I design games. I've also used games to disappear. Both things are true, and I don't think you can talk honestly about games and mental health without holding both.
So, are video games good for your mental health? They can be. A good game gives your brain a clear goal and instant feedback, which is more than most of daily life offers. For an anxious or autistic brain, a world with rules you can actually learn is a relief. There's even a bit of real research. But games are not treatment, and anyone who's played "one more turn" until 3 a.m. knows they can eat you.
Why do games make me feel better?
When you design games, you spend a lot of time asking why something feels good to play. Here's where I've landed.
The rules are knowable. Real life runs on unwritten rules that I've spent fifty years failing to decode. Games write the rules down. Do this, get that. If you lose, you can usually see why. For me that's soothing in a way it's hard to explain to people who never found social life confusing.
The feedback is honest. You get better, the game shows you. You mess up, the game shows you that too, and then it lets you try again in four seconds without anyone sighing.
And a game that takes all your attention leaves nothing left over for the 2 a.m. replay of every conversation you've ever botched. That's the same reason hobbies and special interests help me.
None of this is magic. It's just a break from the noise, and sometimes a break is exactly what's needed.
Can Tetris really help with trauma?
This one gets overhyped online, so let me be careful.
In a 2018 trial led by Oxford researchers, people who'd just been in a car crash were seen in the emergency department. Within six hours, one group got a short reminder of the crash and then played Tetris for about twenty minutes. The other group did something else. In the first week, the Tetris group had fewer intrusive memories of the crash.
That's genuinely interesting. Here's what it doesn't say: it doesn't say Tetris treats PTSD. The effect showed up on intrusive memories in the first week and not on other symptoms or at one month. It was a narrow, early, specific protocol.
My takeaway is smaller and more practical. A game that fills your visual attention can push intrusive pictures out for a while. If your brain is replaying something awful, a block-dropping game can be a decent pressure valve. If you've been through something traumatic, that's a reason to get real help, not a replacement for it.
Tetris Effect: Connected
My take. Play counts. Tetris even has trial data on reducing intrusive memories right after a trauma. Mostly, it just quiets the noise.
Good to know. Not a PTSD treatment. The study was narrow.
Games that are actually about mental health
Most games use mental illness as a horror prop. Celeste doesn't.
It's a hard little platformer about a young woman named Madeline climbing a mountain, and the main obstacle is a version of herself, "Part of Me," who is basically her anxiety and depression given a body. The game's creator has talked about how making it changed how she looked after herself, and there's academic work on how the game models coping. Nobody should mistake it for therapy. Still, it's rare to see a game treat a panic attack with that much care. It's really hard, too. Turn on Assist Mode if you need it. Nobody is grading you.
Full disclosure: I make games too. My own, P.A.T.H.: Vietnam, is a solo roleplaying game where you live a soldier's tour, one shift at a time: the daily routine, the choices, the bonds with your squad, the values you hang onto when it gets hard. There's no score. The goal is to make it through. Making it through something hard, one day at a time, is something I know a bit about.
P.A.T.H.: Vietnam
P.A.T.H. Games
My take. Yes, it's mine. A solo RPG where you live a full tour with Bravo Company, 2/22 Infantry, in 1967-68, four shifts a day. The daily routine, the choices, the history, the bonds with your squad, and what you hold onto when it gets hard. No score, no winning. The goal is to make it through.
Good to know. Full disclosure: I made it. It's about war, so it gets heavy. Plays on phone, tablet or computer, with an internet connection.
When gaming becomes hiding
Here's the other half.
I've used games the same way I used other things in my life: to shut my head off and get away from people and problems. The difference between "I'm relaxing" and "I'm disappearing" is invisible from the couch. I haven't touched cocaine or heroin in sixteen years, and I can tell you the part of the brain that wants more doesn't really care what the more is. I wrote about that in self-medicating undiagnosed autism.
Some signs it's tipped over, in my experience:
- You play to avoid something specific, a conversation, a bill, a feeling.
- Sleep is getting shorter and you're lying to yourself about why.
- The people you live with have stopped asking you to do things.
- Stopping makes you irritable in a way that feels out of proportion.
If that's you, it's worth talking to someone. Gaming can become a compulsion like anything else, and it often sits on top of anxiety or depression that deserves its own attention. Also watch for games built around loot boxes and spending, because those are designed to hook you, not to help you.
Games that get you out of the bubble
The thing I'd push hardest is co-op play.
I'm socially awkward. I can run a room, and my close friends still live hours away. Sitting across a table from someone with a co-op board game is one of the easiest ways I know to be with people without all the improvised small talk. The game gives everybody a shared problem and a script. You talk about the game. The connection sneaks in sideways.
Games like Pandemic, The Crew, Hanabi or Forbidden Island have everyone on the same side, which takes the edge off. If making friends after 50 feels impossible, a weekly game night might be the least scary door in.