Pac Man isn’t a psychiatrist, Sonic the Hedgehog isn’t a licensed counselor, and it’s unlikely that the cast of Grand Theft Auto would made productive contributions to a group therapy session, yet despite their decidedly non-clinical foundations, video games may soon play a crucial role in schizophrenia treatment.
Several studies suggest that certain types of video games may improve cognitive functioning among people diagnosed with schizophrenia. As researchers Clélia Quiles and Hélène Verdoux wrote in a 2023 literature review on this topic:
“Video gaming may contribute to better functional outcome and quality of life in patients suffering from cognitive impairments and difficulties in social functioning. Persons with schizophrenia may benefit from using commercial video games because of their potential therapeutic impact on functioning and cognition.”
Video Games and Schizophrenia: Tools to Train Your Brain
It’s been more than 50 years since Pong machines appeared in arcades around the world, fueling a fervor that continues to this day.
The player experience has advanced substantially since those early days of batting an electronic blip back and forth across a black-and-white screen. Video games have morphed from an activity for children and adolescents into a global entertainment phenomenon for people of all ages.
Through the decades, we’ve learned these immersive, interactive games are effective tools for learning. For example:
- Football coaches encourage players to use EA Sports Madden to enhance their understanding of the game.
- Teachers use video games such as Minecraft to help students grasp key concepts and develop new skills.
- The U.S. Army has used several video games to train soldiers, teach military history, and maintain mission readiness.
We should also recognize that training tools such as flight simulators – used to train critical personnel from fighter pilots to astronauts – are basically high-end video games designed for specific purposes.
A 2015 cybersecurity training report from Carnegie Mellon University noted that:
“Gaming can be used as a tool to train your brain and can be used to teach basic quantitative and qualitative skills such as math and language. Furthermore, games can also serve to enhance proper cooperative behaviors and relieve stress.”
Improving Cognition in Schizophrenia Patients
In May 2024, the journal Translational Psychiatry published a study conducted in Germany that explored the cognitive impact of video games on people with schizophrenia.
The study involved 135 adult participants, including 59 with schizophrenia or schizoaffective disorder and 76 with no history of mental illness.
All participants in the schizophrenia/schizoaffective group were patients in the psychosis ward at University Medical Center Hamburg-Eppendorf. They’d achieved clinical stability, but still experienced what the researchers described as “residual symptoms.”
They completed several cognitive and clinical assessments to establish baseline scores prior to starting the study. They also underwent functional magnetic resonance imaging (fMRI) evaluations at the outset and conclusion of the study.
Over a period of eight weeks, each participant spent about 30 minutes per day playing:
- Super Mario 64, a 3D video game
- New Super Mario Bros, a 2D video game
- Reading an e-book
The researchers referred to both types of games as action/platform video games, or APVGs.
Here’s what assessments at the end of the eight-week study period and two months after the study ended revealed.
Impact of Playing Video Games on Schizophrenia
- Members of both video game groups showed improvements in sustained attention.
- Psychosis patients in the video game groups experienced fewer negative symptoms as well as improvements in both depression and anxiety as scored on the Positive and Negative Syndrome Scale (PANSS).
- Members of the video game groups with schizophrenia and schizoaffective disorder reported they felt better about their mental health after completing the study.
- Improvements in the video game groups were consistent, regardless of the type of game
- fMRIs showed evidence of greater functional connectivity between the hippocampus and prefrontal cortex in both video game groups
The hippocampus is closely involved in memory and learning, while the prefrontal cortex controls functions such as emotions, attention, inhibition, and complex learning. Connectivity improvements in the two brain regions could be particularly significant, as previous researchers have identified dysfunction in these areas as risk factors for schizophrenia.
Here’s how the researchers summarized their findings:
“This is the first study providing evidence that playing an APVG reduces global and negative symptoms in patients with schizophrenia, rendering APVGs a possible therapeutic intervention for this and possibly other diseases.”
Reducing Auditory Hallucinations
The study above may have been the first to document improvements in negative symptoms and overall mental health after playing video games, but it was not the first effort to explore the benefits of video games for people with schizophrenia.
In February 2018, a team from King’s College London published a pilot study that used a video game involving a rocket to help people with schizophrenia minimize auditory verbal hallucinations. These hallucinations involve hearing voices that patients may believe emanate from an external source or from inside their own head.
This research also incorporated neurofeedback, a therapeutic technique that uses real-time information from the brain to help patients exert greater intentional control over brain activity.
The basis for this study included:
- Prior research showing auditory verbal hallucinations (AVHs) result from increased activity in the left posterior superior temporal gyrus (STG). This brain region is essential for processing speech and language.
- About 70% of schizophrenia patients experience AVH, and 30% of this group receive no benefit from traditional antipsychotic medications.
This new study involved:
- Watching a screen with a computer-generated rocket while connected to an fMRI imaging device.
- Learning to control the altitude of the rocket by down regulating their left posterior STG.
Researchers instructed participants to find a way to land the rocket by reducing activity in this brain region.
After completing four sessions in the MRI scanners over a two-week period, most of the participants learned to land the rocket by consciously limiting activity in their left posterior STG. They also learned to exercise this level of control without the visual cue of the rocket, which is essential for transferring this skill from a clinical environment to their everyday lives.
In a news release about the research, study author Natasza Orlov, PhD, said:
“We encouraged our patients to use the same control strategies that they learnt in the MRI scanner at home. The patients know when the voices are about to start – they can feel it, so we want them to immediately put this aid into effect to lessen them, or stop the voices completely.”
Potential Impact
Schizophrenia is a relatively rare disorder. Experts estimate that it affects 0.2-0.64 percent of adults in the United States. To put this rate into context, about 29 percent of U.S. adults have a diagnosis of depression, and about 31 percent will have an anxiety disorder at some point in their life.
However, while schizophrenia is not as widespread as other mental health conditions, its effects can be devastating. For example:
- A 2021 study found that schizophrenia is “by far [the] most disabling psychiatric condition” in the world.
- About 50% of people who receive inpatient psychiatric care have schizophrenia.
- Research indicates that about 10% of people with schizophrenia will die by suicide and an additional 20%-50% will attempt to end their lives. In 2021, the age-adjusted suicide rate among the general public in the U.S. was 0.41%.
- The life expectancy of people with schizophrenia is more than 14 years shorter than those who don’t have it.
Protecting people with schizophrenia from these negative outcomes will require more than the innovative use of video games. But every evidence-based advancement in understanding and treating schizophrenia offers great promise for people who have not benefitted from traditional medications and therapies.
Find Help for Schizophrenia in Southern California
If someone in your life experiences acute symptoms of schizophrenia or another complex mental health disorder, Crownview Psychiatric Institute is here to help.
Our treatment center in Oceanside, California, is a welcoming place where your loved one can receive personalized care and comprehensive wraparound support from a team of skilled professionals.
At CPI, we’re committed to helping our patients achieve greater independence and improved quality of life. We understand that success can look very different from one person to the next, and we focus on developing the customized solutions that align with each patient’s unique history, strengths, and needs.
To learn more about our programs, services, and treatment philosophy please visit our Admissions page or call us today.
Gianna Melendez
Jodie Dahl, CpHT