The Effects of Casual Videogames on Anxiety, Depression, Stress, and Low Mood: A Systematic Review
Abstract
Background: Despite the variety of available treatments for mental health symptoms, many individuals do not engage with treatment and among those who do, dropout rates are often high. Therefore, providing alternative opportunities to access treatment is imperative. Research interest in the therapeutic effects of digital mental health initiatives and serious games has grown in recent years, but the potential of simple, easy-to-use casual videogames (CVGs) that can be played in short bursts of time has seldom been considered.
Objective: The objective of the present study is to provide a systematic review of the literature examining the effects of CVGs on treating anxiety, depression, stress, and low mood.
Method: A systematic search was conducted, using the terms (casual gam* or casual videogam* or mini gam* or minigam* or mini-gam* or gamif*) and (mental health or anx* or depress* or stress or mood) and (study or trial or treatment or prescribed or prevention) as “Title,” “Abstracts,” “Keywords,” or “Topic” words across all years. A Google search was also completed to check for articles that may have been missed.
Results: N = 13 studies met inclusion criteria (no studies were added via the Google search). These studies reported findings for nine different CVGs, with six studies aimed at reducing anxiety, two examining effects for depression, and four investigating the effects of CVGs on treating stress or low mood. Promising effects were identified.
Conclusion: CVGs may have promise for treating anxiety, depression, stress, and low mood.
Introduction
Globally, ∼4.4% of the population is estimated to have depression and 3.6% anxiety disorders.1 Furthermore, depression is the single leading contributor to global disability (7.5% of all years lived with disability in 2015), with anxiety disorder reported as the sixth highest contributor (3.4%).1 As common mental disorders such as depressive disorders and anxiety disorders continue to rise, it is imperative to explore potential treatment approaches.1,2 Cognitive behavioral therapy and selective serotonin reuptake inhibitors, alone or in combination, for those who do not respond to either pharmacological or psychological interventions are often recommended as first-line treatments for anxiety and depression.3 In addition to these approaches, it is important to provide further options that take into account client preferences, treatment availability, and cost to increase adherence and acceptability.4 Alternative approaches such as digital interventions (including online or computerized programs or apps) and serious games show promise for reducing depression and anxiety symptoms.5,6 However, real-world uptake of many evidence-based digital therapies appears disappointing.7
To date, most published research on the positive effects of videogames has focused on the effects of serious games.8 The popularity of these games may be due, in part, to the positive feelings of flow that they elicit. First suggested by Csikszentmihalyi,9 flow can be best understood as a dynamic equilibrium in which the skills of the individual are matched with the rules, goals, and challenges of the game. A promising platform for users to experience flow is through a subset of games known as casual videogames (CVGs). CVGs are quick easily accessible games that are developed across various platforms, such as mobile phones and computers, to increase their availability to users.10 Although there is no single definition of CVGs, they can be best understood as fun, fast to access, and simple to learn games, which require short amounts of time to play and no prior videogame knowledge or skills.11 CVGs are often based around popular traditional games such as chess, Sudoku, or pinball, which have been modernized and modified to fit the electronic climate.12 Typically, CVGs are accessible through social media or mobile device platforms with no cost attached. CVGs can be grouped into multiple categories, including casual action (motor skill), casual puzzle (logic), idle games (observation), and casual strategy games (strategy). Such diversity increases user choice, allowing individuals to select the game that best reflects their current mood or level of interest.
Although many CVGs were developed for teenage users, research indicates that they are popular among people of various ages, genders, and nationalities.11 For instance, among a sample of 263 students with an average age of 20.4 years, Shafter and Carbonara13 found high levels of enjoyment playing CVGs on handheld or console devices. This research is consistent with the growth of the casual game market, in which, for example, the CVG “Angry Birds” reached 1 billion downloads in 2012.14 Similar to other recreational activities, it is possible that the popularity of playing CVGs is due to the fun they elicit.13 With the variety of CVGs available, most people can choose a game that best suits their interests, thus maximizing user's autonomy and enjoyment. Research suggests that individuals who experience mental ill-health-related symptoms can benefit from engaging in pleasant activities.15 Therefore, playing a CVG may provide a similar experience of helping elevate some mental distress.
Emerging research suggests that some people play CVGs to relieve stress and improve their mood.11,16 In an online survey of 833 users of online CVGs, participants were asked to answer questions focused on recovery experiences and playing games at work. Reinecke17 reported that participants who play casual games noted a considerable increase in recovery experience from playing games, and those participants who reported higher levels of work-related fatigue displayed an increase in motivation to play games during work hours. Similarly, in another online survey of 1614 participants, Reinecke18 suggested that participants who reported improved recovery experiences from gameplay used games more often after stressful and exhausting situations. While researchers are yet to fully understand any therapeutic potential of CVGs,19 these games often include social and competitive components that may create support and social capital as well as elicit flow states for mediating recovery experiences from daily hassles and stressful situations.20,21
These findings alongside the popularity of CVGs suggest that CVGs might form a useful addition to the suite of available interventions for some individuals19 and this is a promising area for further study.13,18,19 However, there has been limited research in the area to date, and to the best of our knowledge, no systematic reviews have been published. We aimed to systematically review the literature regarding the effects of CVGs on treating anxiety, depression, stress, and low mood.
Method
Search strategy
A systematic search of the literature was performed in the electronic databases PsycINFO, Web of Science, and MEDLINE. The main search terms were (casual gam* or casual videogam* or mini gam* or minigam* or mini-gam* or gamif*) and (mental health OR anx* or depress* or mood or stress) and (study or trial or treatment or prescribed or prevention) as part of the “Title,” “Abstracts,” “Keywords,” and “Topic” across all years. A Google search was also completed to ensure that potentially relevant studies not included in the above databases were considered, although no studies were added as a result of this search. As this review focuses on an emerging field of research, it was important to ensure that articles published across a range of years were considered to inform the background and discussion. It was also essential to ensure that all significant articles were considered, thus a range of sources were used. Initial screening involved reading the title and abstract of each study. For instances in which more information was required to determine a study's suitability for inclusion, the full text was retrieved and read.
Inclusion criteria
To avoid risk of bias, PRISMA recommendations for systematic literature analysis have been followed. Two authors independently analyzed the full articles that met the inclusion criteria and no discrepancies were found. Studies were included if they (1) were written in English, (2) met the definition for a CVG, and (3) described a trial or study that investigated the effects of a CVG to treat, restore, or prevent symptoms of anxiety, depression, stress, and low mood. As research on CVGs is still in its infancy, few inclusion criteria were specified to develop a broad and appropriate set of studies to examine. All study designs were selected as long as at least one outcome measure was used and the CVG could be delivered on any digital technology, such as a smartphone or computer.
Exclusion criteria
First, studies were excluded if they focused on games that did not meet the definition of CVGs (i.e., easy to learn games that require short amounts of time to play with no prior game knowledge or skills). When a study did not specify the game type in the abstract and appeared a potential fit for the inclusion criteria, the full text was reviewed. Second, studies that were not aimed at examining the effects of CVGs on anxiety, depression, stress, and mood were excluded. For example, studies on the brain training cognitive process and studies of substance abuse, dementia, Alzheimer's, schizophrenia, Parkinson's, and gambling were excluded. Finally, articles that were not written in English were excluded.
Results
Figure 1 shows a flow diagram of the selection process. The search identified over 900 studies, from which duplicates were removed and remaining abstracts read. Twenty-one articles were identified as potentially relevant to the current review. To ensure the study used a CVG and was aiming to examine the effects of CVGs on symptoms of anxiety, depression, stress, and low mood, articles were then read using the inclusion and exclusion criteria. Four studies used a serious game, two targeted gambling, and two examined the effects of CVGs on cognitive functioning. After excluding these studies, 13 studies remained. From these articles, the following information was collected: authors, publication year, CVG, participant number, outcome measures, treatment topic, game characteristics, game mechanics, intervention length, and comparison treatment (Tables 1 and 2).

Description of casual videogame |
“Bejeweled 2” is a matching and sequencing game, in which users swap gems with adjacent ones of the same color to form chains and earn points. Several modes of game play are available, including many secret modes accessed by beating levels of Classic, Puzzle, Endless, Blitz, and Action modes. Good play requires perception and planning. |
“Personal Zen” is a gamified attentional bias modification training (ABMT) app involving two animated characters who are smiling or frowning. Shortly after they appear, both characters burrow into a hole with the happy face causing a path of grass to rustle behind it. Users must trace the path of the rustling grass with their fingers, beginning from the burrow. Good play requires memory. |
“Plants vs. Zombies” requires players to prevent a herd of zombies reaching the user's house using various virtual plants and fungi, which have different offensive and protective properties. Multiple layout types and modes are available, including Adventure mode, Mini games, Puzzles, Survival, and Zen garden. Good play requires planning, strategy, and spatial logic. |
“Bubble Shooter” incorporates both puzzle and shooter elements. The primary aim is to collect as many points as possible by bursting colored bubbles. To burst the bubbles, users must connect at least three bubbles of the same color. Good play requires precision and planning. |
“Peggle” comprises 55 levels with ∼100 blue pegs positioned to correspond with each level's background picture. In each level, users must clear the board of the randomly assorted pegs. If the player does not clear the board with the selected number of balls, they must restart the level. Good play requires planning. |
“Bookworm Adventures” is designed around forming words through a grid of available letters. On each turn, players can form a single word, while enemies use one of their available attacks to injure Lex, the bookworm, or manipulate the tiles in the grid. After players have won a certain number of battles, a “boss of increased difficulty” appears. Good play requires perception and planning. |
“IMPACT” uses a novel visual search training paradigm, Intrinsically Motivating Playable Attentional Control Training (IMPACT). In IMPACT, smiling and disgusted faces drift downward on the computer screen. To score points, participants must click on faces of one valence before the faces reach the bottom of the screen. Good play requires perception and precision. |
“Sushi Cat 2” is a simple CVG in which players must feed the sushi cat as many pieces of sushi as possible. To collect all the sushi, the cat must drop into the pegs and platforms. Good play requires precision, perception, and planning. |
“Frozen Bubble” involves firing a small cannon that shoots bubbles of different colors into a playing area. The objective is to remove all the hanging bubbles by grouping three or more bubbles of the same color, causing them to burst. Good play requires precision and planning. |
First author and year | Casual videogame | Aim | Population (N) | Outcome measures | Results | |
---|---|---|---|---|---|---|
1. | Fish et al. (2018) | “Plants vs. Zombies” | To compare a prescribed regimen of 30–45 minutes of CVG play with an SSRI medication with a traditional two-medication regimen for decreasing symptoms of state anxiety and trait anxiety | Psychiatrists treating adult clinical populations approached participants. Fifty-four met the criteria and participated in the study. | The State–Trait Anxiety Inventory (STAI) | Playing a CVG under a prescribed condition of reduced state anxiety symptom severity and had a medium effect on trait anxiety compared with the medication-only intervention. This significant decrease in state anxiety scores was found after the 1-month prescription of CVG play. |
2. | Fish et al. (2014) | “Bejeweled 2,” “Peggle,” and “Bookworm Adventures” | To determine the effects of CVG play when used as a prescribed intervention three times per week for 30 minutes over a 1-month period for reducing symptoms of anxiety in a depressed population. | Fifty-nine participants were recruited through word of mouth and a recruitment flyer distributed to local mental practitioners. | STAI | The prescribed regimen of CVG play reduced anxiety symptom severity. Furthermore, participants played an average of 10.7 minutes longer than prescribed. |
3. | Russoniello et al. (2013) | “Bejeweled 2,” “Peggle,” and “Bookworm Adventures” | To examine whether a prescribed regimen of CVG play for at least 30 minutes three times per week for 1 month could reduce symptoms associated with depression. | Fifty-nine participants were recruited through word of mouth and distributing a recruitment flier to possible referral sources. | PHQ-9 | A prescribed regimen of playing CVGs significantly reduced symptoms of clinical depression. These results were found during the study and at the end of the 1-month study. |
4. | Horovitz et al. (2016) | “Bubble shooter” | Researchers aimed to test the effects of a single-session attentional bias modification training (ABMT) game in reducing state anxiety among a nonclinical population while waiting for a dental procedure. | Seventy-one participants who were seeking treatment in a private dental clinic took part in the study. | Modified dental anxiety scale (MDAS), STAI, and overall subjective evaluation scale | Distraction tasks such as a CVG have a better immediate effect than ABMT in alleviating state anxiety in nonanxious individuals awaiting a dental appointment. |
5. | Russoniello et al. (2009a) | “Bejeweled 2,” “Bookworm Adventures,” and “Peggle” | To test the brain and heart rate effects of CVGs on mood and stress by comparing people playing CVGs with control subjects under similar conditions. | A total of 134 participants were recruited through fliers around the campus community and consisted of students, faculty members, and staff at the university. | Electroencephalography (EEG) and heart rate variability (HRV). | “Bejeweled 2” decreased left alpha brain waves associated with a decrease in withdrawal and depressive-type behaviors. “Peggle” increased right alpha brain wave activity associated with excitement or euphoric behaviors. “Bookworm Adventures” increased the stability of alpha brain waves between the left and right sides of the brain. |
6. | Russoniello et al. (2009) | “Bejeweled 2” | Investigated EEG, HRV, and psychological correlates while playing a specific CVG called “Bejeweled 2.” | Sixty-nine participants were included in the study. | Profile of mood states (POMS), EEG, and HRV. | Researchers reported that playing a CVG such as “Bejeweled 2” can increase mood and decrease stress. More specifically, EEG and HRV parameters reported changes associated with improvements in mood. |
7. | Russoniello et al. (2019) | “Plants vs. Zombies” | To compare a prescribed regimen of 30–45 minutes of CVG play with a second antidepressant medication regimen for decreasing treatment-resistant depression symptoms (TRDS) and improving HRV. | Forty-nine participants who were actively taking a prescribed antidepressant and had expressed concerns after follow-up evaluations took part in the study. | Quick inventory of depressive symptomatology (QIDS), PHQ-9, and HRV. | A prescribed dosage of CVGs outperformed the second antidepressant medication regimen in the clinical trial. A single 30-minute session of playing the CVG was significantly more effective in reducing TRDS when compared with the antidepressant medication. |
8. | Rupp et al. (2017) | “Sushi Cat 2” | To investigate the effects of a passive break, relaxation activity, and CVG on affect, stress, engagement, and cognitive performance. | Sixty-six undergraduate students took part in the study for course credit. | Affective and cognitive assessments (ACA). These included the Positive and Negative Affect Schedule, shortened version of the Dundee Stress State Questionnaire, and backward digit span | Playing the CVG showed greater engagement and affective restoration than the relaxation condition. The break condition slightly decreased affect and prevented cognitive restoration. Playing a CVG even briefly restored individuals' affective abilities. |
9. | Pieters et al. (2016) | “IMPACT” | To explore the effects of a visual search ABM game, called “Intrinsically Motivating Playable Attentional Control Training” on attention bias processes and mood in undergraduate participants. | Fifty-eight undergraduate students participated in study 1 and 82 in study 2 for financial compensation | Mood and Anxiety Symptoms Questionnaire (MASQ), emotional visual search task (EVST), Ruminative Response Scale (RRS), and visual analog scales (VASs) | Although training performance significantly improved, researchers were unable to show direct effects of ABMT on attention patterns or stress levels. |
10. | Dennis-Tiwary et al. (2016) | “Personal Zen” | To investigate the effects of a gamified ABMT for reducing anxiety among trait anxious adults. | Forty-two undergraduate students were recruited from a university and through Craigslist. | STAI, EEG, POMS, Beck Depression Inventory II (BDI-II), Social Stress Test (TSST), and dot probe task. | Results demonstrate that a single session of gamified AMBT improved performance during an anxiety-related stress task only among females. |
11. | Dennis-Tiwary et al. (2017) | “Personal Zen” | Researchers tested whether a gamified ABMT could reduce prenatal threat bias, anxiety, and stress among 29 women who were in their 19th–29th week of pregnancy. | Study recruiters asked women who were receiving prenatal treatment from a hospital who were between their 19th and 29th week of pregnancy. Twenty-nine women agreed to participate. | The Depression, Anxiety, and Stress Scale (DASS-21), the Hamilton Anxiety Scale (HAM-A), TSST, dot probe task, cortisol, and EEG. | Results showed lower levels of threat bias and laboratory cortisol following ABMT versus placebo training. Although the main effect was not significant and varied with individuals, the use of the ABMT game reduced biobehavioral indices of prenatal stress and anxiety. |
12. | Dennis and O'Toole (2014) | “Personal Zen” | Examined effects of a gamified ABMT game among highly trait anxious participants. | Seventy-eight undergraduate students were recruited and met the criteria for the study. | STAI, POMS, BDI-II, TSST, and dot probe task. | One session lasting 25 minutes of the active compared with placebo training reduced subjective anxiety and observed stress reactivity. |
13. | Parnandi and Gutierrez-Osuna (2017) | “Frozen Bubble” | Examined the effectiveness of a breathing-based CVG under three different biofeedback modalities for reducing stress and promoting relaxation. | Twenty-five participants aged between 19–33 years took part in the study. | Electrodermal activity, HRV, and breathing rate. | Results show that a breathing-based game with biofeedback (BR-GBF) is more effective than the other groups in terms of lowering arousal during the treatment and transferring relaxation skills to a subsequent acute stressor. |
CVG, casual videogame; SSRI, selective serotonin reuptake inhibitors.
Participants
The number of participants in each study ranged from 25 to 134. Some studies recruited participants who reported high levels of anxiety and depressive symptoms, while others recruited participants who reported no psychological distress. None of the studies recruited young people or older adults.
Study design
Most studies used a randomized-controlled research design16,19,22–24 to investigate the effects of CVGs on anxiety, depression, stress, or mood symptoms. Fish et al.25 employed a quasi-experimental design with participants who had been diagnosed with clinical depression. Data were collected across two studies. Russoniello et al.26 conducted one clinical experimental study, a randomized controlled study,27 and one quasi-experimental study28 where participants self-selected a second antidepressant or a prescribed regimen of CVG play. In another study by Pieters et al.,29 participants were nonrandomly assigned, threatening the validity of findings.
Outcome measures
Included studies used a variety of outcome measures, with some commonalities across studies. For instance, five studies used the STAI19,22,23,25,30,31 to record state and trait anxiety before and after the intervention. The PHQ-926,28 was used to measure depressive symptoms in two studies. Biofeedback was used as an outcome measure in one study.24
Health condition
Studies included in the search investigated a number of different conditions. Seven primarily focused on investigating anxiety symptoms, four were aimed at reducing stress and low mood, and two measured depressive symptoms.
Effectiveness
Twelve studies reported improvements in the outcome variables after participants played the CVG. Specifically, CVGs were reported to be superior for reducing anxiety when compared with a waitlist condition, two-medication regimen, placebo training, and a specific dental ABMT. These results were reported across participants who reported some and no mental ill-health symptoms.19,22,25 In the studies by Dennis and O'Toole30 and Dennis-Tiwary et al.,23 the ABMT game was reported to demonstrate significant improvements in state and trait anxiety. In contrast, Pieters et al.29 examined the effects of a novel ABMT game to reduce negative bias and reported no significant group differences after playing.
Discussion
We systematically reviewed studies investigating CVGs for treating anxiety, depression, stress, or low mood. Previous systematic reviews have reported promising results for serious games for psychotherapy and videogames for emotional regulation,33,34 but to our knowledge, this is the first review to focus on CVGs. Although the therapeutic mechanisms of CVGs have yet to be fully examined and understood, taken together, this small set of studies using a variety of research methods justifies further attention to their therapeutic effects.
First, 12 of the 13 articles reviewed reported improvements in outcome measures after participants played a CVG. Of these, we found that some studies reported a reduction in anxiety and depressive symptoms after a single session of CVG play lasting ∼30 minutes.19,28,31 Considering how readily available and inexpensive CVGs are, these emerging results from a single session of CVG play are promising. Moreover, while Pieters et al.29 did not report any significant effects for participants after playing “IMPACT,” researchers reported possible explanations for their findings such as methodological issues recording attentional biases.
Second, the CVGs reviewed shared similar game characteristics. For example, “Bejeweled 2,” “Frozen Bubble,” and “Peggle” used a variety of bright colors and involved immediate feedback, clear goals associated with tasks, repetitive movements to earn points, and progress through the game at an increasing level of difficulty. These characteristics align closely with the characteristics thought to induce flow.9 Research suggests that when a person is in a state of flow, their attention is allocated to the demands of the task at hand, prohibiting the simultaneous experience of anxiety.9,25 Therefore, it is possible that the therapeutic effects described in the reviewed studies may be due, in part, to the CVG's ability to match player's current skill level, promoting their experience of flow states. In addition, Horovitz et al.22 reported the immediate effects of participants playing a CVG for distraction purposes while waiting for the dentist. Interestingly, the nature of CVGs may appear to promote opportunities for individuals to distract themselves from an anxiety-provoking situation by engaging in an intrinsically rewarding CVG that captures their attention.35
Third, although the included studies ranged in size, varied in time spent engaged in a CVG, and used different outcomes, triangulation of the results is possible. Findings can be considered more valid if they remain consistent across multiple research methods as the blind spots inherent to any one approach can be illuminated by others.36 This appeared true in the case of Russoniello et al.27 who reported therapeutic physiological changes in the brain while participants played a CVG. Specifically, participants demonstrated decreased left frontal alpha brain waves suggestive of improvements in mood.37 The effects of CVGs for improving mood are similar to that of the studies by Fish et al.19 and Dennis-Tiwary et al.32 who found a reduction in anxiety symptoms, as measured by the STAI. Moreover, Fish et al.25 used qualitative methods to gain insight into the flow state experienced by participants while playing CVGs. Participant comments included “That was a fun challenge,” “I want to keep playing,” and “I felt focused the entire time.” Convergent positive findings across physiological, psychological, and qualitative methods suggest that more research into the therapeutic potential of CVGs is warranted.25
Four, although the game characteristics shared similar features, the purpose of the identified CVGs was different. Specifically, the purpose of the CVGs can be broken down into two primary categories: games designed around psychological processes to develop skills such as ABMT (e.g., “Personal Zen” and “IMPACT”) or biofeedback CVGs24 and CVGs designed primarily for enjoyment purposes (e.g., “Plants vs. Zombies” and “Bejeweled 2”). Of the reviewed studies, six studies used an ABMT or biofeedback,22–24,29–31 while seven used CVGs designed for enjoyment purposes.16,19,25–28,32
The games identified represent a variety of play styles, core mechanics, and challenges. Like most CVGs, there is an emphasis on perceptual skill and precise motor movement as the primary challenges. The deeper games that include strategic elements for advanced play, such as “Plants vs. Zombies,” include these complex elements to extend game play beyond the first few hours of play. The range of physical skill and cognitive planning suggest that it is not one specific modality of play or skill demanded of the player that is having a beneficial effect. This may suggest that the benefits could be linked to the combination of engagement, cognitive, and physical challenges paired with a clear reward for success, which is common to these games.
Finally, the reviewed studies reported high participant adherence to CVG play.19,27,32 This was after many studies prescribed a dosage of CVG play for 30 minutes three times a week for 1 month.12,19,25,26,28,32 For instance, Fish et al.25 adopted this regimen of CVG play and reported that on average, participants played over 10 minutes longer (41.1 minutes) each session. Research suggests that it is important that individuals with mental ill-health-related symptoms are offered a variety of treatment options to promote their autonomy and adhere to their treatment plan.38 Some studies offered a choice of CVGs and it is possible this approach offers an appealing option, which aligns with individual's needs and preferences. Moreover, when people actively contribute to their treatment plan, they often report improved outcomes such as reduced anxiety and stress-related symptoms.39 With estimates of nonadherence to medical treatments reported at 50%, it is important to identify a range of treatments to provide alternative options and ensure high levels of participation in the treatment process.40
Although small in nature, this set of studies showed promising results, particularly for increasing acceptability toward a regimen of CVGs targeted at reducing anxiety, depressive, mood, or stress-related symptoms.28,32 Furthermore, as collaboration is an essential component of the treatment process, there is room for development of alternative approaches to therapeutic interventions for mental ill-health.41 CVGs, which appear to show promising therapeutic benefits and high acceptability, may be an additional low-cost tool that can be used to support some individuals.
Several limitations must be considered. First, we limited our search to articles published in English, therefore some potentially relevant articles may not have been considered. Second, to focus on the effects of CVGs on mental health, we excluded studies focused on games aiming to train cognitive functions. Recent studies have suggested that training cognitive control and executive functioning show promise for reducing depressive symptoms and disorders that are characterized by intrusive thoughts.42 This is an emerging field of research similar to the current set of studies examining the effects of CVGs on mental health. Future research may look at combining the therapeutic effects of CVGs with those of cognitive training techniques. It is also important to note the key words that were used in the search. As the term CVGs has many definitions, it is possible we did not identify all similar related games.
It would also be interesting to consider the therapeutic potential of CVGs among different populations, such as youth. Mental health problems are common in this population, affecting at least one in four young people.43 Moreover, 13–34-year-olds make up 29% of mobile gamers worldwide.44 Taken together, young people's high levels of engagement with CVGs, the need to address mental ill-health in this population, and the potential therapeutic benefits of CVGs point to a promising research direction. Future studies could extend those considered in this review by including adolescent populations. In addition, although no study reported any side effects from playing CVGs, it would be interesting to investigate the long-term effects of playing these games. Whether or not their therapeutic effects could be maintained is yet to be investigated.
Conclusion
Although, evidence-based treatments exist, there is no one size fits all solution for treating mental health symptoms.41 Furthermore, as common mental health disorders are becoming increasingly prevalent and contribute to losses in both health and functioning, it is imperative to explore a range of therapeutic options.1 CVGs are becoming increasing popular and people report playing them for a range of reasons, such as to relieve stress and relax.17,18 As one of the studies highlighted, health care practitioners could consider identifying a regimen of prescribed CVG play to supplement existing medication or other treatment options. This is particularly beneficial for those who may wish to engage with additional supports or are waiting to access treatment. The limited array of research findings from the current systematic review does not allow us to draw decisive conclusions about the therapeutic effects of CVGs. However, this review suggests that CVGs may have promise for treating anxiety, depression, stress, and low mood.
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Published ahead of print: 13 February 2020
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