This excerpt is taken from Kent Schornack’s article “Gaming and Mental Health” in LRP Media Group’s Academic Esports Guide. The complete article can be found here.
Nearly 200 universities had collegiate varsity esports programs in heading into 2020, and the industry is growing at breakneck pace.
This growth rate likely will become even more intense as esports provide a unique and low-cost opportunity for high schools to provide a new opportunity for students who do not typically participate in traditional sports, as well as universities and colleges at all levels to enhance their enrollment pipelines in a higher education market that is increasingly desperate to attract and recruit new students.
The fast-growing realm of esports presents administrators and esports coaches and directors a unique opportunity, and responsibility, to support the well-being and growth of their players. Understanding the mental health implications of the sport is a key aspect in fostering student development and helping gamers to achieve their personal best.
As with all trends and activities, esports presents potential benefits and harms depending on how the gaming environment is engaged and coached.
Many players report their gaming participation has helped them with issues of social isolation and anxiety by giving them a more comfortable and structured means to interact and develop relationships. At the same time, concerns center around inordinate hours spent gaming and the potential of addiction, negative mental health effects, and the physiological impact of gaming on the brain.
Although these worries are not novel, the explosive growth of esports has often left the medical and mental health community in a position of catch-up when it comes to the study and verification of potential concerns associated with gaming. Rappler, an online news site, identifies what it considers to be the five most common concerns for esports athletes:
- Carpal Tunnel Syndrome and wrist injuries because of repetitive motion
- Collapsed lung due to poor posture, inactive lifestyle
- Performance-enhancing drugs
- Mental fatigue and early burnout
- Poor nutrition and lack of exercise
In this article, we will explore potential mental health concerns associated with gaming and the protective factors that undergird one’s emotional well-being.
Gaming and addiction
Perhaps the biggest mental health concern as it relates to gaming is addiction. It is legitimate, given that video game developers design the games to entice longer and more frequent play.
There is currently no universally accepted definition or established number of gaming hours to categorize video game addiction. However, clinical psychologist Dr. Brent Conrad notes there are clearly some gamers who “struggle to keep their gaming habits under control and may place greater importance on their gaming accomplishments than their happiness and success in the real world (e.g. academic achievement, friendships, relationships, career advancement, and health).”
The World Health Organization (WHO) chose to recognize “gaming disorder” as a diagnosable condition in the International Classification of Diseases (ICD) in June 2018, providing this framework to evaluate concerning behavior:
- A pattern of behavior that has been evident for at least 12 months
- Impaired control that is characterized by an “increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities”
- A continuation of the behavior despite, “significant impairment in personal, family, social, educational, occupational or other important areas of functioning”
Although it is yet to be classified as an official condition, the American Psychological Association (APA) has put forth the following symptoms that give further definition to the concern:
- Heavy focus on Internet gaming
- Withdrawal symptoms when Internet gaming is taken away (sadness, anxiety, and irritability)
- Tolerance, the need to spend more time gaming
- Not being able to play less, unsuccessful attempts to quit playing
- Giving up other activities, and loss of interest in activities that were once enjoyed
- Continuing to play despite problems
- Deceiving family members or others about the amount of time spent on Internet gaming
- The use of Internet gaming to relieve negative moods, such as guilt or hopelessness
- Risk, having jeopardized or lost a job or relationship due to Internet gaming
* Under APA guidelines the individual must have at least five of the listed symptoms to be diagnosed with gaming disorder
These definitions provide administrators, esports coaches and directors, direction and support in assessing potential concerns with their players. Although behavior descriptions alone should never be the final determination of a problem, they do offer guidance for caring conversations with players to further evaluate their overall gaming health.
Red flags for faculty
Warning signs and potential risk factors for addiction are important for esports coaches and directors to understand and look for as they seek to protect and support the heath of their players. If potential concerns are identified, it is best to simply ask about the concern in a non-judgmental and direct fashion. The manner in which the student responds (e.g. defensive, open, avoidant, grateful, dismissive, etc.) is itself telling in assessing the potential degree of concern.
Warning signs for video game addiction include:
- Playing for increasing amounts of time
- Thinking about gaming during other activities
- Gaming to escape from real-life problems, anxiety, or depression
- Lying to friends and family to conceal gaming
- Feeling irritable when trying to cut down on gaming
Common risk factors for video game addiction also include:
- Being male
- Having higher levels of aggression and neuroticism (moodiness and the experience higher levels of anxiety, worry, fear, frustration, jealousy, and loneliness)
- Positively evaluating one’s personal intelligence and negatively evaluating one’s social skills
- Favoring online role-playing games
- Having a greater degree of impulsivity and limited ability to regulate emotions
- Having a lot of free time and little involvement in structured activities outside of work or school
Gaming Excess vs. Gaming Addiction
Although gaming addiction is a concern, it is important to differentiate between excessive gaming and gaming addition. Mark D. Griffiths, in his article in the International Journal of Mental Health and Addiction, suggests that gaming cannot be described as addictive if it is not showing significant negative consequences in the player’s life, even if they are playing exorbitant amounts of hours per day.
Esports coaches can better differentiate between gaming excess and addiction by understanding that addiction is typically defined as:
- The individual needing more and more of a substance or behavior to keep them going, and
- The individual becoming irritable and agitated if they are not able to get more of the substance or behavior. Some gamers actually report withdrawal symptoms from discontinuing gaming.
Other Mental Health Concerns
Two notable studies in the past decade indicate a high correlation between video game addiction and depression.
One, two-year longitudinal study, followed more than 3,000 students in Singapore and found that heavy gamers, those who played an average of 31 hours per week, were found more likely to suffer from depression, anxiety, social phobia, and lower school performance. The other study followed 1,000 healthy Chinese teenagers ages 13-18 and found that those who used the internet excessively, primarily for video games, were two times more likely to be depressed nine months later.
Other detrimental health-related outcomes associated with excessive gaming can be fatigue from lack of sleep, diet-related concerns due to not eating properly, and social avoidance, all of which have corollary mental health implications.
Esports coaches, directors and administrators must take this into account while working with players and supporting the overall health of the individual and the team. They should also be wary of protective factors that help individual deal effectively with stressful events.
Knowing what to observe
One of the most significant studies to come out of mental health research in the past 25 years has been the extensive longitudinal study of Adverse Childhood Experiences (ACEs).
ACEs are 8-10 identified factors (3 for abuse, 2 for neglect, and 5 for household dysfunction) in childhood that create traumatic and high-stress experiences that upset a child’s sense of safety and well-being. Examples of ACEs include one’s parents divorcing or separating, having a family member incarcerated, experiencing physical abuse, and not feeling loved. ACEs were found to be common across the general population, and shown to lead to a host of negative health and social consequences throughout a lifetime.
Astoundingly, adults who experienced six or more ACEs in childhood have, on average, a shortened life expectancy of 20 years. They are also 4,600% more likely to become an IV drug user than a person with zero ACEs. Additional findings show that people with four-plus ACEs compared to people with zero are:
- 6x more likely to have been diagnosed with depression
- 5x more likely to have absenteeism
- 3x more likely to smoke
- 2x more likely to have a heart attack
- 3x more likely to report serious financial problems
Though these findings are both sad and alarming, they provide a window for esports coaches, educators, and other individuals to better understand, assess, and facilitate protective factors for the young people they engage.
An esports coach or director should be able to better predict and evaluate a player’s well-being, and alert them to potential concerns for gaming addiction and other mental health concerns.
Esports athletes who have had a high number of ACEs present a greater risk for addictions and mental health concerns. An individual’s number of ACEs; however, should never be used as a determining factor or a reason not to recruit or accept a student for the team. Instead, the function for assessment that is most helpful to explore with student-athletes, ACES or not, is the story of their lives and how they have been affected by potentially difficult and stressful experiences.
The key is understanding how students interact with difficult events that have occurred in their lives and assessing their propensity for resilience.
Some of the critical questions we can consider and ask the student are:
- Is the student avoiding interpersonal interactions and relationships through excessive time spent gaming?
- Is the student escaping or numbing from difficult emotions through gaming?
- Is the student substituting real life for virtual life?
- Is the student goal-oriented, and do they exhibit effort toward their goals?
- Is the student able to be vulnerable, and do they pursue help when needed?
Conclusion
The expansion of esports into the high school and college realm presents an exciting opportunity for players and schools alike. It recognizes and advances the skill of these gifted players, and provides them an opportunity to further grow and develop through all the academic community has to offer. The unique relationships of player, coach, and team, gives further ascent to personal development, leadership and followership skills, and growth through mentoring. The esports director and coach are in a great position to help guide these young men and women, and help them advance toward their personal best during their academic years.
Valuable strategies for coaches
¢ Use the Wellness Wheel: Coaches can use this visual guide to better understand a player’s overall health in relation to the seven dimensions of wellness. A neglect of any one dimension can have adverse effects on one’s physical and mental health. The dimensions can also give insight into potential programming areas coaches can develop to benefit player health and success.
¢ Promote high school as a protective factor: The high school environment itself can be very beneficial to a player’s personal mental health and well-being. Being part of an “in-person team”, receiving guidance from a coach, and having the ability to be engaged in the activities of a high school community are incredible assets that support overall student development.
¢ Build protective factors to support player mental health: Time given to developing the whole person, in addition to gaming talent and skill, benefits not only the individual player but also the team. Greater personal and team health also has payoffs for overall team and program success.
¢ Find balance: Coaches can support their players by having team exercise/workout programs, study table participation, social activities, personal awareness and growth seminars, and financial planning guidance.
¢ Fostering Grit (Resilience): Few good and satisfying achievements come fast and easy, and rarely are they attained without setbacks and disappointments. Angela Duckworth’s book, “Grit” is an excellent resource for coaches to consider how to develop the mindset and behaviors of resilience in their players.
¢ Utilize resources: Coaches and directors should let students know of academic support, counseling, career services, disability services, multicultural engagement, spiritual development, leadership training, health resources, activities and programming, clubs and organizations, etc. are all available on campus.
¢ Build a Supportive Team: Building a sense of community and connection is important to engagement. The esports coach can help build “real-life” relationships among the team by facilitating trust, encouraging social interaction and establishing team values.
¢ Listen. Although it sounds simple, listening is a skill that must not be overlooked or underestimated. In one of the studies regarding the Adverse Childhood Experiences (ACEs) mentioned earlier, 130,000 patients upon coming to a doctor for a visit were given 10 childhood trauma-oriented questions in their intake paperwork. They could respond yes or no to questions such as: “Were your parents ever separated or divorced?” or “Did you live with anyone who was a problem drinker, alcoholic, or use street drugs?” Upon meeting with the doctor, the patient was asked how they felt any of their identified trauma affected them. The doctors simply listened with care to their answers. The addition of this modest intervention created a 35% decrease in future doctor visits and reduced emergency room visits by 11%.
¢ Create a Grit culture: Culture consists of the shared values and norms of a group of people. As a coach, creating a culture has a great deal to do with continuous communication and messaging around a core set of values, as well as modeling these values by leading with words and actions. For it to be a grit culture, more than half of the vision and messaging must revolve around ideas of teamwork, perseverance, continuous effort, and push. Solid and concise sayings or mantras are key in helping players build identity and shape behavior. Forming mantras such as “The Championship Lifestyle” or basketball legend John Wooden’s “Success is never final, and failure is never fatal” help sustain focus and provide a common language to challenge one another and hold each other accountable.
¢ Get a Gamer’s Perspective: As a self-professed non-gamer who was alive when the very first video game, “Pong”, was introduced in 1972, I would also like to offer Zolton Andrejkovic’s book, “The Invisible Game: Mindset of a Winning Team” as a reference. As an insider to the online gaming world, he upholds values for esports players and programs that are consistent with the mental health directions I offer in this writing. He emphasizes patience and practice while working with new esports teams, the importance of players setting goals that are attractive and enduring, creating a common team goal, stubborn perseverance (resilience), mental preparation and effective practicing and strategies to win matches.
Kent Schornack is the Director of Leadership & Counseling at Grand View University in Des Moines, IA. He also maintains a small private counseling practice, and provides leadership education and consultation to various constituents. Kent is a Licensed Independent Social Worker (LISW) with more than 30 years of experience. He is also a certified facilitator for Everything DISC and Five Behaviors of Cohesive Teams trainings and assessment. Kent deeply believes that relationships provide the most significant understanding of who we are and how we grow, and he uses this lens in addressing the role of esports and mental health. Contact him for comments and training opportunities at [email protected].
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