Fantasy: Kay, a lonely woman who has morphed into a monster, struggles to make her way through a flooded city…while around her, scary monsters shout hurtful personal insults. Reality: Kay is you…and this is a video game. But unlike with other kinds of video games, playing this game can help the player cope with a mental illness.

The video game is Sea of Solitude, a puzzle-adventure game released in 2019 by top gaming company Electronic Arts. It is one of a growing genre of video games that creatively—and compassionately—depict symptoms of mental illness. While not specifically designed for therapeutic use, mental health therapists and their patients are finding that playing such games as a part of therapy can help patients suffering a variety of mental illnesses better cope with their illness. People who have anxiety, depression and post-traumatic stress disorder (PTSD), and the loneliness and isolation that often accompany these illnesses, can benefit.

While it’s true that video game addiction has been identified as a mental illness, using video games to help with mental health disorders makes sense. Gaming can help patients more freely express themselves without being hindered by outside pressures. Getting lost in a fantasy world allows a gamer to “get out of” his/her own head in a sense—something a person struggling, for instance, with depression or generalized anxiety disorder can have a hard time doing. Video games can give a player a greater sense of control than he/she might feel in real life. Both a break from negative ruminating thoughts…and feeling in control, even if it’s only virtual, can reduce anxiety and depression. Some games allow a patient to “socialize” with other players behind the safety of a character, which can help him/her segue to real-time socializing with other people. Plus, observing the patient’s interaction with a game can help the therapist better understand what is going on with the patient.

What the Science Says

There is a long history of specialized video games of all kinds that have been developed for various reasons—such as educational children’s games and simulation training games—and research supports their effectiveness. While not many games have been studied for their mental-health benefits, research has found some mental-health benefits for gaming. For instance, a study from Oxford University found that playing a video game immediately after a traumatic experience can prevent the development of PTSD. The researchers believe that engaging in a visual spatial task such as a video game interferes with the brain’s ability to create a memory of the traumatic experience by overriding the tendency to obsess on what happened—which staves off the flashbacks that are hallmarks of PTSD.

• A study from MacEwan University in Canada found that soldiers who spent long hours playing games such as the war games Call of Duty: Modern Warfare 2, America’s Army and Battlefield: Bad Company 2 and the fantasy game World of Warcraft were less troubled by nightmares about their time in combat and were more mentally well-adjusted in waking life…while soldiers who did not play video games as much experienced more distress from nightmares and were angrier, sadder and more fearful in waking life.

• Another study found that playing a game called Plants vs. Zombies for 30 to 45 minutes four times a week for four weeks was as effective as adding a second antidepressant for people with treatment-resistant depression who weren’t experiencing relief with just one drug.

Could a Video Game Help You?

A video game can’t actually treat a mental illness, but certain kinds of games can help sufferers cope with some of the symptoms of, for instance, depression, anxiety or psychosis. Below are examples of types of games that can have mental health applications. Some are playable on desktop computers or laptops, but some need to be played on a console…

• Games that involve role-playing (examples: Depression Quest, World of Warcraft)

• Fantasy adventures (example: Sea of Solitude)

• Simulation of psychosis symptoms, such as visual distortions, voices and delusions (example: Hellblade: Senua’s Sacrifice)

As more research helps to establish its benefits, gaming is likely to become a more common mental health treatment tool…as an adjunct to traditional therapy such as cognitive behavioral therapy (CBT) and/or medication or potentially used on its own. In the meantime, if you want to give gaming a try, a therapist should guide you in choosing the game that will most likely be beneficial and the best way to use it.

Note: Gaming is not suitable for everyone, as some kinds of video games may exacerbate mental illness for some people. Nor should gaming be a substitute for therapy or other treatments advised or prescribed by your mental health professional.