities, capabilities, and characteristics. Video games are instruments that simulate how we process the world, i.e. tools testing problem solving and decision-making skills. We have to understand the cognitive and physiological effects of video game play in order to understand how these processes can be utilized to help us interpret and navigate our world. By understanding these effects, we can begin to develop games that facilitate our lives, e.g. constructing beneficial stratagems for education and public health.

Cognitive Effects

Video games exercise and train cognitive skills. Cognition is defined as the mental processes associated with memory, language, perception, attention, problem solving, decision-making, and reasoning (Goldstein, 2011). Video games create engaging environments that allow for cognitive growth and development in mental rotational skills, object location ability, attention, visual attention, targeting, iconic and verbal representation of processes, verbal fluency, executive control, and both short and long-term memory skills (Boyan & Sherry, 2011). Cognition develops through bottom-up and top-down processes. The bottom-up process is input and data driven, which involves perceiving the world, remembering features and characteristics about it, and navigating the environment. The top-down process utilizes previously learned knowledge to affect perception, memory, problem solving, decision-making, and the like (Goldstein, 2011).  Similarly, video games incorporate and challenge various cognitive processes through a cyclical flow of bottom-up and top-down processing. A player perceives and interacts with the video game environment—processing bottom-up—and in order to succeed in the game, he or she must solve problems and utilize several cognitive skills to overcome obstacles and challenges—processing top-down. Through their intrinsic qualities, video games promote cognitive growth and development.

A 2003 study by Green and Bavelier demonstrated cognitive growth through video game play. These researchers examined a range of visual skills affected after playing an action video game. They conducted five experiments: four demonstrated greater improvements in different aspects of visual attention, i.e. the rapid and accurate processing of visual information, in habitual video game players compared to non-video game players, and the fifth experiment, which tested only non-video game players, revealed attentional improvement over time through video game play. In all instances of the first four experiments, video game players out performed non-video game players (Figures 1-4). The first experiment examined an overall increase in attentional capacity using the Flank Compatibility effect, which measures a subject’s ability to ignore a distractor. Results revealed an increase in attentional resources in video game players over non-video game players (Figure 1) because they had more attentional resources to process the distractor and ignore it. The second experiment confirmed an increase in video game players’ attentional capacity, which is reflected by the number of items one can attend to, i.e. subitizing (Figure 2), over non-video game players. The third experiment looked at visual processing outside of the standard video game play area using the ‘Useful Field of View’ task, which involves locating a target amongst distracters at various spatial locations. Video game players far outperformed non-video game players at all variations, distractor levels, and different distractor pairs, which indicates an enhanced distribution of spatial attention over the visual field, even in untrained locations (Figure 3). The fourth experiment measured the ability to process items over time using the Attentional Blink task, which measures a subject’s temporal attentional abilities by having him/her report a second target within milliseconds. The results revealed that video game players possess an increased ability to process information over time, as well as an enhancement in task-switching abilities (Figure 4). Finally, the fifth experiment tested two groups of non-video game players after ten days of playing Tetris and Medal of Honor. They found that ten days of training on an action game, i.e. Medal of Honor, was sufficient to increase visual attentional capacity, spatial distribution, and temporal resolution. Green and Bavelier reported that “ is capable of radically altering visual attentional processing” (p. 536).

These 5 experiments reveal cognitive improvements, specifically visual-attention processes, through video game play. Additional studies by Green and Bavelier (2012; 2006) indicate that spatial skills, executive function, task-switching, multi-tasking, and visual short-term memory are being affected and enhanced by video game play as well as a plethora of other cognitive skills (Boyan & Sherry, 2011). Further research suggests that intense, consistent cognitive training can greatly enhance memory, language, attention, executive function, and visuo-spatial skills (Croisile, 2007), and by actively exercising specific cognitive skills, this training can produce both short- and long-term benefits that generalize to everyday life, such as driving, managing money, and solving problems (Banks, 2007). However, recent research indicates that video games possess limits on what can be transferred because human learning is specific to task, content, and context (Green & Bavelier, 2012). These collective findings indicate that a number of cognitive processes, such as memory, attention, and language, are being affected through video game play. Once we are able to understand the extent of these effects, we can utilize video games to increase human memory, language, attention, perception, problem solving, decision-making, and reasoning skills. The brain-mind relationship suggests that physical changes are occurring in parallel to these psychological phenomena (Gazzaniga et al., 2009).

Physiological Effects

Video games impact human physiology in various physical ways. For example, video games act as powerful catalysts: They can affect stress levels through increased heart rate and heightened cortisol production as well as produce pleasurable stimulation in the form of dopamine and opioid release (Boyan & Sherry, 2011; Koepp et al., 1998). Furthermore, traditional video games, such as Ms. Pac-Man, have been shown to increase heart rate, blood pressure, oxygen consumption, and energy expenditure (Segal, 1991). More physically intensive video games such as exergames, e.g. Dance Dance Revolution and Wii Sports, are being used as health tools to increase caloric expenditure and heart rate (Staiano & Calvert, 2011). Additionally, Staiano and Calvert (2011) have shown that utilizing aerobic exercise through video game play affects the structure and function of the brain in a number of ways: It increases cerebral circulation via enhanced cardiorespiratory functioning, and it also decreases the risk of disease by providing an enriched environment of increased neurotransmittters, enhanced physiological and neurological mechanisms, and healthy molecular and neurochemical changes. These physiological effects can lead to improved physical and cognitive performance, social interaction, and academic performance (Staiano & Calvert, 2011). This is only the tip of the iceberg; it is still unclear how video games affect human physiology in a comprehensive and temporal manner, i.e. neuronal communication, hormone interaction, and other physiological changes over different periods of time.

In a 2000 study, Skosnik et al. looked at the effects of moderate stress on attention. Using video games, they exhibited effects on physical and physiological process in the body. Twenty subjects were given an attention task where they had to locate one object and ignore another. After the attention task, they played a 15-min video game stressor and then took another attention task. The researchers took samples of the test subjects’ saliva before the experiment, one minute after the video game stressor, and 20-min post-stressor to measure cortisol and norepinephrine levels, which indicate both early and late stress mechanisms. Norepinephrine and cortisol levels were higher after the video game stressor, and reaction time during the attention task decreased after the video game stressor. These findings support an increase in attentional capabilities from video game play, which implies that neurochemical-hormonal stress-response systems can modulate the cognitive process of selective attention, and furthermore, stress may affect various subtypes of attentional processes (Skosnik et al., 2000). These results indicate that video games affect biological systems, such as the endocrine system and stress hormones, as well as our attentional processes through neurobiological pathways, and this suggests that we can regulate these effects for productive means, e.g. increase attention for the acquisition of new material or to understand and cope with stress more effectively. Moreover, these findings suggest that other cognitive processes, such as mental rotational skills and memory, might be affected by neurobiological interactions in the brain, and if so, we can attempt to modify and modulate these using video games.

The State of Video Game Research: Problems and Solutions

Our lives and our world are characterized by complexity—the workings of a cell, law, quantum physics, etc.—and video games reflect these intricacies. Through genetic and environmental factors, video game play affects people in various ways, and it is difficult to establish a one to one ratio collating video game elements and effects—most results are correlated with several factors (Gentile et al., 2012; Gentile et al., 2004). On the one hand, video games and video game play are a preferred method of learning (Morgan et al., 2002), challenge cognitive skills, e.g. visual attention (Green & Bavelier, 2003), provide neurological benefits (Staiano & Calvert, 2011), and have great utility in a number of areas, such as academia, research, and healthcare (Astle et al., 2011; Griffiths, 2002; Van Eck, 2006). On the other hand, video games and video game play create a number of problems that must be understood and resolved in order to utilize their full potential.

Through surveys, models, experimental tests, and correlational studies, video games have been shown to produce a number of negative effects (Carnagey et al., 2007; Gentile et al., 2012; Gentile et al., 2004; Wang et al., 2011). In 2000, the American Academy of Pediatrics, American Psychological Association, American Academy of Child Adolescent Psychiatry, and American Medical Association issued a statement that revealed a “casual connection” between media violence and aggressive behavior; however, it is a complex effect (Gentile et al., 2004).  Several studies have found correlation effects between aggressive behavior and video game habits (Gentile et al., 2004). Further research reveals video games inducing impulsivity and an inhibition on attention abilities, i.e. the ability to sustain adaptive, goal-oriented behavior or mental processes in effortful or boring contexts, e.g. school work, and equally, if not more, when those games have a violent element attached to them (Gentile et al, 2012). As well, Carnagey et al. (2007) found that violent video games increased desensitization, i.e. a reduction in emotion-related physiological reactivity to real violence. Two hundred and fifty seven college students’ heart rates and galvanic skin responses—an indication of physiological arousal—were monitored for twenty minutes while they played a violent game or nonviolent video game and then again while they watched a 10 minute video of real life violence. Subjects that played the violent video game showed a lower physiological arousal to real life violence than subjects that played a nonviolent video game. This effect might be efficacious for surgeons and soldiers, but it is discouraged for children and civilians. Throughout these studies, researchers reported mixed results, concerns with methodology, i.e. child self-reports, and requests for more research, specifically on content (Carnagey et al., 2007; Gentile et al, 2012).

The major factor in a number of these studies is the nature of video game play: the content of the game, i.e. fighting and death, the context in which people play, i.e. a lack of supervision, and the amount of time spent playing. A person’s environment is a large factor in how they develop, and while these results are perturbing, there is a silver lining. Since we know that video games will create this effect under specific environmental influences, i.e. violent video games producing aggression and desensitization, then specific environmental influences on the other spectrum should be able to produce a different response, e.g. construction games producing cooperation and collaboration (Ito, 2009). As well, if video games are designed with specific elements and features that inhibit attention or cause aggression, then video games can be designed with specific characteristics that help players focus their attention, e.g. practice self-control, or make the player aware of these effects. There are steps we can take right now that can help correct these problems; for example, parental involvement in video game habits reduce aggressive behaviors in adolescents (Gentile et al., 2004). However, the most fruitful endeavors will involve more research and purposeful design (Carnagey et al., 2007; Dignan, 2011; Gentile et al., 2012; Szczurek, 1982).

A more developed understanding of video game play and its affect on players will allow video game design and research to excel. As Green and Bavelier indicate, “characterizing game play factors” and dissecting the components of games will reveal physical and cognitive changes that can be controlled and understood, i.e. elements A, B, and C cause effect X, Y, and Z (2012, p. 204). One way to go about this is trial-and-error testing, i.e. reducing a game to one element and testing that effect. Another method incorporates existing cognitive and physical tests that produce effective results with video games and video game play, such as neurofeedback utilizing video game play (Aart et al., 2007). A third way would be to identify target areas, i.e. working-memory or other cognitive domains, for improvement, and then experimentally testing the effectiveness or ineffectiveness of certain video games, i.e. pre-testing a subject with the Working Memory Battery (WOMBAT) or the Woodcock Johnson Tests of Cognitive Abilities, playing video game X for Y time, and then re-testing the subject with the same test (Englund, 2013; Schrank et al., 2001). However, cognitive training possesses a number of difficulties, such as maintaining blind recruitment and active controls groups, and future research needs to be carefully planned out and rationalized (Green & Bavelier, 2012). While pros and cons exist for any method, the most lucrative advancements are likely to be predicated by experiments and research that are center around cognitive neuroscience. This research can yield intelligible and instrumental results given significant time, energy, effort, and experimental analysis (Dear, 2006)

The Potential Uses for Video Games

Video games have enormous potential as tools to study human growth and development, as training simulators for various jobs and skills, for education at primary, secondary, and collegiate institutions, and so much more. Imagine a world where you could ask someone a question and through his or her answer, you could identify if he or she had a neurological problem, and that the procedure for this process is nothing more than playing a game. This may be a future for video game play. As Griffiths (2002) states, “Videogames can be used as research and/or measurement tools. Furthermore, as research tools, they have great diversity” (p. 47). As assessment tools, video games can measure individual performance over a variety of tasks, which can be changed, standardized, and understood (Griffiths, 2002). Whether their underlying designs test for reading comprehension or measure neuronal activity in a particular region of the brain, video games have great potential in analyzing human behaviors and characteristics. Since video games produce a number of cognitive, physical, and physiological effects, we can develop and utilize these tools to help facilitate our growth and success.

Research Tools

As a research tool, video games can reveal cognitive and physical effects produced by video game play, and they can provide insight into the specific actions, processes, characteristics, and behaviors that cause these effects. In a 2011 Chicago press release, an fMRI analysis found lasting effects of violent video game play on brain regions in young adult men after one week of game play (Wang et al.). They formed two groups: a control group that didn’t play violent video games and a test group that played 10 hours of a first person shooter for 1 week. Subjects took an emotional Stroop test under fMRI. Compared to baseline results from the control group, researchers found less activation in the left inferior frontal lobe of the test group, which plays a role in emotion, and there was less activation in the anterior cingulate cortex, which plays a role in emotion, anger, and monitoring social interaction (Gazzaniga et al., 2009). After a week without play, these changes diminished; however, the results indicate that violent video games can be detrimental to brain function, i.e. attention, inhibition, decision-making, and executive function (Wang et al., 2011). These results reveal that video games have an affect on us—in this case negative. If we maintain a holistic approach when dealing with video game play, we can investigate these effects and provide instruction on their implementation, i.e. incorporate less violence in video games while maintaining competition or making the player cognizant of these violent effects (Corso, 2013).

Video games inherently possess characteristics that make them ideal for researching their own effects. In a 2010 study by Erickson et al., a connection was found between striatal volume and video game acquisition and improvement. The striatum relays input from the cortex to the basal ganglia, which plays a role in the initiation of actions as well as shifting between actions that offer the greatest reward (Gazzaniga, 2009). Using the video game Space Fortress, both ventral (lower) and dorsal (upper) striatal volumes indicated more initial processing and learning of the game. Furthermore, the upper striatal volume predicted improvements in overall performance, i.e. larger dorsal striatal volumes equated to higher scores. The Space Fortress game was measured off a Total score that was composed of sub-scores each with specific, individual game mechanics, i.e. a Control score based on flying the ship in a target area, a Velocity score based on ship speed, a Speed score for killing mines, and a Points score for destroying the fortress (Figure 5). The study had 42 participants split up into two groups: a variable priority group that focused on segments of the game, i.e. obtaining high sub-scores on different aspects of the game, and a fixed priority group that focused on always obtaining the highest Total score possible (Figure 6). In both groups, lower and upper striatal volumes revealed growth, i.e. learning, during early training sessions. However, higher overall performance scores and some sub-scores were associated with larger dorsal striatal volumes, and this shows greater growth and learning during variable priority training sessions (Figure 7). Through playing Space Fortress, subjects revealed an increase in cortical involvement and processing, and this provides a direct link between brain neurology and video game performance; regions in the brain responsible for learning grew in relation to video game play. These results suggest that other physical and cognitive changes are occurring through video game play as well. Once a multitude of video game effects are understood, we can design video games with specific features and for specific purposes, e.g. to identify if feedback in the form of progress and percentages vs. points and grades contributes more towards the player achieving success and accomplishing missions (Dignan, 2011). Intrinsically, video games are valuable instruments that allow us to study various changes and developments in human psychology and physiology.

Prevention and Treatment Strategies

Video games provide an effective prevention and treatment strategy for a variety of problems, such as with Alzheimer’s and ADHD. Cognitive activities, such as playing games, have shown a reduction in the age at onset of Alzheimer’s disease (Hertzog et al., 2009), which can be reflected in changes at a neurobiological level (Croisile, 2006). These cognitive changes might be influenced by top-down processing, i.e. problem solving and decision making in games, or through bottom-up processing, i.e. learning and remembering rules, pieces, etc., attending to new points of interest, visually and mentally modeling the environment, and so on. Aart et al. (2007) report a number of problems that video game neurofeedback can be applied to as medication; these include alleviating attention and hyperactivity disorders, muscular tonicity recovery for cardiovascular patients, relaxation and meditation to cope with mental stress, and improvements in weight loss and overall fitness. By utilizing the intrinsic motivation within video games, video game neurofeedback is effective in training and facilitating patient progress.

Video games serve as effective tools in treating a number of physical problems because they provide results that address the cause as well as the symptoms. For instance, video games provide an effective treatment option to amblyopia patients who have difficulty in visual processing. Amblyopia is a visual problem that results in reduced vision during early development (Astle et al, 2011). Amblyopia treatment utilizes a process—perceptual learning—to help correct neurological problems. Astle et al. (2011) define perceptual learning as the “permanent and consistent improvements in performance on sensory tasks as a result of experience or practice” (p. 566), and this process parallels video game play. For example, many shooting based games involve detecting a target and the precise placement of a pointer on that target, which develops contrast sensitivity; they require the player to work through several elements of the game, such as spatial frequencies, contrasts, colors, and degrees of crowding, which are all aspects of perceptual learning. Video games provide an engaging task, immediate feedback with rewards for good performance, and changes in difficulty to challenge the player—just like perceptual learning. Both processes present most stimuli and thresholds close to the limits of the subject’s capabilities, and improvements are typically exponential and then plateau; however, longer training periods lead to greater improvements (Astle, 2011). Like perceptual learning, video games intrinsically support the treatment of patients with amblyopia by reconstructing neurological connections and perception mechanisms.

Video games can provide treatment for other physical problems. A Stroke Outcome Research Unit conducted a study on video game and virtual reality improvements on arm strength and function after a stroke. Using 195 subjects, 7 observational trails showed 14.7% improvement in their arm, and 5 randomized trails revealed a 4.89% improvement (Saposnik & Levin, 2011). While these results aren’t dramatic, they provide positive evidence of virtual reality gaming as a useful, alternative treatment compared to traditional methods. As Saposnik and Levin (2011) state, “VR and video game applications may be promising strategies to increase the intensity of treatment and to promote motor recovery after stroke” (p. 1385). Video games are a relatively cheap and abundant source for alternative treatment, and they can be customizable for a number of patients and conditions.

Educational Value

Video games are excellent pedagogical tools. As Gentile (2011) reports, video games can provide immediate feedback, motivate players, set specific goals, promote mastery, encourage distributed learning, teach for transfer, adapt themselves to the level of the learner, and provide various other teaching techniques. Whether it’s promoting long-term learning through distributed practice or increasing a player’s mastery of educational content, various elements of game-based learning intrinsically provide challenges that develop their students (Boyan & Sherry, 2011; Gentile et al., 2011). Additionally, video games train a variety of cognitive skills, such as memory recall and problem solving, that can be implemented in a number of ways; for example, a video game that teaches players about the immune system can help solidify immunology-specific information and can potentially help improve general healthcare practices and behaviors. There have been a number of video game genres, i.e. edutainment, children’s software, and learning games, that have entwined interactive gaming and entertainment elements to help K-12 students explore the complex dynamics of microworlds, e.g. Sid Meier’s Civilization, SimEarth, and Railroad Tycoon (Ito, 2009; Squire, 2003). More recently, digital game-based learning (DGBL) is being incorporated into classrooms to provide specific content, e.g. teaching history with Civilization, to practice specific skills, e.g. engineering and management tasks in RollerCoaster Tycoon, and for a number of other purposes (Van Eck, 2006).

As Boyan and Sherry (2011) reveal, game play increases strategic thinking, cognitive skills, and kinesthetic skills. A 1982 meta-analysis found that simulation games produce a moderately positive effect on cognitive learning (Szczurek), and more recent reports indicate that video game play affects and enhances a number of cognitive skills (Boyan & Sherry, 2011; Green & Bavelier, 2012; Green & Bavelier, 2006). Through increased hand-eye coordination from kinesthetic skills, video game playing surgeons perform significantly better in laparoscopic surgical skills than non-video game playing surgeons (Boyan & Sherry, 2011). Laparoscopic surgeons aren’t the only medical professionals that could benefit from video game training; other surgeons, as well as the patients they operate on, could benefit from exercising and honing specific surgical skills, e.g. operating the da Vinci Surgical System, neurosurgeons working in the brain, and other disciplines. Through rigorous training on a video game with similar controls and actions, doctors could reduce operation time, patient injuries, and patient fatalities as well as lower overall healthcare costs for the hospital. Additionally, the military and other instructional institutions utilize video game simulators to drill and practice specific skills, such as training jet pilots (Hays, 1992).

As technology develops, the use of video games in educational settings occurs more frequently; video games are being utilized as educational tools to teach students about a particular field using a “hands-on” approach. In a study by Morgan et al. (2002), researchers compared the success of video-assisted learning and simulator-assisted learning. Using final-year medical students, scientists measured differences in pretest and posttest scores between the two groups studying anesthesia techniques. No significant differences were found between the two educational methods, meaning both are equal in their educational benefit; however, students enjoyed the simulator more, which could be attributed to the application of knowledge in a “hands-on approach” (Morgan et al., 2002, p. 14). In that same study, Morgan et al. refer to a 1994 study, Chopra et al., that evaluated the success of simulator education 4 months after the educational session. It revealed that anesthesia residents and faculty performed better in a simulated emergency case than those without simulator training (Chopra et al., 1994). These results suggest that video game simulators prepare individuals to face real world problems better than traditional means through a combination of faculty, volition, and enjoyability. By training and learning real world skills through video games and simulations, we can provide ourselves with better medical, professional, and cultural care.

Conclusion

Video games have measurable effects—physically and cognitively. Video games produce cognitive improvements, e.g. visual attention processes, as well as physical changes, such as the brain areas responsible for processing and learning. However, video games also produce impairments that cause psychological deficits, e.g. inhibition and decision-making skills, from physical effects, i.e. prolonged stress mechanisms. As long as we approach video games in a holistic sense, we can design them to make us smarter and stronger while minimizing negative effects. There are no limits to the cognitive training and learning opportunities created by video games, and they can be developed to improve cognitive resources, such as memory, language, and problem-solving skills. If we can better understand the psychological and physiological effects video games have on humans, then we can design video games that assess players, educate students, and increase the overall quality of our lives.

We can design and create video games that serve a number of purposes. They can be designed to prevent the onset of neurological disorders, impairments, and behaviors as well as to treat physical problems brought about by accidents and illnesses. Depending on the condition, video games can be designed for a specific circumstance or individual. They serve as useful tools to educate and train professionals. Whether medical, military, or anywhere in between, individuals can benefit from video game simulator training on various levels. For example, video game simulations can provide da Vinci surgeons with operational skills and no medical content, medical content with no kinesthetic training, or both skills and content. As well, future video games can serve as powerful pedagogical tools to teach a process, phenomenon, or any particular interest, e.g. an immune response and the immune system. Whether they’re teaching an elementary or college student about history, these video games can be scaled in content, difficulty, and components. These differences could address a range of characteristics, such as age or IQ, and hone in on individual experiences and problems, such as changing a game’s resistance to focus less on competition and more on teamwork. Ultimately, we can study the effects of these games and modulate them to produce the most desirable results.